Quick answer
Clinicians have long noticed that some men of normal weight develop diabetic kidney disease while heavier men do not. A study led by Wang Weiqing with Zhang Yifei and Zhao Zhiyun at Renji Hospital [3], published in The Lancet Diabetes & Endocrinology on 15 April 2026, suggests the explanation is not weight but visceral fat — and that the relationship differs by sex. In 93,532 adults with diabetes across 640 centres, risk was U-shaped in men: raised both when visceral fat was very low and when it was very high. In women, risk rose only with high visceral fat [1][2][4].
Key takeaways
- Cohort: 93,532 adults with diabetes and no baseline kidney disease, from 640 metabolic management centres in 31 provinces [2][5].
- Median follow-up 18.4 months; 27,486 participants (29.4%) developed diabetic kidney disease [5].
- Visceral fat area measured directly by bioelectrical impedance, not estimated from waist circumference [2].
- Men: risk rose at ≤50 cm² (HR 1.08) and again above 100 cm², reaching HR 1.34 above 150 cm² [4][5].
- Women: risk became significant above 75 cm², with HR about 1.25 above 125 cm² [4][5].
Why direct measurement matters
Most previous studies used BMI, waist circumference or waist-to-height ratio as proxies, and their conclusions disagreed — some found visceral fat harmful, some found no effect, and several found opposite directions in men and women. Measuring visceral fat area directly, in a very large prospective cohort, removes one source of that inconsistency [2][5].
The U-shape in men is the paper's most striking finding. Very low visceral fat is often treated as metabolically favourable, but in this cohort it carried a modestly increased risk — possibly reflecting frailty, sarcopenia or more advanced disease in men who had lost fat [4][5].
What it changes clinically
The practical message is that BMI alone misclassifies risk. A man with a normal BMI but very low or very high visceral fat may be at higher risk than an obviously obese man with moderate visceral fat. The authors propose combining BMI with visceral fat area for stratification, and using waist-to-height ratio as a convenient first-pass screen where impedance scales are not available [4][6].
This is a cohort study, so the associations are not proof of causation, and median follow-up of 18.4 months is short for a complication that develops over years. Kidney disease was defined by albumin-to-creatinine ratio and estimated GFR, which are themselves variable. The bioelectrical impedance estimate of visceral fat correlates with imaging but is not identical to it [2][5].
The condition in context: diabetic kidney disease
Diabetic kidney disease is the leading cause of end-stage renal disease worldwide.
| Region | What the data shows | Source |
|---|---|---|
| Incidence | About 25–35% of people with diabetes develop diabetic kidney disease [2][5]. | Tencent News / MedSci [2][5] |
| Mortality | Coexisting diabetes and kidney disease raises mortality three- to twelve-fold [5]. | MedSci [5] |
| Detection | The disease is silent until late, so risk stratification matters [5]. | MedSci [5] |
Because albuminuria screening is cheap and widely available, better risk models mainly change who gets screened more intensively [4].
Why it matters
| Potential | What the report suggests | Source |
|---|---|---|
| New risk group | Men with very low visceral fat are an overlooked high-risk group [4][5]. | [4][5] |
| Screening | Adding visceral fat to BMI improves stratification [2][4]. | [2][4] |
| Caution | Observational; short follow-up [5]. | [5] |
Availability and limits
- This is an editorial summary of the publication, not medical advice [1][2].
- Associations are observational, not causal [5].
- Bioelectrical impedance is not equivalent to CT or MRI measurement [2].
- Cut-offs derived in a Chinese cohort may not transfer [4].
- The cohort was drawn from metabolic management centres, which may select healthier patients [5].
What to ask before booking
| Question | Why it matters |
|---|---|
| What is my visceral fat area, not just my BMI? | BMI alone misclassifies risk [4]. |
| Has my urine albumin-to-creatinine ratio been checked? | It is the core screening test [2]. |
| Which department handles foreign patients, and in what language? | Renji is a working hospital we do not book; confirm international-department coordination and language support. |
| If I am a man with low visceral fat, am I still at risk? | The U-shape says yes [4][5]. |
Questions patients ask
What did the study find?
In 93,532 Chinese adults with diabetes, visceral fat area was associated with diabetic kidney disease in a U-shape in men and in a high-fat-only pattern in women [1][4].
How was visceral fat measured?
Directly, by bioelectrical impedance analysis, rather than estimated from waist circumference [2].
Where was it published?
The Lancet Diabetes & Endocrinology, online 15 April 2026, led by Wang Weiqing's team at Renji Hospital [1][2].
What are the cut-offs?
Men showed raised risk at ≤50 cm² and above 100 cm², reaching HR 1.34 above 150 cm²; women above 75 cm², with HR about 1.25 above 125 cm² [4][5].
Is this relevant to international patients?
It is useful context for diabetes care in China. Renji is a working hospital we do not book — contact its international department directly [1].