Combined effects of glycemic status and adiposity on cardiovascular risk in chronic kidney disease: A nationwide population-based study

doi:10.4239/wjd.v17.i1.114624

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Jan 15, 2026 (publication date) through Jan 14, 2026

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World Journal of Diabetes

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1948-9358

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Diabetes. Jan 15, 2026; 17(1): 114624
Published online Jan 15, 2026. doi: 10.4239/wjd.v17.i1.114624

Combined effects of glycemic status and adiposity on cardiovascular risk in chronic kidney disease: A nationwide population-based study

Eun Hui Bae, Sang Yup Lim, Bong Seong Kim, Kyungdo Han, Sang Heon Suh, Hong Sang Choi, Eun Mi Yang, Chang Seong Kim, Seong Kwon Ma, Soo Wan Kim

Eun Hui Bae, Sang Heon Suh, Hong Sang Choi, Chang Seong Kim, Seong Kwon Ma, Soo Wan Kim, Department of Internal Medicine, Chonnam National University Medical School, Gwangju 61469, South Korea

Sang Yup Lim, Department of Internal Medicine, Korea University Ansan Hospital, Ansan 15355, South Korea

Bong Seong Kim, Kyungdo Han, Department of Statistics and Actuarial Science, Soongsil University, Seoul 06978, South Korea

Eun Mi Yang, Department of Pediatrics, Chonnam National University Medical School, Gwangju 61469, South Korea

Co-first authors: Eun Hui Bae and Sang Yup Lim.

Author contributions: Bae EH and Lim SY contribute equally to this study as co-first authors; conceptualization was performed by Bae EH and Kim SW; data curation was performed by Bae EH, Lim SY, Kim BS, and Han K; formal analysis was performed by Han K, Choi HS, and Ma SK; methodology was performed by Lim SY, Kim CS, and Han K; project administration was performed by Kim SW; supervision was performed by Han K, Ma SK, and Kim SW; writing—original draft was performed by Bae EH; writing—review and editing were performed by Kim CS, Suh SH, Choi HS, Ma SK, and Kim SW.

Supported by the National Research Foundation of Korea (NRF) Grant Funded by the Korean Government (MSIT), No. RS-2023-00217317.

Institutional review board statement: The study was approved by the Institutional Review Board of Chonnam National University Hospital (Approval No. CNUH-EXP-2025-219).

Informed consent statement: The requirement for written informed consent was waived by the review board due to using anonymous and de-identified information.

Conflict-of-interest statement: The authors have no conflicts of interest to declare.

STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.

Data sharing statement: The data supporting the findings of this study are not currently available. They will be made openly accessible in an electronic repository at a date to be confirmed by the NHIS.

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: Soo Wan Kim, MD, PhD, Professor, Department of Internal Medicine, Chonnam National University Medical School, Jebongro 42, Gwangju 61469, South Korea. skimw@chonnam.ac.kr

Received: September 24, 2025
Revised: October 27, 2025
Accepted: November 27, 2025
Published online: January 15, 2026
Processing time: 112 Days and 4.1 Hours

Abstract

BACKGROUND

Obesity and diabetes are well-established risk factors for cardiovascular disease (CVD), and their coexistence is particularly detrimental in chronic kidney disease (CKD). However, the interactions between various adiposity patterns and glycemic status in influencing CVD outcomes in CKD remain inadequately defined.

AIM

To evaluate the combined effects of diabetes, body mass index (BMI), and waist circumference (WC) on CVD risk.

METHODS

We analyzed data from 1714859 adults with CKD sourced from the Korean National Health Insurance database. Participants were classified into three glycemic groups: Normoglycemia, impaired fasting glucose (IFG), and diabetes mellitus (DM). BMI and WC were further categorized into five and six levels, respectively. Incident CVD events and all-cause mortality were assessed across the combined categories of glycemic status and adiposity. Incidence rates and adjusted hazard ratios were computed using Cox proportional hazards models.

RESULTS

A significant interaction was identified between glycemic status and adiposity indices concerning CVD risk (P for interaction < 0.001). Among normoglycemic individuals, both underweight (BMI < 18.5 kg/m²) and central obesity (WC ≥ 100/95 cm in men/women) were associated with increased CVD risk and mortality. In individuals with IFG, underweight remained a consistent risk factor, while WC displayed a linear relationship with CVD but not with mortality. In those with DM, the highest CVD risk was observed in individuals who were underweight (BMI < 18.5 kg/m²) and had low WC (< 80 cm in men/< 75 cm in women).

CONCLUSION

Cardiovascular risk is jointly influenced by glycemic status and adiposity, with diabetes consistently elevating risk across all BMI and WC categories, underscoring the importance of their assessment in CKD.

Keywords: Chronic kidney disease; Cardiovascular disease; Diabetes mellitus; Waist circumference; Body mass index; Obesity

Core Tip: This nationwide cohort study of over 1.7 million individuals with chronic kidney disease (CKD) demonstrates that cardiovascular (CV) risk is strongly modified by both glycemic status and patterns of adiposity. Diabetes consistently amplified CV risk across all body mass index and waist circumference categories, negating any protective effect of higher adiposity. Conversely, underweight and centrally lean individuals with diabetes exhibited the greatest vulnerability, underscoring that leanness is not universally protective in CKD. These findings highlight the importance of integrating both glycemic status and obesity indices into individualized CV risk assessment and prevention strategies for patients with CKD.