Synergistic Forecast of Frailty by Cardiovascular-Kidney-Metabolic Syndrome and Depressive Symptoms: The Mediating Role of Body Roundness Index
1
Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
2
School of Population and Health, Renmin University of China, Beijing, China
3
Key Laboratory of Health System Reform and Governance, National Health Commission of China, Beijing, China
Popul. Med. 2026;8(Supplement Supplement 1):A68
ABSTRACT
INTRODUCTION:
Frailty is a multidimensional geriatric syndrome associated with increased vulnerability to adverse outcomes in aging populations. Both cardiovascular-kidney-metabolic (CKM) syndrome and depressive symptoms have been independently linked to frailty, but their combined impact and underlying mechanisms remain unclear. This study aimed to examine the separate and joint effects of CKM syndrome stages and depressive symptoms on incident frailty, and to explore the potential mediating role of the body roundness index (BRI).
METHODS:
We analyzed data from 5,513 adults aged ≥ 45 years without frailty at baseline in the China Health and Retirement Longitudinal Study (2011-2020). Cox proportional hazards models were used to estimate the associations of CKM-depressive symptom profiles with frailty risk. Kaplan-Meier (KM) survival curves illustrated cumulative incidence. Mediation analysis assessed the role of BRI, and subgroup analyses evaluated potential effect modification.
RESULTS:
Over a median follow-up of 10 years, both advanced CKM stages (Hazard Ratio (HR) = 1.65; 95% CI: 1.42-1.91) and depressive symptoms (HR = 2.12; 95% CI: 1.88-2.39) were independently associated with higher frailty risk. Compared with non-advanced stages without depressive symptoms, individuals with both advanced stages and depressive symptoms had the highest risk (HR = 3.24; 95% CI: 2.66-3.95). KM curves showed a clear and progressive separation in frailty incidence across four profiles. BRI partially mediated the association between advanced CKM with depressive symptoms and frailty, accounting for 10.70% of the total effect. Stronger associations were observed among adults aged 45-60 years, those employed, and alcohol users.
CONCLUSIONS:
The coexistence of advanced CKM syndrome and depressive symptoms markedly increases frailty risk, partly through excess visceral adiposity. Integrating cardiometabolic and mental health assessment with body composition evaluation into screening may improve early identification and enable targeted prevention strategies for high-risk populations.
Frailty is a multidimensional geriatric syndrome associated with increased vulnerability to adverse outcomes in aging populations. Both cardiovascular-kidney-metabolic (CKM) syndrome and depressive symptoms have been independently linked to frailty, but their combined impact and underlying mechanisms remain unclear. This study aimed to examine the separate and joint effects of CKM syndrome stages and depressive symptoms on incident frailty, and to explore the potential mediating role of the body roundness index (BRI).
METHODS:
We analyzed data from 5,513 adults aged ≥ 45 years without frailty at baseline in the China Health and Retirement Longitudinal Study (2011-2020). Cox proportional hazards models were used to estimate the associations of CKM-depressive symptom profiles with frailty risk. Kaplan-Meier (KM) survival curves illustrated cumulative incidence. Mediation analysis assessed the role of BRI, and subgroup analyses evaluated potential effect modification.
RESULTS:
Over a median follow-up of 10 years, both advanced CKM stages (Hazard Ratio (HR) = 1.65; 95% CI: 1.42-1.91) and depressive symptoms (HR = 2.12; 95% CI: 1.88-2.39) were independently associated with higher frailty risk. Compared with non-advanced stages without depressive symptoms, individuals with both advanced stages and depressive symptoms had the highest risk (HR = 3.24; 95% CI: 2.66-3.95). KM curves showed a clear and progressive separation in frailty incidence across four profiles. BRI partially mediated the association between advanced CKM with depressive symptoms and frailty, accounting for 10.70% of the total effect. Stronger associations were observed among adults aged 45-60 years, those employed, and alcohol users.
CONCLUSIONS:
The coexistence of advanced CKM syndrome and depressive symptoms markedly increases frailty risk, partly through excess visceral adiposity. Integrating cardiometabolic and mental health assessment with body composition evaluation into screening may improve early identification and enable targeted prevention strategies for high-risk populations.
| eISSN: | 2654-1459 |
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