Lin DN, Li D, Peng MM, Yang H, Lin ZZ, Ye EL, Chen WT, Zhou MX, Huang XE, Lu XM. Elevated waist-to-hip ratio, as an abdominal obesity index, predicts the risk of diabetic kidney injury. World J Diabetes 2025; 16(4): 101384 [DOI: 10.4239/wjd.v16.i4.101384]
Corresponding Author of This Article
Xian-En Huang, Doctor, Associate Chief Physician, Department of Endocrinology, The Third Affiliated Hospital of Wenzhou Medical University, No. 108 Wansong Road, Wenzhou 325200, Zhejiang Province, China. huangxianen@wmu.edu.cn
Research Domain of This Article
Endocrinology & Metabolism
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Di-Ni Lin, Meng-Meng Peng, Hong Yang, Zhen-Zhen Lin, En-Ling Ye, Wen-Ting Chen, Meng-Xue Zhou, Xian-En Huang, Department of Endocrinology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou 325200, Zhejiang Province, China
Di-Ni Lin, Meng-Meng Peng, Hong Yang, Zhen-Zhen Lin, En-Ling Ye, Wen-Ting Chen, Xian-En Huang, Xue-Mian Lu, Wenzhou Key Laboratory for the Diagnosis and Prevention of Diabetic Complication, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou 325200, Zhejiang Province, China
Dan Li, Key Laboratory of Digital Technology in Medical Diagnostics of Zhejiang Province, Dian Diagnostics Group Company Limited, Hangzhou 310000, Zhejiang Province, China
Co-corresponding authors: Xian-En Huang and Xue-Mian Lu.
Author contributions: Huang XE and Lu XM were responsible for the conception, data collection; Lin DN was responsible for the data collection, manuscript comment, article writing; Li D was responsible for the background investigation, statistical analysis, methodology and manuscript preparation; Peng MM, Yang H, Lin ZZ, Ye EL, Chen WT, and Zhou MX were responsible for manuscript comment; All authors have read and approved the final manuscript.
Supported by the Science and Technology Project of Wenzhou City, No. Y20240252 and No. Y2023374.
Institutional review board statement: The study was approved by the Ethics Committee of The third Hospital of Wenzhou Medical University Institutional Review Board (Approval No. YJ2023077).
Informed consent statement: The requirement for written informed consent was waived for this study given the retrospective design of the study. All personal identifiers have been removed from the dataset, and any potentially identifiable information has been replaced with pseudonyms.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: The authors confirm that the data supporting the findings of this study are available within the article, and data could be obtained from the corresponding authors at huangxianen@wmu.edu.cn or lu89118@medmail.com.cn upon reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xian-En Huang, Doctor, Associate Chief Physician, Department of Endocrinology, The Third Affiliated Hospital of Wenzhou Medical University, No. 108 Wansong Road, Wenzhou 325200, Zhejiang Province, China. huangxianen@wmu.edu.cn
Received: September 13, 2024 Revised: December 14, 2024 Accepted: February 18, 2025 Published online: April 15, 2025 Processing time: 168 Days and 7.3 Hours
Abstract
BACKGROUND
Diabetic nephropathy (DN) is associated with a high incidence of type 2 diabetic mellitus (T2DM) in Asia. Central obesity is an important risk factor for DN, represented by a series of indices, including waist circumference, waist-to-hip ratio (WHR), hip circumference, and visceral to subcutaneous fat area ratio (VSR). However, limited research has focused on the association between these indices and DN.
AIM
To elucidate the relationship between central fat distribution, as measured by WHR and VSR, and the DN progression.
METHODS
Between August 2018 and April 2023, a total of 991 individuals were retrospectively recruited from the Rui’an People’s Hospital for this cross-sectional analysis. The 753 individuals with T2DM were divided into three groups according to the urinary albumin/creatinine ratio (ACR): normal albuminuria (n = 513, ACR < 30 mg/g), microalbuminuria (n = 166, 30 ≤ ACR < 300 mg/g), and clinical proteinuria (n = 45, ACR ≥ 300 mg/g).
RESULTS
Our results indicated that WHR and VSR were closely correlated with sex, ageing, body mass index, hypertension, T2DM causes, and experience of drinking and smoking, and potential relationships between these factors and DN progression were observed. WHR, but not VSR, gradually increased with the severity of early-stage renal injury. Abnormal serum lipid levels in T2DM patients with early-stage renal injury were strongly correlated with WHR. Logistic regression analysis revealed that WHR may be an independent risk factor for early-stage renal injury.
CONCLUSION
In patients with T2DM, WHR level, rather than VSR level, is closely associated with early-stage renal injury. An abnormal serum lipid spectrum was common in all stages of renal injury and was strongly related to high WHR. Thus, WHR measurement might be a valuable tool for the early prevention of renal injury, which could guide clinical monitoring and prevent diabetic complications.
Core Tip: This study underscores the significance of waist-to-hip ratio (WHR) as an independent predictor of early renal injury in type 2 diabetes mellitus (T2DM) patients, highlighting its potential as a preventive tool for diabetic nephropathy. It reveals a strong association between elevated WHR and abnormal serum lipid levels, which are common in all stages of renal injury, suggesting a pivotal role of WHR in early detection and clinical management of T2DM-related renal complications.
Citation: Lin DN, Li D, Peng MM, Yang H, Lin ZZ, Ye EL, Chen WT, Zhou MX, Huang XE, Lu XM. Elevated waist-to-hip ratio, as an abdominal obesity index, predicts the risk of diabetic kidney injury. World J Diabetes 2025; 16(4): 101384
Approximately 90% of patients with diabetes are diagnosed with type 2 diabetes mellitus (T2DM), and its incidence is rising alarmingly, signaling a significant global health challenge. China has a large population with diabetes, which reached 116.4 million in 2019[1]. Inadequate management and control of diabetes can lead to a series of chronic complications, such as macrovascular diseases (coronary heart disease, arteriosclerosis, and stroke) and microvascular diseases [diabetic nephropathy (DN), diabetic retinopathy, and diabetic neuropathy]. Reportedly, 20%-40% of individuals with diabetes are susceptible to the development of DN, which is also a primary contributor to end-stage renal disease[2]. It is clinically characterized by persistent increased excretion of albuminuria and/or progressive decline in glomerular filtration rate according to the clinical guidelines for the diagnosis and treatment of DN in China. Moreover, chronic renal insufficiency affects the patients’ quality of life and, in severe cases, can even lead to progressive injury and premature death of other end-organs. As reported, about 50000 people die of kidney disease in the world every year[3]. Among these, a relatively high proportion has been observed in Asian countries[4,5]. Therefore, early screening and diagnosis are necessary to prevent and manage DN effectively, leading to positive clinical outcomes.
The following clinical characteristics have been classified as risk factors for DN: Hyperglycemia, hypertension, age, and diabetes course[6-9]. Increasing evidence has revealed that obesity plays an important role in DN progression[10-12]. The distribution of adipose tissue rather than its amount has been identified as an independent risk factor for the occurrence of chronic kidney disease[13]. Previously, central fatness measures, such as waist circumference and waist-to-hip ratio (WHR) demonstrated superior predictive power for microvascular prevalence in T2DM patients with obesity[14]. Consistently, a stronger association between obesity and DN prevalence has been noted in cases of central obesity compared to general obesity[14,15]. Many variables are related to central obesity, including WHR, waist circumference, hip circumference, and the visceral fat area-to-subcutaneous fat area ratio (VSR). The type of fat distribution that correlates with the progression of DN remains unclear, which could guide clinical monitoring and prevent diabetic complications.
Obesity, a common multifactorial disease, is primarily characterized by an abnormal lipid spectrum in the clinical setting. Excessive accumulation of fat can trigger the breakdown of lipids, leading to an increase in the levels of free fatty acids, which can further exacerbate dyslipidemia[16]. Previously, abnormalities in serum lipid levels have been implicated in the development of diabetic complications[17,18]. Furthermore, a cross-sectional study conducted by Li et al[19] indicated that patients with T2DM and high triglyceride (TG) levels are at greater risk of developing microvascular complications. A comprehensive analysis of the impact of fat distribution on serum lipids and the association between fat distribution and DN remains limited. Therefore, this study aimed to investigate the relationship between WHR and/or VSR and the progression of DN and determine whether WHR and/or VSR could serve as independent predictive markers for DN progression, offering a novel strategy for early screening, diagnosis, and clinical prevention of DN.
MATERIALS AND METHODS
Participants enrolment
Between August 2018 and April 2023, a total of 753 individuals diagnosed with T2DM were enrolled in the Department of Endocrinology, Rui’an People’s Hospital. The diagnostic criteria for T2DM were based on the guidelines published by the World Health Organization and the International Diabetes Alliance in 1999 as follows: (1) At least one characteristic of polyuria, polydipsia, unexplained weight loss; (2) Age between 18 and 80 years; and (3) At least one abnormal blood glucose levels [fasting blood glucose ≥ 7 mmol/L; postprandial blood glucose level (2 hours) ≥ 11.1 mmol/L; random blood glucose level ≥ 11.1 mmol/L after a 75 g oral glucose tolerance test; and glycosylated hemoglobin level > 6.5%]. Patients who received hypoglycemic drugs or insulin injections were also included in the study. Individuals with other types of kidney diseases, kidney surgery, cardiovascular and cerebrovascular diseases, tumors, urinary tract infections, acute infections, hyperthyroidism, adrenal cortex dysfunction, severe liver dysfunction, and pregnant women were excluded from the analysis.
In this study, DN was defined as patients with “renal damage” based on the Kidney Disease Outcomes Quality Initiative (KDOQI) Clinical Practice Guidelines. Specifically, T2DM patients with renal damage were diagnosed with DN if their urinary albumin-to-creatinine ratio (UACR) was ≥ 30 mg/g, based on KDOQI Clinical Practice Guidelines. Others were included into the normal albuminuria (NAU) group (n = 513, ACR < 30 mg/g). Furthermore, the patients with DN were divided into the microalbuminuria (MAU) group (n = 166, 30 ≤ ACR < 300 mg/g) and the clinical proteinuria (CAU) group (n = 45, ACR ≥ 300 mg/g) according to the level of UACR. Moreover, 238 individuals without T2DM and other basic diseases were included as healthy controls (Con group) after a careful history and clinical examination. The requirement for written informed consent was waived for this study given the retrospective design of the study. All personal identifiers have been removed from the dataset, and any potentially identifiable information has been replaced with pseudonyms. The study was reviewed and approved by the Ethics Committee of Rui’an People’s Hospital Institutional Review Board (Approval No. YJ2023077), and all protocols were followed as the Declaration of Helsinki.
RESULTS
Overall clinical characteristics of participants
Between August 2018 and April 2023, 753 patients with T2DM, including 513 participants in the NAU group (UACR < 30 mg/g), 166 in the MAU group (30 ≤ UACR < 300 mg/g), and 45 in the CAU group (UACR ≥ 300 mg/g), were retrospectively collected in this cross-sectional study. An additional 238 individuals were collected as Con group. As shown in Table 1, the median age was 48 ± 12 years, and 649 patients (65%) were male. Additionally, 29% of the participants were older than 55 years. Most participants exhibited a duration of T2DM of < 5 years (575, 58%), maintained normal blood pressure (708, 72%), and were classified as obese, with a body mass index (BMI) exceeding 24 kg/cm2 (551, 56%). In terms of lifestyle, the numbers of nondrinkers (499, 53%) and nonsmokers (678, 69%) were high.
Table 1 Overall characteristics of the cohort, n (%).
Variables
Patients
Sex
Male
649 (65.49)
Female
342 (34.51)
Age (years)
18-55
991 (71.14)
> 55
286 (28.86)
Blood pressure
Normal
708 (71.59)
High
281 (28.41)
BMI
BMI > 24
551 (55.71)
BMI ≤ 24
438 (44.29)
Duration of T2DM
0-5 year
575 (58.38)
> 5 years
410 (41.62)
Drinker
Yes
450 (47.42)
No
499 (52.58)
Smoker
Yes
307 (31.17)
No
678 (68.83)
Relationship between obesity variables (WHR and VSR) and health conditions of individuals
Several demographic characteristics have a potential impact on the progression of DN in our study. We observed a significantly higher proportion of individuals with kidney diseases who were men, aged > 55 years, had a BMI over 24, experienced hypertension, had a T2DM duration exceeding 5 years, and currently smoked and drank, corroborating a comparable risk pattern for the progression of DN (Figure 1A-G). Similarly, significantly higher levels of VSR were observed in men and older individuals; comparable results were also determined for WHR levels (Figure 1A and B).
Figure 1 Relationship between basic characteristics and waist-to-hip ratio, visceral fat area to subcutaneous fat area ratio, the kidney injury classification of patients in each condition.
A: Comparison of waist-to-hip ratio (WHR), visceral fat area to subcutaneous fat area ratio (VSR), and severity of kidney injury between groups in terms of sex; B: Comparison of WHR, VSR, and severity of kidney injury between groups in terms of age. Herein, 18-55 represented individuals aged between 18 and 55 years; > 55 means individuals aged > 55 years old; C: Comparison of WHR, VSR, and severity of kidney injury between groups in terms of body mass index (BMI). < 24: BMI value was < 24; > 24: BMI value was > 24; D: Comparison of WHR, VSR, and severity of kidney injury between patients with hypertension and normal blood pressure. High: The patients with systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg; E: Comparison of WHR, VSR, and severity of kidney injury between groups in terms of type 2 diabetic mellitus (T2DM) duration. 0-5: The individuals suffered from T2DM no more than 5 years; > 5: The individuals suffered from T2DM for > 5 years; F: Exploring the impact of smoking on WHR, VSR, and kidney disease progression; G: Exploring the impact of drinking on WHR, VSR, and kidney disease progression. cP < 0.001. Y: The patients experienced smoking; N: The blank of smoking history; BMI: Body mass index; T2DM: Type 2 diabetic mellitus; NAU: Normal albuminuria; MAU: Microalbuminuria; CAU: Clinical proteinuria; WHR: Waist-to-hip ratio; VSR: Visceral fat area to subcutaneous fat area ratio.
Individuals with BMI > 24 demonstrated higher levels of obesity, as reflected by the corresponding levels of VSR and WHR (Figure 1C). Individuals with hypertension displayed more severe obesity in both VSR and WHR, additionally, participants with hypertension were more likely to experience kidney injury (Figure 1D). The progression of DN was related to smoking and drinking history, which may be associated with an increase in fat accumulation (Figure 1F and G). Collectively, fat accumulation and central obesity, as represented by WHR and VSR, positively correlated with the progression of “renal injury”.
WHR, rather than VSR, was positively correlated with the progression of DN
To further identify the potential relationship between central obesity and the progression of DN, abdominal fat accumulation indexes, such as WHR and VSR, were compared following the severity of kidney injury. As shown in Figure 2, compared with healthy participants, VSR was significantly higher in individuals with T2DM, while it was comparable among the groups that had a nonlinear relationship with the progression of DN, suggesting that they were relatively stable following kidney injury in T2DM patients. Interestingly, T2DM patients expressed higher levels of WHR compared with the Con group. Moreover, WHR was significantly increased in individuals following the progression of DN. Furthermore, compared to individuals in the MAU group, participants in the CAU group exhibited an increasing trend (P = 0.09), suggesting a positive correlation between WHR and kidney injury. Therefore, our findings imply that WHR, rather than VSR, is more closely associated with the progression of kidney injury in T2DM patients.
Figure 2 Waist-to-hip ratio not visceral fat area to subcutaneous fat area ratio level was elevated following severity of kidney diseases.
A: Level of visceral fat area to subcutaneous fat area ratio; B: The level of waist-to-hip ratio. bP < 0.01. cP < 0.001. NAU: Normal albuminuria; MAU: Microalbuminuria; CAU: Clinical proteinuria; WHR: Waist-to-hip ratio; VSR: Visceral fat area to subcutaneous fat area ratio.
WHR levels were closely associated with a cluster of serum lipids and renal function parameters in patients with T2DM
Growing evidence has highlighted the correlation between blood lipid levels and microvascular complications in patients with T2DM. A comparison of the serum lipid and renal function profiles of all participants is presented in Table 2. TG, non- high-density lipoprotein cholesterol (HDL-C), and the data of log (TG/HDL-C) (AIP) levels in T2DM patients were significantly higher than those in the control group. Conversely, HDL-C levels were reduced in T2DM patients compared to healthy individuals. Moreover, both TG levels and AIP scores in the CAU group were further elevated compared to those in the NAU and MAU groups. Several variables for evaluating renal function, including glutamyl transferase, urine acid (UA), creatinine, and blood urea nitrogen (BUN), were significantly higher in the Con group than in those with T2DM. Furthermore, participants in the CAU group had higher UA and BUN levels compared with those in the MAU and CAU groups. These results supported the scientific rationale for grouping T2DM patients with DN according to UACR levels. Furthermore, the significance suggests that an abnormal lipid spectrum developed due to kidney injury in patients with T2DM.
Elevated WHR levels were observed in individuals with kidney injury alongside altered clinical parameters. A comparative analysis was conducted based on WHR categorization to explore the association between WHR and these metabolic parameters. This analysis revealed a positive correlation of WHR with several parameters, such as TG, non-HDL-C, and the AIP index, all of which are linked to lipid metabolism (Figure 3A-C), as well as with uric acid, indicative of renal function (Figure 3D). Conversely, HDL-C levels were negatively associated with WHR (Figure 3E). In summary, WHR demonstrated a significant impact on lipid metabolism and the progression of DN.
Figure 3 Impact of different waist-to-hip ratio level on serum lipids and renal function in type 2 diabetic mellitus patients.
A: Levels of triglyceride (TG); B: Levels of non-high-density lipoprotein cholesterol (HDL-C); C: Levels of the data of log (TG/HDL-C); D: Levels of urine acid; E: Levels of HDL-C. Low waist-to-hip ratio: 0.7556-0.9451; High waist-to-hip ratio: 0.9452-1.1319; WHR: Waist-to-hip ratio; HDL-C: High-density lipoprotein cholesterol; AIP: The data of log (triglyceride/high-density lipoprotein cholesterol).
WHR was independently associated with chronic kidney disease in T2DM patients
The risk factors for DN prevalence in patients with T2DM were explored to determine whether WHR is related to kidney injury. As described previously, WHR was significantly higher in individuals with kidney disease. Similarly, compared to those of individuals in NAU group, serum lipid levels, and renal function parameters were significantly increased in patients with kidney injury. Table 3 shows the results of the univariate logistic analysis. The significant risk factors for DN were WHR, TC, HDL-C, non-HDL-C, UA, and creatinine, suggesting that these variables could serve as valuable markers for identifying individuals at high risk of DN (Table 3). Table 4 shows the results of the stepwise multiple regression analysis and that multiple models adjusted for various parameters could be used as excellent predictors of kidney injury morbidity. Higher levels of creatinine [odds ratio (OR) = 0.002, 95% confidence interval (CI): 0-0.004, P = 0.038], TC (OR = 0.03, 95%CI: 0.007-0.052, P = 0.011), and HDL-C (OR = 0.225, 95%CI: 0.098-0.351, P = 0.001) were protective factors against DN. Moreover, a higher level of WHR was found to be significantly associated with the progression of DN (OR = 1.113, 95%CI: 0.56-1.67, P < 0.001). WHR was a critical factor in all models, indicating that its levels were independently associated with kidney injury in T2DM patients.
Table 3 Factors associated with kidney injury in patients with type 2 diabetic mellitus in univariable logistic regression analysis.
T2DM patients are susceptible to diabetic complications due to the disturbance of multiple risk factors[19,20]. DN represents a significant microvascular complication of diabetes, predominantly characterized by proteinuria and renal impairment in clinical settings. In this context, our study classified individuals with T2DM into three distinct groups: Those in the NAU group exhibited an albumin/creatinine ratio (ACR) of < 30 mg/g, the MAU group had an ACR ranging from 30 to < 300 mg/g, and the CAU group presented with an ACR of ≥ 300 mg/g.
In our study, elevated renal function variables were observed in both the MAU and CAU groups. Evidence from a series of studies has underscored the utility of monitoring hypertension and T2DM courses in predicting DN progression. Factors such as age, BMI, smoking status, and sex are recognized as clinical risk markers for the progression of chronic kidney disease[21-26]. Consistently, we found that patients aged > 55 years with a BMI > 24, T2DM duration > 5 years, hypertension, history of drinking, and smoking were more likely to develop “renal injury”.
In our study, individuals with diabetes who were prone to kidney injury exhibited higher WHR and VSR. Moreover, the WHR progressively increased with a progressive decline of kidney function. Obesity, a classical manifestation of diabetes, has seen a rapid increase over the past two decades in China, emerging as a significant global health challenge[27,28]. Regardless of whether considering general or central adiposity, T2DM patients with kidney injury demonstrated higher levels of fat accumulation, indicating a potential role for obesity in the development and progression of chronic kidney disease[27]. Fat deposition can promote the release of pro-inflammatory cytokines, pro-fibrotic cytokines, and reactive oxygen species, leading to oxidative stress in the kidneys. These alterations can accelerate kidney injury and structural changes, eventually leading to renal dysfunction[29]. In a previous mouse model, accelerated chronic kidney disease could be explained by renal mitochondrial dysfunction and energy imbalance due to obesity[30].
Compared with the amount of fat accumulation, the distribution of adipose tissue plays a more important role in the progression of diabetic complications[14]. Various variables, including waist circumference, hip circumference, WHR, waist-to-height ratio, VSR, and BMI, can be used to assess obesity from different perspectives[31,32]. However, considerable controversy remains regarding which obesity parameters can effectively predict the progression of DN[21,33-36]. Our study revealed no significant difference in VSR levels among patients at different stages of renal injury; however, WHR levels gradually increased with increasing severity of renal impairment. Regression analysis further indicated that a high WHR could serve as a risk factor for kidney injury and potentially contribute to the development of DN. Therefore, managing T2DM patients should focus not only on BMI standards but also on improving WHR.
In addition to fat accumulation, more pronounced dyslipidemia was observed with disease severity, and a similar observation was previously reported. Abnormality of lipid spectrum is present in all stages of DN and may be closely related to adipose tissue accumulation. By secreting insulin-sensitizing factors, such as adiponectin and isolating lipids, adipose tissue regulates the action of insulin, preventing lipid accumulation in other tissues that would otherwise promote fat oxidation and have detrimental effects, which in turn exacerbates lipid metabolism impairment. Consistent with this notion, we observed a considerable positive association between fat accumulation and dyslipidemia, characterized by elevated levels of TGs, non-HDL cholesterol, and AIP, along with reduced levels of HDL-C in individuals with a high WHR. Moreover, the reno-protective effects were demonstrated in obese mice by suppressing lipid deposition and abnormal lipid metabolism[37,38]. These findings, in conjunction with regression analysis, underscore the reliability of WHR in predicting DN and highlight its significance in the daily management of T2DM patients.
However, this retrospective study has limitations. All patients were from a specific hospital, and the relatively small population limited the generalizability of the observations. Thus, a prospective study that includes a larger population is warranted. Further investigation is needed to understand the causality and mechanisms between WHR and DN progression.
CONCLUSION
The present study broadens our understanding of the association between specific types of central obesity and DN, underscoring WHR rather than VAR as significant risk factors for DN in individuals with T2DM. This insight offers a novel perspective for the early detection, diagnosis, and prevention of DN. In managing patients with T2DM, a greater emphasis on WHR as a marker of central obesity, beyond mere weight control, is advisable.
ACKNOWLEDGEMENTS
The authors would like to express their sincere gratitude to all individuals who have made significant contributions to this manuscript. Special thanks are extended to all members of the endocrinology department from The Third Affiliated Hospital of Wenzhou Medical University for generously sharing the data that underpinned our analysis. We also acknowledge the support from the Science and Technology Project of Wenzhou City, which provided the financial assistance that enabled us to conduct this research. Lastly, we are grateful to all the participants who willingly engaged in our study, without whom this work would not have been possible.
Footnotes
Provenance and peer review: Unsolicited article; Externally peer reviewed.
GBD 2016 Causes of Death Collaborators. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016.Lancet. 2017;390:1151-1210.
[PubMed] [DOI][Cited in This Article: ][Cited by in Crossref: 3175][Cited by in RCA: 3164][Article Influence: 395.5][Reference Citation Analysis (0)]
Yokoyama H, Araki SI, Kawai K, Yamazaki K, Tomonaga O, Shirabe SI, Maegawa H. Declining trends of diabetic nephropathy, retinopathy and neuropathy with improving diabetes care indicators in Japanese patients with type 2 and type 1 diabetes (JDDM 46).BMJ Open Diabetes Res Care. 2018;6:e000521.
[PubMed] [DOI][Cited in This Article: ][Cited by in Crossref: 32][Cited by in RCA: 36][Article Influence: 5.1][Reference Citation Analysis (0)]
Jia W, Gao X, Pang C, Hou X, Bao Y, Liu W, Wang W, Zuo Y, Gu H, Xiang K. Prevalence and risk factors of albuminuria and chronic kidney disease in Chinese population with type 2 diabetes and impaired glucose regulation: Shanghai diabetic complications study (SHDCS).Nephrol Dial Transplant. 2009;24:3724-3731.
[PubMed] [DOI][Cited in This Article: ][Cited by in Crossref: 53][Cited by in RCA: 57][Article Influence: 3.6][Reference Citation Analysis (0)]
Gu W, Wang X, Zhao H, Geng J, Li X, Zheng K, Guan Y, Hou X, Wang C, Song G. Resveratrol ameliorates diabetic kidney injury by reducing lipotoxicity and modulates expression of components of the junctional adhesion molecule-like/sirtuin 1 lipid metabolism pathway.Eur J Pharmacol. 2022;918:174776.
[PubMed] [DOI][Cited in This Article: ][Cited by in Crossref: 2][Cited by in RCA: 2][Article Influence: 0.7][Reference Citation Analysis (0)]
Yau K, Kuah R, Cherney DZI, Lam TKT. Obesity and the kidney: mechanistic links and therapeutic advances.Nat Rev Endocrinol. 2024;20:321-335.
[PubMed] [DOI][Cited in This Article: ][Cited by in Crossref: 2][Reference Citation Analysis (0)]
Zeng ZQ, Ma Y, Yang C, Yu CQ, Sun DJY, Pei P, Du HD, Chen JS, Chen ZM, Li LM, Zhang LX, Lyu J. [Associations of body mass index and waist circumference with risk of chronic kidney disease in adults in China].Zhonghua Liu Xing Bing Xue Za Zhi. 2024;45:903-913.
[PubMed] [DOI][Cited in This Article: ][Reference Citation Analysis (0)]
Chen J, Li YT, Niu Z, He Z, Xie YJ, Hernandez J, Huang W, Wang HHX; Guangzhou Diabetic Eye Study Group. Investigating the causal association of generalized and abdominal obesity with microvascular complications in patients with type 2 diabetes: A community-based prospective study.Diabetes Obes Metab. 2024;26:2796-2810.
[PubMed] [DOI][Cited in This Article: ][Reference Citation Analysis (0)]
de Araújo Sugizaki CS, da Silva LLS, de Souza Freitas ATV, Costa NA, Lopes LCC, Peixoto MDRG. Comparison between general obesity and abdominal adiposity to estimate cardiovascular disease prevalence in individuals with chronic kidney disease: results from NHANES 2005-2016.Eur J Clin Nutr. 2024;78:449-451.
[PubMed] [DOI][Cited in This Article: ][Reference Citation Analysis (0)]
Guasch-Ferré M, Bulló M, Martínez-González MÁ, Corella D, Estruch R, Covas MI, Arós F, Wärnberg J, Fiol M, Lapetra J, Muñoz MÁ, Serra-Majem L, Pintó X, Babio N, Díaz-López A, Salas-Salvadó J. Waist-to-height ratio and cardiovascular risk factors in elderly individuals at high cardiovascular risk.PLoS One. 2012;7:e43275.
[PubMed] [DOI][Cited in This Article: ][Cited by in Crossref: 49][Cited by in RCA: 55][Article Influence: 4.2][Reference Citation Analysis (0)]
Gitay MN, Sohail A, Arzoo Y, Shakir MA. Changes in serum lipids with the onset and progression of Diabetic Retinopathy in Type-II Diabetes Mellitus.Pak J Med Sci. 2023;39:188-191.
[PubMed] [DOI][Cited in This Article: ][Reference Citation Analysis (0)]
Saiyed NS, Yagoub U, Al Qahtani B, Al Zahrani AM, Al Hariri I, Syed MJ, Elmardi ME, Tufail MA, Manajreh M. Risk Factors of Microvascular Complications Among Type 2 Diabetic Patients Using Cox Proportional Hazards Models: A Cohort Study in Tabuk Saudi Arabia.J Multidiscip Healthc. 2022;15:1619-1632.
[PubMed] [DOI][Cited in This Article: ][Cited by in Crossref: 1][Cited by in RCA: 3][Article Influence: 1.0][Reference Citation Analysis (0)]
Gall MA, Hougaard P, Borch-Johnsen K, Parving HH. Risk factors for development of incipient and overt diabetic nephropathy in patients with non-insulin dependent diabetes mellitus: prospective, observational study.BMJ. 1997;314:783-788.
[PubMed] [DOI][Cited in This Article: ][Cited by in Crossref: 261][Cited by in RCA: 261][Article Influence: 9.3][Reference Citation Analysis (0)]
Dabers T, Sass P, Fechner F, Weyer J, Völzke H, Mahnken AH, Lorbeer R, Mensel B, Stracke S. Age- and Sex-Specific Reference Values for Renal Volume and Association with Risk Factors for Chronic Kidney Disease in a General Population-An MRI-Based Study.J Clin Med. 2024;13.
[PubMed] [DOI][Cited in This Article: ][Reference Citation Analysis (0)]
Phengpol N, Thongnak L, Lungkaphin A. The programming of kidney injury in offspring affected by maternal overweight and obesity: role of lipid accumulation, inflammation, oxidative stress, and fibrosis in the kidneys of offspring.J Physiol Biochem. 2023;79:1-17.
[PubMed] [DOI][Cited in This Article: ][Cited by in Crossref: 1][Cited by in RCA: 3][Article Influence: 1.5][Reference Citation Analysis (0)]
Andres-Hernando A, Lanaspa MA, Kuwabara M, Orlicky DJ, Cicerchi C, Bales E, Garcia GE, Roncal-Jimenez CA, Sato Y, Johnson RJ. Obesity causes renal mitochondrial dysfunction and energy imbalance and accelerates chronic kidney disease in mice.Am J Physiol Renal Physiol. 2019;317:F941-F948.
[PubMed] [DOI][Cited in This Article: ][Cited by in Crossref: 18][Cited by in RCA: 29][Article Influence: 4.8][Reference Citation Analysis (0)]
Wang Z, Ding L, Huang X, Chen Y, Sun W, Lin L, Huang Y, Wang P, Peng K, Lu J, Chen Y, Xu M, Wang W, Bi Y, Xu Y, Ning G. Abdominal adiposity contributes to adverse glycemic control and albuminuria in Chinese type 2 diabetic patients: A cross-sectional study.J Diabetes. 2017;9:285-295.
[PubMed] [DOI][Cited in This Article: ][Cited by in Crossref: 4][Cited by in RCA: 5][Article Influence: 0.6][Reference Citation Analysis (0)]
Hanai K, Babazono T, Nyumura I, Toya K, Ohta M, Bouchi R, Suzuki K, Inoue A, Iwamoto Y. Involvement of visceral fat in the pathogenesis of albuminuria in patients with type 2 diabetes with early stage of nephropathy.Clin Exp Nephrol. 2010;14:132-136.
[PubMed] [DOI][Cited in This Article: ][Cited by in Crossref: 29][Cited by in RCA: 35][Article Influence: 2.2][Reference Citation Analysis (0)]
Ma C, Yuan M. 14-LB: Abdominal Obesity Indices Predict Incident Renal Events in a 10-Year Cohort with Type 2 Diabetes Mellitus.Diabetes. 2023;72.
[PubMed] [DOI][Cited in This Article: ]
Sang H, Cho YK, Han K, Koh EH. Impact of abdominal obesity on the risk of glioma development in patients with diabetes: A nationwide population-based cohort study in Korea.PLoS One. 2023;18:e0283023.
[PubMed] [DOI][Cited in This Article: ][Reference Citation Analysis (0)]
Luo J, Tan J, Zhao J, Wang L, Liu J, Dai X, Sun Y, Kuang Q, Hui J, Chen J, Kuang G, Chen S, Wang Y, Ge C, Xu M. Cynapanoside A exerts protective effects against obesity-induced diabetic nephropathy through ameliorating TRIM31-mediated inflammation, lipid synthesis and fibrosis.Int Immunopharmacol. 2022;113:109395.
[PubMed] [DOI][Cited in This Article: ][Cited by in RCA: 1][Reference Citation Analysis (0)]
