Cumulative metabolic burden and urinary albumin-to-creatinine ratio in non-diabetic adults: a nationwide population-based study.

Authors

Xiaohan Xu, Shanhu Qiu, Xiaoying Zhou, Wei Li, Hailing Lin, Yan Liu, Miao He, Wenjuan Wang, Xiaohang Wang, Yaling Chen, Chanjuan Ma, Duolao Wang, Haijian Guo, Yang Yuan, Zilin Sun

Published in

Journal of endocrinological investigation. Sep 10, 2026. Epub Sep 10, 2026.

Abstract

Albuminuria is an established marker of kidney risk and a predictor of cardiovascular and renal outcomes. Although albuminuria assessment is commonly emphasized in individuals with diabetes or chronic kidney disease, metabolic abnormalities often cluster before the onset of diabetes. Whether cumulative metabolic burden is associated with urinary albumin-to-creatinine ratio (ACR) in adults without diabetes remains incompletely understood.
We conducted a cross-sectional analysis using data from the first follow-up survey of the nationwide multi-ethnic SENSIBLE cohort in China. Among 5,664 participants, individuals with diabetes, missing data, or abnormal routine urinalysis findings suggestive of transient urinary conditions were excluded. Metabolic abnormalities including hypertension, overweight or obesity, dyslipidaemia, and prediabetes were assessed and summed to generate a clustering score ranging from 0 to 4. Urinary ACR was analysed as a continuous outcome after logarithmic transformation and as elevated ACR defined as ≥ 30 mg/g. Associations were evaluated using multivariable linear and logistic regression models with sequential adjustment, including an extended model additionally adjusted for educational level, ethnicity, and geographic region. Prespecified subgroup analyses were performed according to hypertension status, sex, and age group.
A total of 3,335 non-diabetic adults were included, of whom 12.1% had elevated ACR. Urinary ACR increased progressively with the number of metabolic abnormalities. In the extended fully adjusted model, participants with four metabolic abnormalities had higher ln(ACR) than those without metabolic abnormalities (β = 0.605, 95% CI 0.470-0.740) and greater odds of elevated ACR (OR = 5.96, 95% CI 3.54-10.04). When metabolic abnormalities were modelled continuously, each additional abnormality was associated with higher ln(ACR) (β = 0.163, 95% CI 0.136-0.190) and greater odds of elevated ACR (OR = 1.55, 95% CI 1.41-1.71). The associations remained consistent across sensitivity and subgroup analyses.
Cumulative metabolic abnormality burden was independently associated with higher urinary ACR in adults without diabetes. These findings should be interpreted as hypothesis-generating and suggest that adults without diabetes but with clustered metabolic abnormalities may warrant further longitudinal evaluation for kidney risk stratification.

PMID:
42720890
Bibliographic data and abstract were imported from PubMed on 11 Sep 2026.

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