Visceral fat score predicts diabetic kidney disease: analysis of 20 years of U.S. NHANES data

Metabolic Score for Visceral Fat (METS-VF) serves as an innovative surrogate marker for evaluating visceral fat and associated cardiometabolic risks. This study aimed to explore the relationship between METS-VF and diabetic kidney disease (DKD). This cross-sectional study included diabetic patients aged 20 years or older who participated in the National Health and Nutrition Examination Surveys (NHANES). DKD was diagnosed in diabetic patients based on the presence of an impaired estimated glomerular filtration rate (eGFR 2) and/or albuminuria, defined as a urinary albumin-to-creatinine ratio (UACR) ≥30 mg/g. Logistic regression, subgroup analysis, restricted cubic spline (RCS), and mediation analysis were utilized. A total of 3871 diabetic patients were included in this study. The prevalence of DKD progressively increases with higher levels of METS-VF. Multivariate logistic regression analysis indicated that individuals in the highest METS-VF quartile exhibited adjusted odd ratios of 1.56 (95%CI: 1.28-1.91) for DKD, compared to those in the lowest quartile. METS-VF demonstrated superior discriminative performance with area under the curve (AUC) values of 58.0% for DKD, 56.1% for albuminuria, and 60.6% for low-eGFR compared to traditional obesity indices. RCS analysis reveal a distinct J-shaped relationship, with a turning point at 7.42. Subgroup analyses did not reveal specific populations, and hemoglobin A1c (HbA1c) was identified as a partial mediator in this association. METS-VF can serve as an epidemiological tool to quantify the effect of visceral fat on DKD risk. However, due to the cross-sectional design of this study, causality cannot be established, and further longitudinal research is necessary.