{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T16:13:19Z","timestamp":1788365599717,"version":"build-2803163510"},"reference-count":52,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:00:00Z","timestamp":1782777600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:00:00Z","timestamp":1782777600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Diabetes Invest"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Handgrip strength (HGS) is a key indicator of functional decline. We investigated whether central adiposity (waist\u2010to\u2010height ratio, WHtR) and renal dysfunction independently or additively correlate with low HGS across body mass index (BMI) categories in Asian patients with type 2 diabetes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>This retrospective cross\u2010sectional study included 1,468 patients. Low HGS was defined by the Asian Working Group for Sarcopenia 2019 criteria. Multivariable logistic regression evaluated independent and combined correlates. Subgroup analyses examined the interactions between WHtR, BMI, and chronic kidney disease (CKD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Older age, higher albuminuria, CKD (adjusted odds ratio [aOR]\u2009=\u20091.98), and WHtR &gt;0.5 (aOR\u2009=\u20091.82) were independently associated with low HGS, whereas BMI\u2009&gt;\u200924\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      was protective (aOR\u2009=\u20090.44). Significant effect modification existed between BMI and WHtR (\n                      <jats:italic>P<\/jats:italic>\n                      for interaction\u2009=\u20090.026): central obesity neutralized the protective effect of higher BMI (aOR shifted from 0.13 to 0.81). Furthermore, while WHtR &gt;0.5 and CKD showed no multiplicative interaction, their co\u2010occurrence exerted a clear additive clinical burden, yielding the highest risk for low HGS (aOR\u2009=\u20091.74,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.025) compared to patients without either condition.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Central obesity and renal dysfunction (impaired eGFR and albuminuria) are distinct, additive correlates of low HGS. WHtR effectively unmasks functional vulnerability, especially in normal\u2010weight individuals. Integrating WHtR and comprehensive renal parameters provides a robust, low\u2010cost screening strategy for sarcopenia risk in diabetes care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jdi.70379","type":"journal-article","created":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T07:51:12Z","timestamp":1782805872000},"page":"1538-1547","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Waist\u2010to\u2010height ratio and renal dysfunction as independent correlates of low handgrip strength in patients with type 2 diabetes"],"prefix":"10.1111","volume":"17","author":[{"given":"Shing\u2010Hua","family":"Chen","sequence":"first","affiliation":[{"name":"Division of Endocrinology and Metabolism, Department of Internal Medicine Kaohsiung Chang Gung Memorial Hospital  Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3972-2225","authenticated-orcid":false,"given":"Chen\u2010Kai","family":"Chou","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, Department of Internal Medicine Kaohsiung Chang Gung Memorial Hospital  Kaohsiung Taiwan"},{"name":"School of Medicine, College of Medicine Chang Gung University  Taoyuan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4053-4819","authenticated-orcid":false,"given":"Shao\u2010Wen","family":"Weng","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, Department of Internal Medicine Kaohsiung Chang Gung Memorial Hospital  Kaohsiung Taiwan"},{"name":"School of Medicine, College of Medicine Chang Gung University  Taoyuan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jung\u2010Fu","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, Department of Internal Medicine Kaohsiung Chang Gung Memorial Hospital  Kaohsiung Taiwan"},{"name":"School of Medicine, College of Medicine Chang Gung University  Taoyuan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9936-6074","authenticated-orcid":false,"given":"Feng\u2010Chih","family":"Shen","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, Department of Internal Medicine Kaohsiung Chang Gung Memorial Hospital  Kaohsiung Taiwan"},{"name":"School of Medicine, College of Medicine Chang Gung University  Taoyuan Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,30]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu13010183"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.2147\/DMSO.S186600"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.2147\/DMSO.S410834"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(14)70034-8"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dsx.2023.102835"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)31138-9"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2019.12.012"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jshs.2020.06.009"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)62000-6"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/00075197-200405000-00005"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1159\/000490361"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1467-789X.2011.00952.x"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrneph.2014.112"},{"key":"e_1_2_10_15_1","first-page":"370","article-title":"How to define obesity? 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