Journal of Shandong University (Health Sciences) ›› 2026, Vol. 64 ›› Issue (9): 68-77.doi: 10.6040/j.issn.1671-7554.0.2025.0820

• Public Health and Preventive Medicine • Previous Articles    

Association between relative fat mass index and all-cause mortality and cardiovascular mortality among individuals with diabetes and prediabetes

LI Aijing1, WEI Maoying1, WU Chan1, GUO Jingyi1, SUN Anning1, GU Xin1, GONG Yanbing1,2   

  1. 1. Division Ⅱ of Nephrology and Endocrinology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China;
    2. Beijing University of Chinese Medicine, Beijing 100029, China
  • Published:2026-09-09

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Abstract: Objective To investigate the association between the relative fat mass(RFM)index and all-cause mortality as well as cardiovascular mortality in patients with diabetes or prediabetes. Methods A total of 11,852 patients with diabetes or prediabetes from the American National Health and Nutrition Examination Survey(NHANES)database(1999-2018)were included. The study participants were divided into four groups according to the quartiles of the RFM index: Q1(9.63-29.75), Q2(29.75-35.54), Q3(35.54-44.05), and Q4(44.05-58.41). Multivariable Cox proportional hazards regression models were applied to evaluate the associations of RFM index, treated both as a continuous variable and as a categorical variable, with all-cause mortality and cardiovascular mortality. Restricted cubic spline and threshold effect analyses were applied to explore potential nonlinear relationships. Additionally, subgroup and sensitivity analyses were conducted. Results During a mean follow-up of 103.94 months, a total of 2,039 all-cause deaths(17.20%)and 661 cardiovascular deaths(5.58%)occurred among the 11,852 participants with diabetes or prediabetes. In the fully adjusted model, when RFM index was analyzed as a continuous variable, each unit increase in RFM index was associated with a 1.6% increase in all-cause mortality risk(HR=1.016, 95%CI: 1.002-1.030, P=0.029)and a 3.6% increase in cardiovascular mortality risk(HR=1.036, 95%CI: 1.007-1.066, P=0.005). When the RFM index was analyzed as a categorical variable, compared to the Q1 group, the Q3 and Q4 groups showed a 58.8%(HR=1.588, 95%CI: 1.286-1.961, P<0.001)and 61.3%(HR=1.613, 95%CI: 1.229-2.116, P=0.001)increase in all-cause mortality risk, respectively, and a 79.8%(HR=1.798, 95%CI: 1.238-2.610, P=0.002)and 124.8%(HR=2.248, 95%CI: 1.355-3.729, P=0.002)increase in cardiovascular mortality risk, respectively. Restricted cubic spline analysis revealed a nonlinear U-shaped curve between RFM index and all-cause mortality, while cardiovascular mortality showed a linear increasing trend with higher RFM index. Subgroup analysis indicated that education level significantly modified the associations of RFM index with both all-cause and cardiovascular mortality. Sensitivity analyses yielded results consistent with the main findings. Conclusion In patients with diabetes or prediabetes, a higher RFM index is associated with increased risks of both cardiovascular mortality and all-cause mortality.

Key words: Relative fat mass index, National Health and Nutrition Examination Survey, NHANES, Diabetes, Prediabetes, Mortality

CLC Number: 

  • R587.1
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