The Association of Body Weight, Composition, and Anthropometric Indices of Obesity with the Presence of Diabetic Neuropathy in People with Type 2 Diabetes: A Systematic Review and Meta‐Analysis of Observational Studies

Background and Aims Obesity has been identified as an independent risk factor for the development of diabetic neuropathy in type 2 diabetes (T2D). However, the relationship of individual parameters relating obesity with diabetic neuropathy is poorly understood. We evaluated these relationships in this systematic review and meta‐analysis. Methods PubMed, Scopus, Web of Science, and Embase were searched from 1980 to July 5, 2025, for observational studies comparing anthropometric measures, including body weight, visceral fat (%), body mass index (BMI), waist circumference (WC), and waist‐to‐hip ratio (WHR), between individuals with and without diabetic neuropathy. Mean differences (MDs), odds ratios (ORs), and hazard ratios (HRs) were pooled using random‐effects models. Subgroup and meta‐regression analyses explored sources of heterogeneity by neuropathy type, geographic region, study design, diabetes duration, and HbA1c. Results Higher BMI was significantly associated with diabetic neuropathy (OR = 1.09; 95% CI: 1.02 to 1.16; MD = 0.55; 95% CI: 0.22 to 0.89). Central obesity was associated with neuropathy risk (WC MD = 2.05 cm; 95% CI: 1.15 to 2.94; HR = 1.25; 95% CI: 1.04 to 1.51; WHR MD = 0.01; 95% CI: 0.00 to 0.01). Associations were more evident for peripheral neuropathy than for autonomic neuropathy. Diabetes duration and HbA1c may contribute to the heterogeneity between studies. Conclusion BMI and WC were consistently, albeit modestly, associated with diabetic neuropathy in individuals with T2D, whereas the difference in WHR was small and inconsistent across neuropathy subtypes. No significant differences were observed in either body weight or visceral fat between individuals with and without diabetic neuropathy.