{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T17:38:29Z","timestamp":1791308309985,"version":"4.3.1"},"reference-count":43,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T00:00:00Z","timestamp":1776816000000},"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>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Epidemiological data and the comorbidity situation of cardiovascular-kidney-metabolic disease (CKM) in ethnic minority regions of southern China are lacking. This study aimed to (1) estimate the prevalence and stage distribution of CKM syndrome and (2) identify factors associated with CKM stages and explore the interrelationships among coexisting chronic conditions in a multi-ethnic population in southern China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed data from the 2020\u20132021 China Cardiovascular Disease and Risk Factors Surveillance project in Guangxi. CKM syndrome was defined as the coexistence of cardiovascular disease (CVD), chronic kidney disease (CKD), and metabolic disorders. The primary outcome was CKM stage (0\u20134), and binary CKM variables were used in regression analyses. Prevalence was estimated using data from questionnaires, physical examinations, and laboratory tests. Regression and network analyses were conducted to examine factors associated with CKM and the interrelationships among chronic conditions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 8,552 participants (median age 50 [IQR 36\u201363]; 41.9% male; 66.6% urban; 42.3% Zhuang), the age- and sex-adjusted prevalence of CKM stages 1\u20134 was 76.4% (95% CI: 75.5\u201377.3%), with 17.2% at stage 1, 57.7% at stages 2\u20133, and 1.4% at stage 4 (all p &amp;lt; 0.001). The prevalence of CKM stages 2\u20134 was significantly higher among males, older individuals, rural residents, and non-Zhuang populations (p &amp;lt; 0.05). Factors independently associated with CKM (stages 2\u20134) included male sex, older age, rural residence, lower education level, alcohol consumption, low fruit intake, high red meat intake, and hyperuricemia (all p &amp;lt; 0.05). The prevalence of individual chronic conditions was as follows: hypertension, 39.7%; non-hypertension CVD (other CVD), 1.6%; CKD, 13.8%; obesity, 12.2%; and diabetes, 12.1%. Hypertension was a central condition linking CVD, CKD, hyperuricemia, obesity, and diabetes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study reveals a substantial burden of CKM stages 2\u20133 in Guangxi, China, affecting over half of the population, especially rural elderly men. The findings highlight the need for targeted prevention strategies focusing on modifiable factors associated with CKM in ethnic minority regions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1818782","type":"journal-article","created":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T04:37:20Z","timestamp":1776832640000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Prevalence of cardiovascular-kidney-metabolic syndrome in areas of Southern China where ethnic minority populations reside: a cross-sectional study"],"prefix":"10.3389","volume":"17","author":[{"given":"Kehui","family":"Li","sequence":"first","affiliation":[{"name":"Department of Nephrology, The First Affiliated Hospital of Guangxi Medical University","place":["Nanning, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Zeng","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The First Affiliated Hospital of Guangxi Medical University","place":["Nanning, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manqiu","family":"Mo","sequence":"additional","affiliation":[{"name":"Geriatric Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University","place":["Nanning, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunan","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Medical Research, The First Affiliated Hospital of Guangxi Medical University","place":["Nanning, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaohua","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The First Affiliated Hospital of Guangxi Medical University","place":["Nanning, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanshan","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The First Affiliated Hospital of Guangxi Medical University","place":["Nanning, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiqiang","family":"Nong","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The First Affiliated Hospital of Guangxi Medical University","place":["Nanning, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Nephrology, The First Affiliated Hospital of Guangxi Medical University","place":["Nanning, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rongjie","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University","place":["Nanning, Guangxi, China"]},{"name":"Guangxi Key Laboratory of Precision Medicine in Cardio-cerebrovascular Diseases Control and Prevention, Guangxi Medical University","place":["Nanning, Guangxi, China"]},{"name":"Guangxi Clinical Research Center for Cardio-cerebrovascular Diseases, Guangxi Medical University","place":["Nanning, Guangxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,22]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpcardiol.2023.102344","article-title":"Cardiovascular-kidney-metabolic (CKM) syndrome: A state-of-the-art review","volume":"49","author":"Sebastian","year":"2024","journal-title":"Curr Probl Cardiol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-024-21131-2","article-title":"Joint association of the inflammatory marker and cardiovascular-kidney-metabolic syndrome stages with all-cause and cardiovascular disease mortality: a national prospective study","volume":"25","author":"Cao","year":"2025","journal-title":"BMC Public Health"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2024.6892","article-title":"Prevalence of cardiovascular-kidney-metabolic syndrome stages in US adults, 2011-2020","volume":"331","author":"Aggarwal","year":"2024","journal-title":"Jama"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2022.982344","article-title":"Agricultural production structure and inequality of educational development in China","volume":"13","author":"Wei","year":"2022","journal-title":"Front Psychol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"3949","DOI":"10.3390\/nu14193949","article-title":"Geographic variations in dietary patterns and their associations with overweight\/obesity and hypertension in China: Findings from China Nutrition and Health Surveillance (2015-2017)","volume":"14","author":"Zhao","year":"2022","journal-title":"Nutrients"},{"key":"B6","doi-asserted-by":"publisher","first-page":"2835","DOI":"10.3390\/nu13082835","article-title":"Trajectories of dietary patterns and their associations with overweight\/obesity among Chinese adults: China Health and Nutrition Survey 1991-2018","volume":"13","author":"Zhang","year":"2021","journal-title":"Nutrients"},{"key":"B7","doi-asserted-by":"publisher","first-page":"25021","DOI":"10.1038\/s41598-025-09004-z","article-title":"Trends and urban-rural disparities in cervical cancer epidemiology in China, 2005-2018","volume":"15","author":"Liu","year":"2025","journal-title":"Sci Rep"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.3967\/bes2024.162","article-title":"Report on cardiovascular health and diseases in China 2023: An updated summary","volume":"37","year":"2024","journal-title":"BioMed Environ Sci"},{"key":"B9","volume-title":"Dietary guidelines for Chinese residents: 2022","year":"2022"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-150-9-200905050-00006","article-title":"A new equation to estimate glomerular filtration rate","volume":"150","author":"Levey","year":"2009","journal-title":"Ann Intern Med"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1161\/cir.0000000000001184","article-title":"Cardiovascular-kidney-metabolic health: A presidential advisory from the American Heart Association","volume":"148","author":"Ndumele","year":"2023","journal-title":"Circulation"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1161\/cir.0000000000001186","article-title":"A synopsis of the evidence for the science and clinical management of cardiovascular-kidney-metabolic (CKM) syndrome: A scientific statement from the American Heart Association","volume":"148","author":"Ndumele","year":"2023","journal-title":"Circulation"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1007\/s10157-018-1615-x","article-title":"KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease","volume":"105","year":"2024","journal-title":"Kidney Int"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.2337\/dc24-S002","article-title":"2. Diagnosis and classification of diabetes: Standards of care in diabetes-2024","volume":"47","year":"2024","journal-title":"Diabetes Care"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.ejim.2024.05.033","article-title":"2024 European Society of Hypertension clinical practice guidelines for the management of arterial hypertension","volume":"126","author":"Kreutz","year":"2024","journal-title":"Eur J Intern Med"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2023.1190934","article-title":"2023 Chinese guideline for lipid management","volume":"14","author":"Li","year":"2023","journal-title":"Front Pharmacol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1016\/s2213-8587(21)00047-4","article-title":"Clinical management and treatment of obesity in China","volume":"9","author":"Zeng","year":"2021","journal-title":"Lancet Diabetes Endocrinol"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.14341\/2071-8713-5281","article-title":"Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity","volume":"120","author":"Alberti","year":"2009","journal-title":"Circulation"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1002\/imt2.238","article-title":"Sangerbox 2: Enhanced functionalities and update for a comprehensive clinical bioinformatics data analysis platform","volume":"3","author":"Chen","year":"2024","journal-title":"Imeta"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1038\/srep05918","article-title":"A new method for constructing networks from binary data","volume":"4","author":"van Borkulo","year":"2014","journal-title":"Sci Rep"},{"key":"B21","doi-asserted-by":"publisher","first-page":"195","DOI":"10.3758\/s13428-017-0862-1","article-title":"Estimating psychological networks and their accuracy: A tutorial paper","volume":"50","author":"Epskamp","year":"2018","journal-title":"Behav Res Methods"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1934","DOI":"10.1186\/s12889-023-16697-2","article-title":"Associations of dietary, sociodemographic, and anthropometric factors with anemia among the Zhuang ethnic adults: a cross-sectional study in Guangxi Zhuang Autonomous Region, China","volume":"23","author":"Wen","year":"2023","journal-title":"BMC Public Health"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacasi.2024.10.016","article-title":"Prevalence of the cardiovascular-kidney-metabolic syndrome in 3 Chinese cohorts","volume":"5","author":"Huang","year":"2025","journal-title":"JACC Asia"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2024.03.368","article-title":"Prevalence of the cardiovascular-kidney-metabolic syndrome in the United States","volume":"83","author":"Minhas","year":"2024","journal-title":"J Am Coll Cardiol"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1017\/s0007114513003917","article-title":"Longitudinal analysis of dietary patterns in Chinese adults from 1991 to 2009","volume":"111","author":"Batis","year":"2013","journal-title":"Br J Nutr"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1038\/s43016-024-01038-2","article-title":"Adoption of region-specific diets in China can help achieve gains in health and environmental sustainability","volume":"5","author":"Ye","year":"2024","journal-title":"Nat Food"},{"key":"B27","unstructured":"2022 Statistical Bulletin of National Economic and Social Development: National Bureau of Statistics\n          \n          2022"},{"key":"B28","unstructured":"2022 Statistical Bulletin of National Economic and Social Development of Guangxi Zhuang Autonomous Region"},{"key":"B29","unstructured":"2022 Statistical Bulletin on National Education Development"},{"key":"B30","unstructured":"2022 Annual Report on Educational Development in Guangxi Zhuang Autonomous Region"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1161\/jaha.124.034996","article-title":"Social risk profile and cardiovascular-kidney-metabolic syndrome in US adults","volume":"13","author":"Li","year":"2024","journal-title":"J Am Heart Assoc"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.2196\/57920","article-title":"Gender disparities in the association between educational attainment and cardiovascular-kidney-metabolic syndrome: Cross-sectional study","volume":"10","author":"Ding","year":"2024","journal-title":"JMIR Public Health Surveill"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1161\/cir.0000000000001078","article-title":"Life's essential 8: Updating and enhancing the American Heart Association's construct of cardiovascular health: A presidential advisory from the American Heart Association","volume":"146","author":"Lloyd-Jones","year":"2022","journal-title":"Circulation"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1111\/acer.14539","article-title":"Alcohol consumption, cardiovascular\u2010related conditions, and ALDH2*2 ethnic group prevalence in Asian Americans","volume":"45","author":"Cook","year":"2021","journal-title":"Alcohol: Clin Exp Res"},{"key":"B35","doi-asserted-by":"publisher","first-page":"622","DOI":"10.1186\/s12967-023-04495-8","article-title":"Association between life's essential 8 and biological ageing among US adults","volume":"21","author":"Zhang","year":"2023","journal-title":"J Transl Med"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1161\/jaha.123.032743","article-title":"Epigenetic age mediates the association of life's essential 8 with cardiovascular disease and mortality","volume":"13","author":"Carbonneau","year":"2024","journal-title":"J Am Heart Assoc"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1161\/atvbaha.123.319290","article-title":"Life's essential 8, genetic susceptibility, and incident cardiovascular disease: A prospective study","volume":"43","author":"Li","year":"2023","journal-title":"Arterioscler Thromb Vasc Biol"},{"key":"B38","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1186\/s12916-023-02824-8","article-title":"Association of the American Heart Association's new \"Life's Essential 8\" with all-cause and cardiovascular disease-specific mortality: prospective cohort study","volume":"21","author":"Sun","year":"2023","journal-title":"BMC Med"},{"key":"B39","doi-asserted-by":"publisher","first-page":"12","DOI":"10.5334\/gh.1102","article-title":"Hyperuricemia is related to the risk of cardiovascular diseases in ethnic Chinese elderly women","volume":"17","author":"Liu","year":"2022","journal-title":"Global Heart"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2022.853917","article-title":"Effect modification of hyperuricemia, cardiovascular risk, and age on chronic kidney disease in China: A cross-sectional study based on the China Health and Nutrition Survey Cohort","volume":"9","author":"Li","year":"2022","journal-title":"Front Cardiovasc Med"},{"key":"B41","doi-asserted-by":"publisher","first-page":"e038723","DOI":"10.1161\/jaha.124.038723","article-title":"Exploration of the interrelationship between serum uric acid, gout, and cardiac, renal, and metabolic conditions in middle aged and older people","volume":"14","author":"Han","year":"2025","journal-title":"J Am Heart Assoc"},{"key":"B42","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1186\/s12933-023-01937-x","article-title":"The cardio-renal-metabolic connection: a review of the evidence","volume":"22","author":"Marassi","year":"2023","journal-title":"Cardiovasc Diabetol"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.1161\/hypertensionaha.120.13896","article-title":"Metabolites and hypertension: Insights into hypertension as a metabolic disorder: 2019 Harriet Dustan Award","volume":"75","author":"Chakraborty","year":"2020","journal-title":"Hypertension"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1818782\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T04:37:36Z","timestamp":1776832656000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1818782\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,22]]},"references-count":43,"alternative-id":["10.3389\/fendo.2026.1818782"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2026.1818782","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,22]]},"article-number":"1818782"}}