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. 2025 Jan;17(1):e70039.
doi: 10.1111/1753-0407.70039.

Linking Creatinine-to-Body Weight Ratio With Diabetes Incidence: A Multiethnic Malaysian Cohort Study

Noraidatulakma Abdullah  1 , Ying-Xian Goh  1 , Aisyatul Najihah Khuzaimi  1 , Azwa Shawani Kamalul Arifin  1 , Nurul Ain Mhd Yusuf  1 , Nazihah Abd Jalal  1 , Norliza Ismail  1 , Nurul Faeizah Husin  1 , Mohd Arman Kamaruddin  1 , Rahman Jamal  1
Affiliations

Linking Creatinine-to-Body Weight Ratio With Diabetes Incidence: A Multiethnic Malaysian Cohort Study

Noraidatulakma Abdullah et al. J Diabetes. 2025 Jan.

Abstract

Background: Emerging evidence suggests that the creatinine-to-body weight (Cre/BW) ratio is a predictor for incident diabetes in the Asian population. This study examined the association between Cre/BW ratio and incident diabetes, as well as the relationship between Cre/BW ratio and skeletal muscle and body fat mass in a multiethnic Malaysian cohort.

Methods: A total of 13 047 eligible participants were selected from 119 560 The Malaysian Cohort participants. Of these, 750 who developed diabetes were selected as cases, while 3750 controls were chosen randomly from healthy participants. This nested case-control study included 4500 eligible participants from The Malaysian Cohort, with a 1:5 case-to-control ratio. Participants were stratified into four groups based on Cre/BW ratio quartiles. The Cox proportional hazards model evaluated the effect of Cre/BW ratio on developing incident diabetes. The association between Cre/BW ratio and body composition was assessed using the Pearson correlation coefficient.

Results: Of the 13 047 eligible participants followed up over 5.3 years, 5.75% (n = 750) developed diabetes. Diabetes incidence decreased with increasing Cre/BW ratios. The Cre/BW ratio was inversely correlated with diabetes risk (HR: 0.403, 95% CI: 0.315-0.515, p < 0.001). Additionally, males and Indians had a higher risk of developing incident diabetes. A significant correlation was observed between Cre/BW ratio and body fat mass (p < 0.001).

Conclusions: This study reveals an inverse association between the Cre/BW ratio and incident diabetes. It also found a significant moderate correlation between the Cre/BW ratio and body fat mass.

Keywords: body fat mass; body weight; creatinine; diabetes; multiethnic population.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Flowchart of study participants and design.
FIGURE 2
FIGURE 2
The (A) inverse relationship between Cre/BW quartiles and incident diabetes, further stratified by (B) gender and (C) ethnicity.
FIGURE 3
FIGURE 3
The relationship between Cre/BW ratio and incident diabetes in adjusted proportional hazards model 3, stratified based on gender and ethnicities. Additional information for both unadjusted and adjusted models that can be found in Tables [Link], [Link], [Link]; (A) The overall model is adjusted for age, gender, ethnicity, WHR, HDL‐C, TG, and SBP; (B) For males, the model is adjusted for age, ethnicity, WHR, TG, FPG, and BMI. For females, the model is adjusted for age, ethnicity, TG, and SBP; (C) Across different ethnicities, all models were adjusted for age, gender, HDL‐C, and DBP. Additionally, models for Malays and other ethnicities include an extra adjustment for WC.
FIGURE 4
FIGURE 4
Kaplan–Meier analysis of diabetes risk based on Cre/BW ratio. Kaplan–Meier analysis for incident diabetes (A) as a whole, in (B) male and (C) female, as well as in different ethnicities, including (D) Malay, (E) Chinese, (F) Indian, and (G) other races in Malaysia. The log‐rank test has shown significant (p < 0.001) differences for cumulative risk of incident diabetes across Cre/BW ratio quartiles, irrespective of gender and ethnicity.
FIGURE 5
FIGURE 5
Correlation between Cre/BW ratio and (A) BFM and (B) SMM. ρ denotes the Spearman's rank correlation coefficient.
See this image and copyright information in PMC

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