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World J Diabetes. Aug 15, 2026; 17(8): 121923
Published online Aug 15, 2026. doi: 10.4239/wjd.121923
Published online Aug 15, 2026. doi: 10.4239/wjd.121923
Visceral fat area and red-blood-cell-related indices in adults with type 2 diabetes: Cross-sectional evidence of nonlinear associations
Zi-Chen Rao, Liang-Yan Hua, Zi-Ru Fang, Chun-Yan Zhu, Yi-Ming Zhang, Department of Endocrinology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital, Quzhou 324000, Zhejiang Province, China
Chun-Yi Xu, Department of Endocrinology and Metabolism, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
Co-first authors: Zi-Chen Rao and Chun-Yi Xu.
Author contributions: Rao ZC and Xu CY contributed equally to this work and share first authorship; Zhang YM conceived the study, critically revised the manuscript and supervised the work; Rao ZC, Xu CY, and Hua LY curated the data; Rao ZC and Xu CY performed the statistical analyses; Fang ZR and Zhu CY contributed to data interpretation and manuscript revision; Rao ZC drafted the manuscript; all authors have read and approved the final manuscript.
AI contribution statement: No AI tool was involved in the generation of research data, interpretation of results, or formulation of conclusions. During the preparation of the point-by-point response, we used AI-assisted tools only for limited language support, mainly to improve English wording and sentence clarity. The reviewers’ comments were understood and answered by the authors ourselves. No AI tool was used to generate or change the study data, statistical results, tables, figures, interpretation of results, or conclusions. All revisions in the manuscript were made and checked by the authors. We have also reviewed the response document again and confirm that the scientific content and the replies to the reviewers reflect the authors’ own work and judgment.
Institutional review board statement: The study protocol complied with the Declaration of Helsinki and was approved by the Ethics Committee of Quzhou People’s Hospital (Quzhou Affiliated Hospital of Wenzhou Medical University) (approval No. 2022-110).
Informed consent statement: The requirement for informed consent was waived because this study was a cross-sectional analysis of de-identified routine-care data and posed minimal risk to participants.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
STROBE statement: The authors have read the STROBE Statement—a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-a checklist of items.
Data sharing statement: The datasets used and/or analyzed during the current study are not publicly available due to institutional regulations and data privacy requirements, but are available from the corresponding author on reasonable request.
Corresponding author: Yi-Ming Zhang, MD, Doctor, Department of Endocrinology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital, No. 100 Minjiang Road, Kecheng District, Quzhou 324000, Zhejiang Province, China.
Received: April 7, 2026
Revised: May 4, 2026
Accepted: June 12, 2026
Published online: August 15, 2026
Processing time: 123 Days and 0.9 Hours
Revised: May 4, 2026
Accepted: June 12, 2026
Published online: August 15, 2026
Processing time: 123 Days and 0.9 Hours
Core Tip
Core Tip: This study revealed a nonlinear relationship between visceral fat area (VFA) and red blood cell-related indices, specifically hematocrit, hemoglobin and red blood cell count, in adults with type 2 diabetes (T2D). The association was more pronounced at lower VFA levels (inflection point approximately 45 cm2) and in nonobese individuals. These findings suggest that routine hematological markers serve as accessible indicators of visceral adiposity burden. This emphasizes the importance of integrated metabolic and hematological monitoring to better assess cardiometabolic risk in T2D management.