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Aims and background <p>Diabetic foot ulcer (DFU) is a serious diabetes complication and a leading cause of non-traumatic lower extremity amputation. Obesity-related anthropometric indices may serve as early predictors of DFU. This study examined associations between the following four indices: body mass index (BMI), weight-adjusted waist index (WWI), body roundness index (BRI), and relative fat mass (RFM), and DFU risk.</p> Methods <p>Data were drawn from the 1999–2004 U.S. National Health and Nutrition Examination Survey (NHANES). Weighted multivariable regression, restricted cubic spline models, and ROC curve analyses were used to assess associations. Subgroup and sensitivity analyses were also conducted.</p> Results <p>Among 1,487 people with diabetes, 100 had DFU and 733 had pre-DFU symptoms. DFU patients showed higher HbA1c and UACR levels. After adjusting for confounders, all four indices were positively associated with DFU: BMI (OR = 1.07), WWI (OR = 1.95), BRI (OR = 1.47), and RFM (OR = 1.13). However, no significant associations were found between the indices and pre-DFU. Non-linear analysis suggested a potential curved relationship between WWI and DFU. Additionally, WWI (HR = 1.34) and BRI (HR = 1.18) were linked to increased all-cause mortality. Subgroup and sensitivity analyses confirmed robustness of the results.</p> Conclusions <p>BMI, WWI, BRI, and RFM were all independently associated with DFU, while WWI and BRI were also predictors of all-cause mortality in people with diabetes. These anthropometric markers may aid in early identification and management of high-risk individuals.</p>

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The impact of obesity-related anthropometric indices on diabetic foot ulcer and mortality: analysis of a nationally representative sample

  • 期刊论文

  • 发表日期：

    2025年12月22日

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  • ZhaoLiang Zhang,
  • LiMing Zhou,
  • YunFei Xu,
  • LieHui Yao,
  • Tao Ma,
  • XiaYun Pan

摘要

Aims and background

Diabetic foot ulcer (DFU) is a serious diabetes complication and a leading cause of non-traumatic lower extremity amputation. Obesity-related anthropometric indices may serve as early predictors of DFU. This study examined associations between the following four indices: body mass index (BMI), weight-adjusted waist index (WWI), body roundness index (BRI), and relative fat mass (RFM), and DFU risk.

Methods

Data were drawn from the 1999–2004 U.S. National Health and Nutrition Examination Survey (NHANES). Weighted multivariable regression, restricted cubic spline models, and ROC curve analyses were used to assess associations. Subgroup and sensitivity analyses were also conducted.

Results

Among 1,487 people with diabetes, 100 had DFU and 733 had pre-DFU symptoms. DFU patients showed higher HbA1c and UACR levels. After adjusting for confounders, all four indices were positively associated with DFU: BMI (OR = 1.07), WWI (OR = 1.95), BRI (OR = 1.47), and RFM (OR = 1.13). However, no significant associations were found between the indices and pre-DFU. Non-linear analysis suggested a potential curved relationship between WWI and DFU. Additionally, WWI (HR = 1.34) and BRI (HR = 1.18) were linked to increased all-cause mortality. Subgroup and sensitivity analyses confirmed robustness of the results.

Conclusions

BMI, WWI, BRI, and RFM were all independently associated with DFU, while WWI and BRI were also predictors of all-cause mortality in people with diabetes. These anthropometric markers may aid in early identification and management of high-risk individuals.