Diabetes-dependent association between metabolic score for visceral fat and chronic kidney disease: findings from a longitudinal cohort study

Abstract

Aims: Metabolic dysfunction drives chronic kidney disease (CKD). Although the metabolic score for visceral fat (METS-VF) emerged as a novel marker of cardiometabolic health, its association with CKD remains unclear. We investigated the association between METS-VF and incident CKD and determined whether this relationship varies according to diabetes status. Methods: This longitudinal study analyzed data from 8,092 participants in the Korean Genome and Epidemiology Study. METS-VF was categorized into quartiles. Hazard ratios (HRs) for CKD development were estimated using Cox proportional hazards model and underwent multivariate adjustment. Results: During a mean follow-up of 12.8 years, 2,202 incident CKD cases were identified. Compared to Q1, Q4 was associated with an increased CKD risk in the unadjusted model (HR: 2.941; 95% CI: 2.591-3.339; P < 0.001) which persisted after multivariate adjustment (adjusted HR: 1.373; 95% CI: 1.201-1.571; P < 0.001). Subgroup analyses revealed the association between METS-VF and incident CKD was significant only in individuals with normoglycemia. Conclusions: Higher METS-VF was associated with increased risk of CKD development; however, it was confined to individuals with normal glucose tolerance. This suggests METS-VF may serve as an exploratory marker for stratified risk assessment for early CKD risk before the onset of glucose dysregulation, emphasizing the critical window for early metabolic intervention.