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Background <p>Elevated urinary albumin-to-creatinine ratio (UACR) is associated with increased mortality risk in general populations. However, the prognostic significance of UACR within the normal range (&lt; 30&#xa0;mg/g) among adults with obesity remains unclear.</p> Methods <p>We conducted a cohort study using data from the National Health and Nutrition Examination Survey (NHANES) 1999–2018, with mortality outcomes ascertained through linkage to the National Death Index through December 31, 2019. Adults with obesity (BMI ≥ 30&#xa0;kg/m²) and normal-range UACR were included. UACR was analyzed as both a continuous variable and categorized by tertiles. Weighted multivariable Cox proportional hazards models adjusted for demographics, lifestyle factors, and clinical characteristics were employed to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).</p> Results <p>Among 10,754 participants with obesity, during a median follow-up of 9.6 years (interquartile range: 5.2–13.9), 1,084 all-cause deaths and 305 cardiovascular deaths occurred. After multivariable adjustment, each 5&#xa0;mg/g increment in UACR was associated with increased all-cause mortality (HR: 1.14; 95% CI: 1.06–1.22; <i>P</i> &lt; 0.001) and cardiovascular mortality (HR: 1.13; 95% CI: 1.01–1.26; <i>P</i> = 0.03). Compared with the lowest tertile, participants in the highest UACR tertile had significantly higher risks of all-cause mortality (HR: 1.56; 95% CI: 1.25–1.96; <i>P</i> &lt; 0.001) and cardiovascular mortality (HR: 2.22; 95% CI: 1.45–3.41; <i>P</i> &lt; 0.001), with significant dose-response relationships (both P for trend &lt; 0.001). Results remained consistent across sensitivity analyses.</p> Conclusions <p>In adults with obesity, a higher UACR within the clinically normal range was independently associated with increased risks of all-cause and cardiovascular mortality. This observational association highlights the potential prognostic value of normal-range UACR and supports its consideration in the comprehensive risk assessment of this population.</p>

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Normal-range urinary albumin-to-creatinine ratio and mortality risk in adults with obesity: a cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月8日

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  • Xianhua Li,
  • Jihong Ma,
  • Yongsong Xu,
  • Haolin Gong,
  • Haibin Wen,
  • Jing ke

摘要

Background

Elevated urinary albumin-to-creatinine ratio (UACR) is associated with increased mortality risk in general populations. However, the prognostic significance of UACR within the normal range (< 30 mg/g) among adults with obesity remains unclear.

Methods

We conducted a cohort study using data from the National Health and Nutrition Examination Survey (NHANES) 1999–2018, with mortality outcomes ascertained through linkage to the National Death Index through December 31, 2019. Adults with obesity (BMI ≥ 30 kg/m²) and normal-range UACR were included. UACR was analyzed as both a continuous variable and categorized by tertiles. Weighted multivariable Cox proportional hazards models adjusted for demographics, lifestyle factors, and clinical characteristics were employed to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).

Results

Among 10,754 participants with obesity, during a median follow-up of 9.6 years (interquartile range: 5.2–13.9), 1,084 all-cause deaths and 305 cardiovascular deaths occurred. After multivariable adjustment, each 5 mg/g increment in UACR was associated with increased all-cause mortality (HR: 1.14; 95% CI: 1.06–1.22; P < 0.001) and cardiovascular mortality (HR: 1.13; 95% CI: 1.01–1.26; P = 0.03). Compared with the lowest tertile, participants in the highest UACR tertile had significantly higher risks of all-cause mortality (HR: 1.56; 95% CI: 1.25–1.96; P < 0.001) and cardiovascular mortality (HR: 2.22; 95% CI: 1.45–3.41; P < 0.001), with significant dose-response relationships (both P for trend < 0.001). Results remained consistent across sensitivity analyses.

Conclusions

In adults with obesity, a higher UACR within the clinically normal range was independently associated with increased risks of all-cause and cardiovascular mortality. This observational association highlights the potential prognostic value of normal-range UACR and supports its consideration in the comprehensive risk assessment of this population.