Association between life’s crucial 9 (LC9) score and diabetic nephropathy: based on the NHANES data (2005?2018)_Chinese Journal of Evidence-Based Medicine

Authors：

ZHANG Ruirui ¹ , WEI Tiantian ² , ZHENG Yang ³ ,  WANG Zheng ⁴

1. Department of Employee Healthcare, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Department of Nephrology, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
3. The Second Internal Medicine Department, Nanchong Hospital of Traditional Chinese Medicine, Nanchong 637000, P. R. China;
4. Party Committee Office, West China Clinical Medical College, Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

WANG Zheng, Email: 1289422294@qq.com

Keywords：

Diabetic kidney disease; Life’s crucial 9 score; Risk stratification

DOI：

10.7507/1672-2531.202510081

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To clarify the association between the life’s crucial 9 (LC9) score and the risk of diabetic kidney disease (DKD) in patients with diabetes. Methods A cross-sectional analysis was conducted based on data from the National Health and Nutrition Examination Survey (NHANES) spanning 2005 to 2018. A total of 3 862 diabetic patients aged 20?85 years were initially enrolled. Logistic regression analysis was used to explore the association between LC9 score and DKD. Results The prevalence of DKD was 38.7%. A higher quartile of the LC9 score was associated with a lower prevalence of DKD. Multivariate analysis confirmed a negative correlation between the LC9 score and the risk of DKD: for every 10-point increase in the LC9 score, the risk of developing DKD decreased (OR=0.68, 95%CI 0.62 to 0.73); compared with the Q1 group, the risk of DKD in the Q4 group was reduced (OR=0.29, 95%CI 0.22 to 0.38). Conclusion Higher LC9 scores are associated with lower DKD risk in diabetic patients. The LC9 can be used as a tool for DKD risk stratification, and targeted interventions may help reduce the disease burden.

Citation： ZHANG Ruirui, WEI Tiantian, ZHENG Yang, WANG Zheng. Association between life’s crucial 9 (LC9) score and diabetic nephropathy: based on the NHANES data (2005?2018). Chinese Journal of Evidence-Based Medicine, 2026, 26(3): 285-291. doi: 10.7507/1672-2531.202510081 Copy

1.	American Diabetes Association Professional Practice Committee. 11. Chronic kidney disease and risk management: standards of care in diabetes-2024. Diabetes Care, 2024, 47(Suppl 1): S219-S230.
2.	Thurlow JS, Joshi M, Yan G, et al. Global epidemiology of end-stage kidney disease and disparities in kidney replacement therapy. Am J Nephrol, 2021, 52(2): 98-107.
3.	Minutolo R, Gabbai FB, Provenzano M, et al. Cardiorenal prognosis by residual proteinuria level in diabetic chronic kidney disease: pooled analysis of four cohort studies. Nephrol Dial Transplant, 2018, 33(11): 1942-1949.
4.	Cao H, Liu T, Wang L, et al. Comparative efficacy of novel antidiabetic drugs on cardiovascular and renal outcomes in patients with diabetic kidney disease: a systematic review and network meta-analysis. Diabetes Obes Metab, 2022, 24(8): 1448-1457.
5.	Dias JP, Shardell M, Golden SH, et al. Racial/ethnic trends in prevalence of diabetic kidney disease in the United States. Kidney Int Rep, 2018, 4(2): 334-337.
6.	He Q, Wu W, Chen J, et al. Global burden of type 2 diabetes in non-elderly individuals 1990 to 2021 and projections for 2050: a systematic analysis of the 2021 Global Burden of Disease. Diabetes Metab, 2025, 51(4): 101660.
7.	Basutkar RS, Cutinha RM, Sathish V, et al. Impact of SGLT2 inhibitors on renal function in type 2 diabetic patients with coronary artery disease undergoing percutaneous intervention: a systematic review and meta-analysis. Curr Diabetes Rev, 2025, 21(9): e030724231535.
8.	Chaudhuri A, Ghanim H, Arora P. Improving the residual risk of renal and cardiovascular outcomes in diabetic kidney disease: a review of pathophysiology, mechanisms, and evidence from recent trials. Diabetes Obes Metab, 2022, 24(3): 365-376.
9.	Madero M, Levin A, Ahmed SB, et al. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2024 clinical practice guideline. Ann Intern Med, 2025, 178(5): 705-713.
10.	Moriyama M, Huq KATME, Mondol L, et al. Telenursing health education and lifestyle modification among patients with diabetes in Bangladesh: protocol for a pilot study with a quasi-experimental pre- and postintervention design. JMIR Res Protoc, 2025, 14: e71849.
11.	Zhang Y, Yang B, Tan M, et al. Hirsutine attenuated oxidative stress and autophagy in diabetic kidney disease through Keap1/Nrf2 pathway. J Pharmacol Sci, 2025, 158(2): 143-153.
12.	Bonnet F, Cooper ME, Kopp L, et al. A review of the latest real-world evidence studies in diabetic kidney disease: what have we learned about clinical practice and the clinical effectiveness of interventions. Diabetes Obes Metab, 2024, 26(Suppl 6): 55-65.
13.	Podadera-Herreros A, Arenas-de Larriva AP, Gutierrez-Mariscal FM, et al. Correction: mediterranean diet as a strategy for preserving kidney function in patients with coronary heart disease with type 2 diabetes and obesity: a secondary analysis of CORDIOPREV randomized controlled trial. Nutr Diabetes, 2024, 14(1): 44.
14.	Zhu X, Cheang I, Fu Y, et al. Comparative discrimination of life's simple 7, life's essential 8, and life's crucial 9: evaluating the impact of added complexity on mortality prediction. BMC Med, 2025, 23(1): 265.
15.	Zhang J, Chen Y, Zou L, et al. Prognostic nutritional index as a risk factor for diabetic kidney disease and mortality in patients with type 2 diabetes mellitus. Acta Diabetol, 2023, 60(2): 235-245.
16.	Ge J, Peng W, Lu J. Predictive value of life's crucial 9 for cardiovascular and all-cause mortality: a prospective cohort study from the NHANES 2007 to 2018. J Am Heart Assoc, 2024, 13(20): e036669.
17.	Liu C, Yang J, Li H, et al. Association between life's essential 8 and diabetic kidney disease: a population-based study. Ren Fail, 2025, 47(1): 2454286.
18.	Jia W, Yu R, Wang L, et al. Prevalence of chronic kidney disease among Chinese adults with diabetes: a nationwide population-based cross-sectional study. Lancet Reg Health West Pac, 2025, 55: 101463.
19.	Joshi S, McMacken M, Kalantar-Zadeh K. Plant-based diets for kidney disease: a guide for clinicians. Am J Kidney Dis, 2021, 77(2): 287-296.
20.	Martínez-Montoro JI, Cornejo-Pareja I, Díaz-López A, et al. Effect of an intensive lifestyle intervention on cystatin C-based kidney function in adults with overweight and obesity: from the PREDIMED-Plus trial. J Intern Med, 2025, 297(2): 141-155.
21.	Gündo?du Y, Anaforo?lu ?. Effects of smoking on diabetic nephropathy. Front Clin Diabetes Healthc, 2022, 3: 826383.
22.	Saguban R, Shanmugam SR, Rondilla E, et al. Self-efficacy, social support, and depression: mediators of medication adherence in dialysis patients. Healthcare (Basel), 2025, 13(4): 425.
23.	Bonnekoh LM, Seidenbecher S, Knigge K, et al. Long-term cortisol stress response in depression and comorbid anxiety is linked with reduced N-acetylaspartate in the anterior cingulate cortex. World J Biol Psychiatry, 2023, 24(1): 34-45.
24.	Osimo EF, Baxter LJ, Lewis G, et al. Prevalence of low-grade inflammation in depression: a systematic review and meta-analysis of CRP levels. Psychol Med, 2019, 49(12): 1958-1970.
25.	Bernier V, Alsaleh G, Point C, et al. Low-grade inflammation associated with major depression subtypes: a cross-sectional study. Brain Sci, 2024, 14(9): 850.
26.	Zhang Z, He P, Liu M, et al. Association of depressive symptoms with rapid kidney function decline in adults with normal kidney function. Clin J Am Soc Nephrol, 2021, 16(6): 889-897.
27.	Gong S, Deng F. Renin-angiotensin system: the underlying mechanisms and promising therapeutical target for depression and anxiety. Front Immunol, 2023, 13: 1053136.
28.	Janaszak-Jasiecka A, P?oska A, Wierońska JM, et al. Endothelial dysfunction due to eNOS uncoupling: molecular mechanisms as potential therapeutic targets. Cell Mol Biol Lett, 2023, 28(1): 21.
29.	Xu L, Yu C, Chen A, et al. Longitudinal analysis of renal function changes in elderly populations: health status evaluation and risk factor assessment. Clin Interv Aging, 2024, 19: 1217-1224.
30.	Gao Z, Zhu Y, Sun X, et al. Establishment and validation of the cut-off values of estimated glomerular filtration rate and urinary albumin-to-creatinine ratio for diabetic kidney disease: a multi-center, prospective cohort study. Front Endocrinol (Lausanne), 2022, 13: 1064665.
31.	中華醫學會內分泌學分會, 中國內分泌代謝病專科聯盟. 中國糖尿病合并慢性腎臟病臨床管理共識. 中華內分泌代謝雜志, 2024, 40(6): 455-461.
32.	Chen Z, Qiu X, Gao Q. Life's crucial 9 and its influence on frailty and survival in patients with cancer: insights from NHANES. J Geriatr Oncol, 2025, 16(6): 102276.
33.	Norris KC. Chronic kidney disease and type 2 diabetes. Arlington (VA): American Diabetes Association, 2021.

1. American Diabetes Association Professional Practice Committee. 11. Chronic kidney disease and risk management: standards of care in diabetes-2024. Diabetes Care, 2024, 47(Suppl 1): S219-S230.
2. Thurlow JS, Joshi M, Yan G, et al. Global epidemiology of end-stage kidney disease and disparities in kidney replacement therapy. Am J Nephrol, 2021, 52(2): 98-107.
3. Minutolo R, Gabbai FB, Provenzano M, et al. Cardiorenal prognosis by residual proteinuria level in diabetic chronic kidney disease: pooled analysis of four cohort studies. Nephrol Dial Transplant, 2018, 33(11): 1942-1949.
4. Cao H, Liu T, Wang L, et al. Comparative efficacy of novel antidiabetic drugs on cardiovascular and renal outcomes in patients with diabetic kidney disease: a systematic review and network meta-analysis. Diabetes Obes Metab, 2022, 24(8): 1448-1457.
5. Dias JP, Shardell M, Golden SH, et al. Racial/ethnic trends in prevalence of diabetic kidney disease in the United States. Kidney Int Rep, 2018, 4(2): 334-337.
6. He Q, Wu W, Chen J, et al. Global burden of type 2 diabetes in non-elderly individuals 1990 to 2021 and projections for 2050: a systematic analysis of the 2021 Global Burden of Disease. Diabetes Metab, 2025, 51(4): 101660.
7. Basutkar RS, Cutinha RM, Sathish V, et al. Impact of SGLT2 inhibitors on renal function in type 2 diabetic patients with coronary artery disease undergoing percutaneous intervention: a systematic review and meta-analysis. Curr Diabetes Rev, 2025, 21(9): e030724231535.
8. Chaudhuri A, Ghanim H, Arora P. Improving the residual risk of renal and cardiovascular outcomes in diabetic kidney disease: a review of pathophysiology, mechanisms, and evidence from recent trials. Diabetes Obes Metab, 2022, 24(3): 365-376.
9. Madero M, Levin A, Ahmed SB, et al. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2024 clinical practice guideline. Ann Intern Med, 2025, 178(5): 705-713.
10. Moriyama M, Huq KATME, Mondol L, et al. Telenursing health education and lifestyle modification among patients with diabetes in Bangladesh: protocol for a pilot study with a quasi-experimental pre- and postintervention design. JMIR Res Protoc, 2025, 14: e71849.
11. Zhang Y, Yang B, Tan M, et al. Hirsutine attenuated oxidative stress and autophagy in diabetic kidney disease through Keap1/Nrf2 pathway. J Pharmacol Sci, 2025, 158(2): 143-153.
12. Bonnet F, Cooper ME, Kopp L, et al. A review of the latest real-world evidence studies in diabetic kidney disease: what have we learned about clinical practice and the clinical effectiveness of interventions. Diabetes Obes Metab, 2024, 26(Suppl 6): 55-65.
13. Podadera-Herreros A, Arenas-de Larriva AP, Gutierrez-Mariscal FM, et al. Correction: mediterranean diet as a strategy for preserving kidney function in patients with coronary heart disease with type 2 diabetes and obesity: a secondary analysis of CORDIOPREV randomized controlled trial. Nutr Diabetes, 2024, 14(1): 44.
14. Zhu X, Cheang I, Fu Y, et al. Comparative discrimination of life's simple 7, life's essential 8, and life's crucial 9: evaluating the impact of added complexity on mortality prediction. BMC Med, 2025, 23(1): 265.
15. Zhang J, Chen Y, Zou L, et al. Prognostic nutritional index as a risk factor for diabetic kidney disease and mortality in patients with type 2 diabetes mellitus. Acta Diabetol, 2023, 60(2): 235-245.
16. Ge J, Peng W, Lu J. Predictive value of life's crucial 9 for cardiovascular and all-cause mortality: a prospective cohort study from the NHANES 2007 to 2018. J Am Heart Assoc, 2024, 13(20): e036669.
17. Liu C, Yang J, Li H, et al. Association between life's essential 8 and diabetic kidney disease: a population-based study. Ren Fail, 2025, 47(1): 2454286.
18. Jia W, Yu R, Wang L, et al. Prevalence of chronic kidney disease among Chinese adults with diabetes: a nationwide population-based cross-sectional study. Lancet Reg Health West Pac, 2025, 55: 101463.
19. Joshi S, McMacken M, Kalantar-Zadeh K. Plant-based diets for kidney disease: a guide for clinicians. Am J Kidney Dis, 2021, 77(2): 287-296.
20. Martínez-Montoro JI, Cornejo-Pareja I, Díaz-López A, et al. Effect of an intensive lifestyle intervention on cystatin C-based kidney function in adults with overweight and obesity: from the PREDIMED-Plus trial. J Intern Med, 2025, 297(2): 141-155.
21. Gündo?du Y, Anaforo?lu ?. Effects of smoking on diabetic nephropathy. Front Clin Diabetes Healthc, 2022, 3: 826383.
22. Saguban R, Shanmugam SR, Rondilla E, et al. Self-efficacy, social support, and depression: mediators of medication adherence in dialysis patients. Healthcare (Basel), 2025, 13(4): 425.
23. Bonnekoh LM, Seidenbecher S, Knigge K, et al. Long-term cortisol stress response in depression and comorbid anxiety is linked with reduced N-acetylaspartate in the anterior cingulate cortex. World J Biol Psychiatry, 2023, 24(1): 34-45.
24. Osimo EF, Baxter LJ, Lewis G, et al. Prevalence of low-grade inflammation in depression: a systematic review and meta-analysis of CRP levels. Psychol Med, 2019, 49(12): 1958-1970.
25. Bernier V, Alsaleh G, Point C, et al. Low-grade inflammation associated with major depression subtypes: a cross-sectional study. Brain Sci, 2024, 14(9): 850.
26. Zhang Z, He P, Liu M, et al. Association of depressive symptoms with rapid kidney function decline in adults with normal kidney function. Clin J Am Soc Nephrol, 2021, 16(6): 889-897.
27. Gong S, Deng F. Renin-angiotensin system: the underlying mechanisms and promising therapeutical target for depression and anxiety. Front Immunol, 2023, 13: 1053136.
28. Janaszak-Jasiecka A, P?oska A, Wierońska JM, et al. Endothelial dysfunction due to eNOS uncoupling: molecular mechanisms as potential therapeutic targets. Cell Mol Biol Lett, 2023, 28(1): 21.
29. Xu L, Yu C, Chen A, et al. Longitudinal analysis of renal function changes in elderly populations: health status evaluation and risk factor assessment. Clin Interv Aging, 2024, 19: 1217-1224.
30. Gao Z, Zhu Y, Sun X, et al. Establishment and validation of the cut-off values of estimated glomerular filtration rate and urinary albumin-to-creatinine ratio for diabetic kidney disease: a multi-center, prospective cohort study. Front Endocrinol (Lausanne), 2022, 13: 1064665.
31. 中華醫學會內分泌學分會, 中國內分泌代謝病專科聯盟. 中國糖尿病合并慢性腎臟病臨床管理共識. 中華內分泌代謝雜志, 2024, 40(6): 455-461.
32. Chen Z, Qiu X, Gao Q. Life's crucial 9 and its influence on frailty and survival in patients with cancer: insights from NHANES. J Geriatr Oncol, 2025, 16(6): 102276.
33. Norris KC. Chronic kidney disease and type 2 diabetes. Arlington (VA): American Diabetes Association, 2021.

Chinese Journal of Evidence-Based Medicine

Association between life’s crucial 9 (LC9) score and diabetic nephropathy: based on the NHANES data (2005?2018)

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content