探讨体重指数（BMI）、体重调整腰围指数（WWI）、身体圆度指数（BRI）和相对脂肪质量指数（RFM）与糖尿病足溃疡（DFU）及全因死亡风险之间的关系，为糖尿病患者风险分层提供依据。

基于美国国家健康与营养调查（NHANES）1999～2004年数据，纳入年龄≥35岁的糖尿病患者1 487例。采用加权Logistic回归分析BMI、WWI、BRI和RFM与DFU及DFU前期状态的关联，采用ROC曲线和限制性立方样条分析各指标对DFU的判别能力及其非线性关系；通过链接国家死亡指数数据库，随访至2019年12月31日，并采用加权Cox比例风险回归分析各指标与全因死亡的关系。

共纳入1 487例糖尿病患者，其中DFU 100例（6.7%），DFU前期状态733例（49.3%）。完全调整混杂因素后，BMI、WWI、BRI和RFM均与DFU风险升高显著相关，OR值分别为1.07、1.95、1.47和1.13；而上述指标与DFU前期状态均无显著关联。4项指标对DFU均具有中等判别效能，AUC约为0.71～0.72。RCS分析显示，WWI与DFU风险之间存在非线性关系。全因死亡分析显示，WWI、BRI和RFM与死亡风险升高显著相关，BMI相关性相对较弱，其中WWI和BRI在死亡风险分层中的表现更为突出。

多项肥胖相关人体测量指标与糖尿病患者DFU风险升高显著相关，其中WWI和BRI还与全因死亡风险增加相关。简便、无创的人体测量指标有望用于识别DFU高危人群，并为早期预防和风险分层提供参考。

To explore the relationship between body mass index (BMI), weight-adjusted waist circumference index (WWI), body roundness index (BRI), and relative fat mass index (RFM) and the risk of diabetic foot ulcer (DFU) and all-cause mortality, and to provide a basis for risk stratification in diabetic patients.

Based on the data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2004, 1,487 diabetic patients aged ≥35 years were included. Weighted logistic regression was used to analyze the association between BMI, WWI, BRI, and RFM and DFU and the pre-DFU state. ROC curves and restricted cubic splines were used to analyze the discriminatory ability of each index for DFU and its non-linear relationship. By linking to the National Death Index database, the patients were followed up until December 31, 2019, and weighted Cox proportional hazards regression was used to analyze the relationship between each index and all-cause mortality.

A total of 1,487 diabetic patients were included, among whom 100 (6.7%) had DFU and 733 (49.3%) were in the pre-DFU state. After fully adjusting for confounding factors, BMI, WWI, BRI, and RFM were all significantly associated with an increased risk of DFU, with OR values of 1.07, 1.95, 1.47, and 1.13, respectively; however, these indices were not significantly associated with the pre-DFU state. All four indices had moderate discriminatory power for DFU, with AUCs of approximately 0.71 to 0.72. RCS analysis showed a non-linear relationship between WWI and the risk of DFU. The analysis of all-cause mortality revealed that WWI, BRI, and RFM were significantly associated with an increased risk of death, while the association of BMI was relatively weak. Among them, WWI and BRI performed more prominently in the stratification of mortality risk.

Multiple obesity-related anthropometric indices are significantly associated with an increased risk of DFU in diabetic patients, and WWI and BRI are also associated with an increased risk of all-cause mortality. Simple and non-invasive anthropometric indices are promising for identifying high-risk populations for DFU and providing references for early prevention and risk stratification.