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Lower creatinine-to-body weight ratio associated with increased prediabetes risk in Chinese adultsStudy links lower creatinine-to-weight ratio with higher prediabetes risk in Chinese adults

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Key Takeaway
Consider creatinine-to-body weight ratio as a potential prediabetes risk marker in Chinese adults, but recognize this is observational evidence.

A retrospective cohort study examined the association between baseline creatinine-to-body weight ratio (Cre/BW) and incident prediabetes in 173,476 Chinese adults from health check-up programs across 11 cities. Participants were followed for a median of 3.0 years, during which 18,506 (10.67%) developed prediabetes. The primary analysis found that a lower Cre/BW ratio was associated with increased prediabetes risk, with an adjusted hazard ratio of 0.869 (95% CI: 0.806-0.973).

Subgroup analyses suggested the association might be more pronounced in certain populations. For participants aged 30-40 years, the HR was 0.614 (95% CI: 0.532-0.708), and for females, the HR was 0.726 (95% CI: 0.640-0.824). The study also noted that the association appeared stronger below an inflection point (HR=0.407, 95% CI: 0.328-0.506), though absolute numbers for these subgroup analyses were not reported.

Safety and tolerability data were not reported in this observational analysis. The study has several limitations: it is observational and therefore cannot establish causation, only association. Key details including funding sources, conflicts of interest, and specific practice relevance were not reported. The findings should be interpreted cautiously as they represent associations in a specific population of Chinese adults undergoing health check-ups.

For clinical practice, this evidence suggests that Cre/BW ratio might serve as a potential marker for prediabetes risk assessment in similar populations. However, the observational nature of the study means these findings require validation in prospective studies before considering clinical application. The stronger associations in younger adults and females warrant further investigation but should not guide clinical decisions without additional evidence.

Researchers looked at whether a simple measurement from a routine blood test—the creatinine-to-body weight ratio—might be linked to developing prediabetes. They studied health check-up data from over 173,000 adults across 11 Chinese cities, following them for a median of three years. Prediabetes means blood sugar levels are higher than normal but not yet high enough for a type 2 diabetes diagnosis.

During the follow-up, about 10.7% of participants (18,506 people) developed prediabetes. The analysis showed that people with a lower creatinine-to-weight ratio had a higher risk of developing prediabetes. The link appeared stronger in certain groups, including women, people aged 30–40, and those with normal blood pressure.

This was an observational study, which means it can only show an association, not prove that a low ratio causes prediabetes. The study did not report on safety concerns, as it analyzed existing health data rather than testing a treatment. The findings are a first step and need confirmation in other populations and study types. For now, this research suggests a potential new area for investigation in diabetes prevention, but the ratio is not yet a tool for individual risk assessment.

What this means for you:
A large study found a link between a lower creatinine-to-weight ratio and higher prediabetes risk, but more research is needed.

Study Details

Study typeCohort
EvidenceLevel 3
PublishedApr 2026
View Original Abstract ↓
Background and objectiveWhile the creatinine-to-body weight ratio (Cre/BW) has emerged as a promising biomarker for muscle mass assessment, its relationship with prediabetes remains unclear. This study aimed to investigate the association between Cre/BW ratio and incident prediabetes in Chinese adults.MethodsWe conducted a large-scale retrospective cohort study involving 173,476 participants from health check-up programs across 11 Chinese cities. Cox proportional hazards models were employed to evaluate the association between baseline Cre/BW ratio and incident prediabetes. To address potential non-linear relationships, we applied Cox proportional hazards regression with cubic spline functions and smooth curve fitting, using a recursive algorithm to calculate inflection points. Multiple imputation was used for missing data, and comprehensive sensitivity analyses were performed to assess result robustness.ResultsDuring a median follow-up of 3.0 years, 18,506 participants (10.67%) developed prediabetes. A lower Cre/BW ratio was associated with an increased risk of prediabetes (adjusted HR = 0.869, 95%CI: 0.806-0.973). Exploratory threshold effect analysis suggested a potential inflection point at 0.96(95% CI 0.90-1.01)μmol/L/kg, below which the association might be stronger (HR = 0.407, 95%CI: 0.328-0.506). The association remained stable in sensitivity analyses excluding participants with smoking history, drinking history, or family history of diabetes. Subgroup analyses revealed more pronounced associations among individuals aged 30–40 years (HR = 0.614, 95%CI: 0.532-0.708), females (HR = 0.726, 95%CI: 0.640-0.824), and those with normal blood pressure (systolic blood pressure
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