<p>Anthropometric indices assessed in the study.</p>

Background Diabetic nephropathy is a serious microvascular complication of type 2 diabetes mellitus, yet the sex-specific relationship between visceral adiposity and renal dysfunction remains insufficiently explored in Chinese populations. Objective To investigate the association between visceral adiposity indices and renal dysfunction in Chinese type 2 diabetes mellitus patients, emphasizing this population’s unique risk profile and the clinical utility of composite adiposity measures. Methods This cross-sectional study involved 1,335 type 2 diabetes mellitus patients. The primary outcome variable was renal dysfunction, defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m². Thirteen visceral adiposity indices were evaluated through correlation analysis, overall population regression modeling, and sex-stratified approaches. Multiple regression models were progressively adjusted for demographic characteristics, lifestyle factors, clinical parameters, and medications to assess independent associations with estimated glomerular filtration rate. Results The study population (median age: 54 years; 67.04% male) demonstrated distinct characteristics between estimated glomerular filtration rate groups. The estimated glomerular filtration rate decline group exhibited significantly higher age, blood pressure, and fasting glucose compared to the normal group (all p < 0.05). Despite similar body mass index levels, multiple visceral adiposity indices (waist-to-hip ratio, lipid accumulation product, Chinese visceral adiposity index, visceral adiposity index, body roundness index, relative fat mass, and metabolic score for visceral fat) were significantly elevated in the eGFR Decline Group. Comprehensive correlation analysis revealed substantial attenuation after confounder adjustment, with only visceral adiposity index maintaining significance in the total population (adjusted r = −0.075, p = 0.007). Multivariate regression confirmed visceral adiposity index as the most robust predictor (β = −1.63, 95% CI: −2.75 to −0.50, p = 0.0048). Sex-stratified analyses revealed profound differences: visceral adiposity index demonstrated independent predictive value exclusively in males (β = −2.41, 95% CI: −3.84 to −0.98, p = 0.001), while all female associations became non-significant after full adjustment. Conclusion Visceral adiposity index showed strong and consistent associations with renal dysfunction specifically in Chinese male T2DM patients, while female associations were primarily mediated through confounding pathways. These findings highlight critical sex-specific differences and support the integration of composite visceral adiposity indices into routine clinical assessment for male diabetic patients, emphasizing the necessity of population-specific and gender-tailored approaches in renal risk stratification.背景 糖尿病肾病是2型糖尿病（type 2 diabetes mellitus, T2DM）严重的微血管并发症，但目前中国人群中内脏脂肪蓄积与肾功能不全之间的性别特异性关联仍未得到充分探索。 目的 探讨中国2型糖尿病患者内脏脂肪蓄积指标与肾功能不全的关联，阐明该人群独特的风险特征，以及复合脂肪蓄积指标的临床应用价值。 方法 本研究为横断面研究，共纳入1335名2型糖尿病患者。主要结局指标为肾功能不全，定义为估算肾小球滤过率（estimated glomerular filtration rate, eGFR）<60 mL/min/1.73 m²。通过相关性分析、全人群回归建模以及性别分层分析，对13项内脏脂肪蓄积指标进行评估。采用逐步校正人口学特征、生活方式因素、临床参数及用药情况的多元回归模型，分析其与估算肾小球滤过率的独立关联。 结果 研究人群（中位年龄54岁；男性占比67.04%）在不同估算肾小球滤过率分组中呈现出显著特征差异。与肾功能正常组相比，估算肾小球滤过率下降组患者的年龄、血压及空腹血糖水平均显著更高（所有P<0.05）。尽管两组的体质量指数（body mass index, BMI）水平相近，但多项内脏脂肪蓄积指标在估算肾小球滤过率下降组中显著升高，包括腰臀比、脂质蓄积乘积、中国内脏脂肪指数、内脏脂肪指数、体圆度指数、相对体脂量及内脏脂肪代谢评分。综合相关性分析显示，校正混杂因素后关联强度大幅减弱，仅内脏脂肪指数在全人群中仍具有统计学意义（校正后r=-0.075，P=0.007）。多元回归分析证实，内脏脂肪指数是最具稳健性的预测因子（β=-1.63，95%置信区间：-2.75~-0.50，P=0.0048）。性别分层分析则揭示了显著的性别差异：内脏脂肪指数仅在男性患者中表现出独立预测价值（β=-2.41，95%置信区间：-3.84~-0.98，P=0.001），而女性患者的所有关联在完全校正后均无统计学意义。 结论 内脏脂肪指数仅在中国男性2型糖尿病患者中与肾功能不全存在强且一致的关联，而女性患者的关联主要由混杂因素介导。本研究结果凸显了关键的性别特异性差异，支持将复合内脏脂肪蓄积指标纳入男性糖尿病患者的常规临床评估体系，强调了针对特定人群及性别定制的肾脏风险分层策略的必要性。