Weight-adjusted waist index emerges as key predictor of diabetic peripheral neuropathy in type 2 diabetes
Aims: Obesity is a major cardiometabolic risk factor contributing to the development and progression of diabetic peripheral neuropathy (DPN). However, evidence linking body mass index (BMI) to DPN is inconsistent. Measures of central adiposity may therefore better identify DPN risk. This study examines the association between weight-adjusted waist index (WWI) calculated as waist circumference (WC) divided by the square root of body weight (cm/√kg), a novel indicator of central fat independent of body weight, and DPN in Chinese patients with type 2 diabetes mellitus (T2DM), evaluating its role as a simple, non-invasive tool for early detection and risk stratification.
Methods: This retrospective, single-centre cross-sectional study included 1,790 adults with T2DM (mean age 55.4 years; 694 women). Patients with non-diabetic neuropathies, acute diabetic complications, chronic kidney or cardiovascular diseases, malignancies, or missing key data were excluded. Demographic, anthropometric, and laboratory data were collected. DPN was diagnosed based on characteristic clinical symptoms and signs, with nerve conduction and sensory tests used in atypical cases. Associations between WWI, BMI, WC and DPN were evaluated using logistic regression, restricted cubic spline, subgroup, and ROC-AUC analyses.
Results: A total of 895 cases of DPN was identified; participants were stratified into three tertiles based on their WWI levels. A linear relationship between WWI and DPN was observed for values above 10.757 cm/√kg (OR: 1.38, 95% CI: 1.12–1.70). In contrast, BMI showed a nonlinear association with DPN (p-nonlinear < 0.05), with age significantly modifying this relationship. ROC analysis demonstrated that WWI outperformed both BMI and WC in discriminating DPN risk.
Conclusions: Elevated WWI is a strong and independent predictor of DPN. Unlike BMI, WWI demonstrates a consistent linear relationship with neuropathy risk and is less influenced by confounding variables, making it a more reliable marker of central adiposity. These results highlight WWI’s potential as a practical tool for routine screening and risk stratification in T2DM, although further prospective studies are required to confirm its clinical utility and generalizability.
Comments: This study provides evidence that WWI, an indicator of central adiposity independent of overall body weight, is a more reliable predictor of DPN than traditional obesity measures. Unlike BMI, which does not distinguish between fat and lean mass, or WC, which does not account for body size variability, WWI better captures visceral fat accumulation and its metabolic consequences. The observed linear association between WWI and DPN risk further strengthens its clinical relevance, suggesting that risk increases progressively without an apparent threshold effect. Moreover, WWI demonstrated superior diagnostic performance compared with conventional anthropometric indices, although AUC is only 0.56 and sensitivity and specificity of 40% and 72%. The cut-off value identified (10.757 cm/√kg) may serve as a reference point in routine clinical settings. Given its simplicity, low cost, and non-invasive nature, WWI could be incorporated into risk assessment models for early identification and closer monitoring of high-risk patients with T2DM. Validation in longitudinal studies and different population is needed before wider application in clinical practice.
Ilenia D’Ippolito
Reference. Cheng MK, Guo YY, Zhang ZY, Kang XN, Wang D, Ren HH, Yuan G. Predictive role of weight-adjusted waist index in diabetic peripheral neuropathy among patients with type 2 diabetes mellitus. Ann Med. 2025 Dec;57(1):2522970. doi: 10.1080/07853890.2025.2522970. Epub 2025 Jun 23. PMID: 40551587; PMCID: PMC12931302.
