Association of obesity-related indices with chronic kidney disease risk in diabetes: A cross-sectional study

doi:10.4239/wjd.v17.i5.117338

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May 15, 2026 (publication date) through May 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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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Diabetes. May 15, 2026; 17(5): 117338
Published online May 15, 2026. doi: 10.4239/wjd.v17.i5.117338

Association of obesity-related indices with chronic kidney disease risk in diabetes: A cross-sectional study

Dong-Ni Huang, Jing Ma, Qi Pan, Guo-Gang Xu, Li-Xin Guo

Dong-Ni Huang, Qi Pan, Li-Xin Guo, Department of Endocrinology, Beijing Hospital, National Center for Gerontology, National Clinical Research Center for Gerontology, The Key Laboratory of Geriatrics of NHC, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China

Jing Ma, Guo-Gang Xu, Health Management Institute, The Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China

Co-first authors: Dong-Ni Huang and Jing Ma.

Co-corresponding authors: Guo-Gang Xu and Li-Xin Guo.

Author contributions: Huang DN and Ma J performed data analysis and wrote the manuscript. They contributed equally to the study and are the co-first authors of this manuscript; Huang DN, Xu GG, and Guo LX conceptualized and designed the research study; Ma J and Pan Q screened patients and acquired clinical data; Xu GG provided guidance on study design and data interpretation and led critical revision of the manuscript; Guo LX applied for and secured the funding for this research project; and conceptualized, designed, and supervised the entire project; Xu GG and Guo LX have both played essential and indispensable roles in the research design, data interpretation, and manuscript preparation; they contributed equally to this article and are the co-corresponding authors of this manuscript; all authors thoroughly reviewed and approved the final manuscript.

Supported by Beijing Municipal Health Commission, No. 2022-1-4051; and Beijing Municipal Science and Technology Commission, No. Z221100007422007.

Institutional review board statement: This study was approved by the Medical Ethics Committee of Beijing Hospital (approval No. 2025BJYYEC-KY039-01).

Informed consent statement: The ethics committee waived the requirement for obtaining written informed consent.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

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: No additional data are available.

Corresponding author: Li-Xin Guo, MD, PhD, Professor, Department of Endocrinology, Beijing Hospital, National Center for Gerontology, National Clinical Research Center for Gerontology, The Key Laboratory of Geriatrics of NHC, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Dongdan Dahua Road, Dongcheng District, Beijing 100730, China. glxwork2016@163.com

Received: December 5, 2025
Revised: March 7, 2026
Accepted: March 30, 2026
Published online: May 15, 2026
Processing time: 157 Days and 19.7 Hours

Abstract

BACKGROUND

Chronic kidney disease (CKD) is a major microvascular complication of diabetes and a leading cause of morbidity and mortality. Obesity and visceral fat accumulation contribute to renal dysfunction, but traditional measures such as body mass index may incompletely reflect metabolism-related harm from adipose tissue. Although numerous adiposity indices have been developed, comparative evidence on their associations with CKD in adults with diabetes remains limited.

AIM

To compare 10 adiposity indices and evaluate their associations and discriminative abilities for CKD among adults with diabetes.

METHODS

This retrospective cross-sectional study included 3526 adults with diabetes who underwent health examinations at a tertiary hospital. A total of 10 adiposity indices were calculated. CKD was classified as estimated glomerular filtration rate below 60 mL/min/1.73 m² and/or an albumin-to-creatinine ratio ≥ 30 mg/g. Multivariable logistic regression estimated odds ratios per standard-deviation increase, with additional adjustment. Restricted cubic splines assessed dose-response patterns, and discrimination was evaluated using the area under the receiver operating characteristic curve.

RESULTS

Among the 3526 participants, 456 (12.9%) had CKD. The CKD group had a higher proportion of men (86.0% vs 80.7%, P = 0.007) and a higher prevalence of hypertension (62.7% vs 46.4%, P < 0.001) compared with the non-CKD group. In both the primary and the comorbidity-adjusted sensitivity models, all examined indices were positively associated with CKD (all P < 0.001). Restricted cubic splines analyses showed no evidence of nonlinearity for body mass index, Chinese visceral adiposity index (CVAI), body roundness index, conicity index, and waist-to-height ratio, whereas the other indices showed evidence of nonlinearity (P < 0.05). CVAI had the highest area under the curve (0.637), whereas a body shape index had the lowest (0.526).

CONCLUSION

In adults with diabetes, multiple adiposity indices are associated with CKD. CVAI shows the best discrimination and may aid CKD risk assessment.

Keywords: Chronic kidney disease; Diabetes; Obesity-related indices; Chinese visceral adiposity index; Visceral adiposity

Core Tip: In this retrospective cross-sectional study of 3526 adults with diabetes who underwent health examinations, 9 out of 10 adiposity indices were independently associated with chronic kidney disease (CKD) after multivariable adjustment. Restricted cubic spline analyses identified linear associations for several commonly used indices and nonlinearity for others. Among all indices, the Chinese visceral adiposity index showed the strongest discriminative ability for CKD, suggesting that indices reflecting visceral adiposity may be more informative than body mass index alone for assessing CKD risk in diabetes.