Waist‐to‐height ratio and renal dysfunction as independent correlates of low handgrip strength in patients with type 2 diabetes

INTRODUCTION: Handgrip strength (HGS) is a key indicator of functional decline. We investigated whether central adiposity (waist-to-height 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. MATERIALS AND METHODS: This retrospective cross-sectional 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). RESULTS: was protective (aOR = 0.44). Significant effect modification existed between BMI and WHtR (P for interaction = 0.026): central obesity neutralized the protective effect of higher BMI (aOR shifted from 0.13 to 0.81). Furthermore, while WHtR >0.5 and CKD showed no multiplicative interaction, their co-occurrence exerted a clear additive clinical burden, yielding the highest risk for low HGS (aOR = 1.74, P = 0.025) compared to patients without either condition. CONCLUSIONS: Central obesity and renal dysfunction (impaired eGFR and albuminuria) are distinct, additive correlates of low HGS. WHtR effectively unmasks functional vulnerability, especially in normal-weight individuals. Integrating WHtR and comprehensive renal parameters provides a robust, low-cost screening strategy for sarcopenia risk in diabetes care.