Abstract
Background: The impact of visceral fat area (VFA) on diabetic peripheral neuropathy (DPN) remains controversial in Type 2 diabetes mellitus (T2DM), with conflicting evidence. Methods: We conducted a cross-sectional study at the National Metabolic Management Center of Beijing Luhe Hospital between October 2017 and May 2024. VFA was quantified using bioelectrical impedance analysis, and DPN was diagnosed according to standardized clinical criteria. The association between VFA and DPN was examined using multiple logistic regression models with comprehensive confounder adjustment. Nonlinear relationships were investigated through generalized additive models and threshold effect analyses. Results: Among 7436 T2DM patients (3044 females), the median VFA was 104 cm(2) (interquartile range: 79.5-132 cm(2)), with DPN present in 26.55% of participants. Generalized additive models revealed a significant U-shaped association between VFA and DPN, with an inflection point at 133 cm(2) (log-likelihood ratio test, p < 0.001). In the segmented regression analysis, each 10 cm(2) increase in VFA below this threshold was associated with decreased DPN risk (OR: 0.95, 95% CI: 0.93-0.97, p < 0.05), while increases above the threshold were associated with elevated risk (OR: 1.06, 95% CI: 1.03-1.09, p < 0.05). Conclusions: A U-shaped association exists between VFA and DPN prevalence in T2DM patients, suggesting clinical relevance of moderate visceral adiposity.