Sex-specific and BMI-specific associations between visceral fat and diabetic kidney disease in patients with diabetes: a large-scale multicentre prospective cohort study
Authors' conclusion
VFA is a significant risk factor for diabetic kidney disease, exhibiting distinct sex-specific patterns that persist across BMI strata. These findings support precise clinical risk stratification and identify low-VFA men as a previously overlooked high-risk population.
Study context
- Population
- Adults with diabetes without prevalent DKD at baseline, 640 centres of the China Metabolic Management Center (MMC) project; median age 55.0 years, 61.9% malefinal analytical cohort
- Participants
- 93,532 adults
- Exposure
- Visceral fat area (VFA) categories, stratified by sex and BMI
- Outcome
- Incident DKD: albuminuria (urinary albumin-to-creatinine ratio ≥3.39 mg/mmol) or eGFR <60 mL/min per 1.73m2
- Follow-up
- Median 18.4 months (IQR 9.4-32.3)
Methodological detailsmulticentre, large-scale, VFA measured by bioelectrical impedance analysis
- Multicentre
- Large-scale
- VFA measured by bioelectrical impedance analysis
Main finding
As reported in the abstract
Incident DKD by VFA
- Developed DKD
- 27 486 (29.4%) of 93 532
- VFA per IQR (52 cm²), aHR
- 1.08 (95% CI 1.05-1.10; p<0.0001)
- Men, VFA ≤50 cm², aHR (1.06-1.19; p=0.0002)
- 1.12
- Men, VFA 100-125 cm², aHR (1.01-1.11; p=0.013)
- 1.06
- Women, VFA 75-100 cm², aHR (1.03-1.14; p=0.0014)
- 1.09
Observational data: associations, not effects.
Further findings
DKD by VFA in men without overweight (BMI <24 kg/m²)
- VFA ≤50 cm², aHR
- 1.12 (95% CI 1.04-1.21; p=0.0045)
- VFA >125 cm², aHR (1.09-1.44; p=0.0019)
- 1.25
DKD by VFA in men with overweight (BMI 24-28 kg/m²)
- VFA ≤50 cm², aHR
- 1.15 (95% CI 1.01-1.31; p=0.039)
- VFA 100-125 cm², aHR (1.02-1.18; p=0.010)
- 1.10
- VFA >125 cm², aHR (1.06-1.24; p=0.0005)
- 1.15
DKD by VFA in men with obesity (BMI ≥28 kg/m²)
- VFA ≤50 cm², aHR
- 2.15 (95% CI 1.44-3.23; p=0.0002)
- VFA >125 cm², aHR (1.20-1.42; p<0.0001)
- 1.31
- Risk significantly elevated across all VFA categories, highest at both extremes
DKD by VFA in women by BMI
- Without overweight, VFA 75-100 cm², aHR
- 1.10 (95% CI 1.02-1.19; p=0.011)
- With overweight, VFA 75-100 cm², aHR (1.02-1.17; p=0.011)
- 1.10
- With obesity, VFA 50-75 cm², aHR
- 1.22 (95% CI 1.02-1.46; p=0.033)
Original publication
Sex-specific and BMI-specific associations between visceral fat and diabetic kidney disease in patients with diabetes: a large-scale multicentre prospective cohort study. Lancet Diabetes Endocrinol. Published May 2026. doi:10.
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