METHODS: A total of 13 047 eligible participants were selected from 119 560 The Malaysian Cohort participants. Of these, 750 who developed diabetes were selected as cases, while 3750 controls were chosen randomly from healthy participants. This nested case-control study included 4500 eligible participants from The Malaysian Cohort, with a 1:5 case-to-control ratio. Participants were stratified into four groups based on Cre/BW ratio quartiles. The Cox proportional hazards model evaluated the effect of Cre/BW ratio on developing incident diabetes. The association between Cre/BW ratio and body composition was assessed using the Pearson correlation coefficient.