{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T19:45:46Z","timestamp":1791920746739,"version":"4.3.4"},"reference-count":50,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T00:00:00Z","timestamp":1760659200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Diabetic peripheral neuropathy (DPN), a common chronic complication of type 2 diabetes mellitus (T2DM), lacks simple biomarkers for early monitoring. This study aimed to explore the association between the ratio of extracellular water to total body water (ECW\/TBW) and DPN.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 707 T2DM patients recruited from the Third Affiliated Hospital of Soochow University were included in this cross-sectional study. Multivariate logistic regression analyses were performed to assess the association between the ECW\/TBW ratio and DPN after adjusting. Receiver operating characteristic (ROC) curves were used to evaluate the predictive value of the ECW\/TBW ratio for DPN.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The risk of DPN is related significantly with ECW\/TBW ratio by multivariate logistic regression analyses, especially the ECW\/TBW ratio of arms, trunk, and legs. And the ECW\/TBW ratio can not be a indicator to predict the DPN rick of whose BMI is above 28kg\/m\u00b2. Besides, adding the ECW\/TBW ratio to the baseline model gained a positive change in the integrated discrimination improvement and continuous net reclassification improvement. The area under the curve (AUC) of ECW\/TBW (AUC:0.678) was higher than that of Neutrophil-to-Lymphocyte Ratio (NLR, AUC:0.620) and Platelet-to-Lymphocyte Ratio (PLR, AUC:0.568).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The ratio of ECW\/TBW exhibits a potential predictive capacity for DPN and better than NLR and PLR in T2DM patients with BMI &amp;lt;28 kg\/m\u00b2.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2025.1560902","type":"journal-article","created":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T04:13:23Z","timestamp":1760674403000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["The ratio of extracellular water to total body water serves as a potential  predictor of diabetic peripheral  neuropathy in 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