When Obesity Hits the Kidneys: Sex-Specific Effects of Visceral Adiposity Indices on Diabetic Kidney Disease Risk

Visceral obesity is a significant risk factor for metabolic disorders and is also an important risk factor for diabetic kidney disease (DKD). However, there is still insufficient research on the predictive value of different visceral obesity indices for DKD and the sex differences in this regard. This study aims to explore the correlations between the cardiac metabolic index (CMI), lipid accumulation product (LAP), triglyceride-glucose (TyG) index, visceral adiposity index (VAI), and the risks and mortality associated with DKD, with a focus on sex differences.

This study utilized data from NHANES conducted from 2007 to 2016. Weighted logistic regression models were employed to investigate the relationships between four visceral obesity indices and DKD. Restricted cubic splines (RCSs) were also used to assess the dose-response relationship, and subgroup and interaction analyses were conducted. Receiver operating characteristic (ROC) curve analysis was conducted to evaluate the screening utility of each index for DKD risk identification. Kaplan-Meier (K-M) curves were used to analyze survival outcomes across different tertiles of the four visceral obesity indices.

A total of 6722 diabetic patients were included in the study, with 5301 in the diabetes-only group and 1421 in the DKD group. All four visceral obesity indices were significantly positively correlated with the risk of DKD, exhibiting a nonlinear relationship, with notable sex differences. Compared to males, TyG and LAP showed a stronger correlation in females. The area under the curve (AUC) was generally higher in females. Furthermore, all four visceral obesity indices showed significantly lower all-cause and cardiovascular mortality rates in the lowest tertile (Q1 group) compared to the higher tertiles (Q2-Q3 groups).

CMI, LAP, TyG, and VAI are significantly associated with the risk of DKD in diabetic patients, with notable differences between male and female populations. These metabolic indices may serve as important indicators for risk assessment and potential intervention strategies for DKD.