Novel body roundness index related to cardiovascular disease, diabetes and mortality: A systematic review and combined analysis.

Background: Obesity is one of the major risk factors for cardiovascular disease (CVD), body roundness index (BRI) is more comprehensive in assessing fat distribution than traditional measurements. However, evidence regarding the association between BRI and the risk of CVD was limited, particularly in American people. This current study aimed to investigate the association between BRI and the risk of CVD among US adults. Hypothesis: We hypothesized that higher BRI was associated with a higher risk of CVD. Methods: A total of 21,852 participants were included in the National Health and Nutrition Examination Surveys from 6 survey cycles (2003-2004, 2005-2006, 2007-2008, 2009-2010, 2011-2012, 2013-2014, 2015-2016 and 2017-2018). Weighted multivariate logistic regression was carried out to examine the relationship between BRI and the risk of CVD. Restricted cubic spline (RCS) curves were employed to analyze nonlinear relationships. Results: Among 21,852 US adults, the mean (SD) age was 47.5 (17.3) years, 10,669 (48.8%) were female, and 1886 were diagnosed with CVD. In the weighted multi-variable logistic regression model with adjustment for demographics, lifestyle, economic status and dietary factors, higher BRI was significantly associated with a substantially higher risk of CVD. Compared with the participants in the lowest quartile of BRI, those in the highest quartile of BRI had a higher CVD, with OR and 95%CI of 2.47 (1.92-3.17). Furthermore, the RCS demonstrated a linear dose-response relationship between BRI and CVD (Pnon-linearity=0.29). Conclusion: This national cohort study found a higher BRI was associated with a higher risk of CVD among US adults. BRI may provide a new perspective for CVD prevention among adults.

Background:The body roundness index (BRI) offers a more precise evaluation of body fat and visceral fat levels. However, studies on the relationship between BRI and the risk of cardiovascular disease (CVD) remain limited.Methods:Survival differences across BRI quartiles were estimated using Kaplan-Meier analysis. The association between the BRI and the risk of CVD was examined through Cox proportional hazards and restricted cubic spline (RCS) models. Additional subgroup and sensitivity analyses were also conducted.Results:This study included 6401 patients (47.43% male), with an incidence of CVD of 17.51%. Kaplan-Meier survival analysis revealed statistically significant differences between groups based on the assigned BRI quartiles. Cox models revealed a strong association between the BRI and CVD risk, while RCS models showed a non-linear link between higher BRIs and increased CVD risk. In certain subgroups, an elevated BRI was closely correlated with an increased incidence of CVD. Notable interactions were found between BRI and gender, age, hypertension, diabetes, alcohol consumption, and smoking status. Sensitivity analysis excluding early CVD cases yielded consistent results.Conclusion:A significant non-linear association was found between the BRI and CVD risk. The BRI could be a valuable and sensitive marker for identifying individuals at high risk of CVD, with varying predictive value across different population subgroups.

Cardiometabolic syndrome (CMS), marked by abdominal obesity and metabolic dysregulation, is associated with a heightened risk of cardiovascular disease (CVD). Compared to the traditional anthropometric predictors represented by body mass index (BMI) and waist circumference (WC), body roundness index (BRI) appears to provide a more accurate reflection of the abdominal fat distribution associated with metabolic diseases. Therefore, this study intends to investigate the association of BRI with the risk of CVD and its components including congestive heart failure (CHF), coronary heart disease (CHD), angina, heart attack, and stroke in patients with CMS. At the same time, we hypothesized that BRI would identify CVD better than BMI or WC. Data from the 2009-2018 National Health and Nutrition Examination Survey (NHANES). Logistic regression models were mainly utilized to evaluate the relationship between BRI and CVD in patients with CMS, including smooth curve analysis, threshold effects analysis, subgroup analysis and multiple imputation. In addition, receiver operating characteristic (ROC) curves were used to assess the ability of BRI to predict CVD. The logistic regression model showed a positive association between the BRI and CVD. The highest quartile of BRI (Q4) showing the strongest association with CVD. The smoothed curve revealed a linear relationship between BRI and CVD, but a U-shaped association between the BRI and CHF. For CVD, stratified analyses did not show significant difference between strata. For CHF, BMI interacted with the association, with BRI being associated with decreased risk of CHF in a subgroup of normal weight subjects and increased risk of CHF in a subgroup of obese subjects. The multiple imputation further confirmed the robustness of these results. Additionally, the ROC curve indicated that BRI, BMI and WC had predictive power for CVD and CHF (AUC > 0.05). BRI has similar predictive power to WC but better than BMI. An elevated BRI is associated with a heightened risk of CVD in patients with CMS. BRI has similar ability to predict CVD and CHF as WC, but superior to BMI.

BackgroundAmong noncommunicable diseases, cardiovascular disease (CVD) is the leading cause of mortality and morbidity. In China, diabetes is renowned for its high incidence rate, and the body roundness index (BRI) is an emerging indicator for assessing obesity, particularly abdominal obesity. High BRI may lead to new-onset CVD events. However, the relationships between the BRI and new-onset CVD in individuals with or without diabetes remain unclear. MethodsData for this analysis were extracted from the China Health and Retirement Longitudinal Study (CHARLS). Our research utilized a cohort that was meticulously assessed over a period from 2011 to 2018, encompassing a comprehensive follow-up of 17,708 participants. Ultimately, this study focused on a subset of 6,737 individuals aged 45 years or older. Methodological approaches include Cox regression, Kaplan-Meier survival analysis, restricted cubic splines (RCS) analysis, receiver operating characteristic (ROC) curve analysis, subgroup analysis, and mediation analysis to explore the relationships of interest.ResultsThis study included 6,737 participants, all of whom were above the age of 45. Our findings revealed that within this demographic group, 1,481 (22.0%) patients experienced new-onset CVD. The Kaplan-Meier survival analysis further revealed that the group characterized by non-diabetes mellitus (Non-DM) had the lowest cumulative incidence of CVD compared with the diabetes mellitus (DM) group. Multivariate Cox regression revealed that in the fully adjusted model (Model 3) (HR = 1.122, 95% CI = 1.080 to 1.167), BRI was associated with the risk of CVD in the Non-DM group during the three-wave follow-up. RCS analysis revealed a positive, linear-like dose‒dependent relationship between BRI and new-onset CVD in Non-DM patients (P = 0.007, P for nonlinearity = 0.938). Smoking could affect the ability of the BRI to predict the incidence rate of CVD in the total population and in the population without diabetes (P interaction = 0.007). Moreover, the mediating effect of the BRI on new-onset CVD among diabetic patients was particularly pronounced in the long term, exceeding 4 years.ConclusionsOur findings demonstrate a significant association between the BRI and CVD risk in non-diabetic individuals, with diabetes influencing the incidence and risk of new-onset CVD in middle-aged and elderly Chinese populations through the BRI playing a mediating role. As an obesity indicator, the BRI provides a valuable tool for early detection and intervention of CVD.Clinical trial numberNot applicable.

Associations of Body-Roundness Index and Sarcopenia with Cardiovascular Disease among Middle-Aged and Older Adults: Findings from CHARLS.

Background: Elevated triglyceride-glucose (TyG) related indices, such as TyG-body mass index, TyG-waist-to-height ratio, TyG-waist circumference was associated with higher risk of cardiovascular disease (CVD). Body roundness index (BRI) is superior to traditional anthropometric indices in predicting metabolic syndrome. However, the association between the TyG-BRI, as a new metabolic indicator, and CVD incidence and whether its predicting effect of CVD incidence is better than other TyG related indices remains unknown. Method: The datasets analyzed in our study were derived from two nationally representative prospective cohort studies: English Longitudinal Study of Ageing (ELSA) and China Health and Retirement Longitudinal Study (CHARLS). TyG was calculated as ln [TG (mg/dL) × FBG (mg/dL)/2]; The TyG-BRI index is determined by TyG index * BRI index. The participants were classified into four groups (Q1, Q2, Q3, and Q4) by the quartiles of TyG-BRI index. We performed Cox proportional hazards models after adjusting for potential confounders to analyze the association between the TyG-BRI index and CVD incidence. Restricted cubic spline models (RCS) were used to explore the non-linear relationship between TyG-BRI and CVD incidence. Receiver operating characteristic (ROC) curve analysis to evaluate and compare the predictive performance of TyG-BRI and TyG-related indices for CVD assessment Results: A total of 3,256 participants from ELSA (female: 54.0%, age more than 60: 63.7%) and 8,323 participants from CHARLS (female: 53.5%, age more than 60: 41.6%) were included in the analysis. The median follow-up periods were 12 years in the ELSA and 7 years in the CHARLS. After adjusting for potential confounding factors, the highest TyG-BRI group (Q4) had an increased risk of CVD compared with the Q1 group. (ELSA, HR 1.81, 95% CI 1.09–2.98; CHARLS, HR 1.57, 95% CI 1.32–1.87). An inverted U-shaped association was identified between TyG-BRI and CVD during the examination of nonlinear relationships (both P <0.05). TyG - BRI has a higher AUC of 0.557 (95% CI: 0.531 - 0.583) in ELSA and AUC of 0.581 (95% CI: 0.565 - 0.596) in CHARLS than other TyG-related indices in predicting CVD incidence. Conclusions: Elevated TyG-BRI levels was associated with higher risk of incident CVD. TyG-BRI offers a new tool for early risk identification, and TyG-BRI had a better predictive ability than other TyG- related indices in predicting CVD incidence.

BackgroundCardiovascular-Kidney-Metabolic (CKM) syndrome, encompassing metabolic dysfunction, chronic kidney disease, and cardiovascular disease (CVD), represents a growing global health challenge. Body Roundness Index (BRI) is an index representing viscera obesity, and its prospective association with CVD across CKM stages and mediation by insulin resistance remain unexamined.ObjectiveThe aim of the study was to explore the association between BRI and CVD among the population of CKM syndrome stage 0–3, and discover the potential mediation of insulin resistance.MethodsThis prospective cohort study included 7,214 participants from the China Health and Retirement Longitudinal Study (CHARLS). BRI was calculated using waist circumference and height. CKM stages (0–3) were classified according to the American Heart Association criteria. CVD was defined as new-onset myocardial infarction, angina, coronary heart disease, heart failure, or other physician-diagnosed cardiac events during follow-up and was reported by participants. Cox models adjusted for demographics and metabolic factors assessed BRI-CVD associations. Restricted cubic splines tested nonlinearity, and mediation analysis quantified the contribution of TyG index.ResultsAmong participants (mean age 59.8 ± 9.4 years, 52.9% female), each 1-unit BRI increase elevated CVD risk by 12.2% (HR = 1.122, 95% CI:1.080–1.166). The highest BRI quartile (vs. lowest) showed 58% higher CVD risk (HR = 1.585, 95% CI:1.351–1.859). A linear dose-response relationship was observed (P nonlinear > 0.05). Stronger relationship between BRI and CVD was observed in CKM stage 1–2. TyG index mediated 22.7% of the BRI-CVD association (P = 0.008).ConclusionsBRI positively linear associated with CVD, especially in early CKM syndrome population. Insulin resistance mediated the BRI-CVD association. The findings highlight BRI’s potential for early risk stratification and the multifactorial pathophysiology linking adiposity to CVD.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13098-025-02007-w.

Obesity is a major global health issue, driving high morbidity and mortality rates. The body roundness index (BRI), which includes waist circumference, offers a more accurate measure of visceral and total body fat. However, despite evidence of BRI's effectiveness in predicting obesity-related diseases, national-level data, especially from non-Western populations like China, remain limited. This study utilized data from the China Health and Retirement Longitudinal Study (CHARLS), a large, nationally representative cohort of Chinese adults, to examine the temporal trends of BRI, identify associated risk factors, and investigate the longitudinal associations between BRI and cardiovascular disease (CVD) outcomes. BRI was calculated using height and waist circumference measurements. Temporal trends and risk factors were analyzed cross-sectionally, while longitudinal associations were examined using Cox proportional hazards models adjusted for confounders. Mediation analyses were conducted to assess the role of intermediate factors such as hypertension and diabetes in the relationship between BRI and CVD. A total of 12,902 participants were included for risk factor analysis, 10,525 for longitudinal analysis, and 7,310 for cumulative analysis. BRI continued to rise slowly across survey cycles but was higher in women, older adults, and urban residents. Multivariable analysis identified age, alcohol consumption, elevated blood pressure, and diabetes as positive predictors of BRI, while male sex, rural residence, and smoking were negatively associated. Higher baseline BRI was significantly associated with increased CVD risk (HR: 1.44, 95% CI: 1.22-1.69), stroke (HR: 1.49, 95% CI: 1.12-1.98), and heart disease (HR: 1.47, 95% CI: 1.22-1.77). Cumulative BRI similarly predicted increased risks of CVD, stroke, and heart disease. Mediation analysis showed that hypertension accounted for 20.69% of the association between BRI and CVD risk. BRI is a robust predictor of CVD risk. Targeting hypertension and other metabolic conditions could mitigate the elevated CVD risk associated with high BRI in Chinese adults. These findings underscore the importance of incorporating BRI into public health strategies to better manage obesity-related health risks in China.

To determine the impact of body roundness index (BRI) on the 10-year risk of cardiovascular disease (CVD) and all-cause mortality in Chinese adults. We utilized data from a nationwide prospective cohort of 165 785 Chinese adults (aged ≥40 years, free of CVD and cancer at baseline), which was extracted from the China Cardiometabolic Disease and Cancer Cohort (4C). Cox regression and restricted cubic splines quantified BRI-outcome associations and identified optimal BRI cutoffs. During a median follow-up of 10.1 years, we documented 10 538 CVD events and 8679 deaths. A monotonic increasing dose-response association was observed between BRI and CVD risk, while BRI and all-cause mortality exhibited a U-shaped relationship (p for non-linear <0.001), with the nadir at a BRI of 3.9. Gender differences indicated that increased CVD risk was associated with higher BRI in men. As age increases, the excess risk of CVD and mortality associated with BRI diminishes, with a significant harmful effect of low BRI observed on mortality in individuals aged ≥75 years. Moreover, the inclusion of BRI in the model significantly enhanced the C-statistic for CVD prediction by 0.00412 (p <0.001) and for mortality prediction by 0.00045 (p = 0.0097). Our findings indicate a positive association between BRI and CVD and a U-shaped association between BRI and mortality. These findings underscore the importance of the BRI in assessing the risk of CVD and all-cause mortality, particularly when considering different genders and age groups.

The body roundness index (BRI) and circadian syndrome (CircS) are considered new risk factors for cardiovascular disease (CVD), yet it remains uncertain whether elevated BRI is associated with CVD incidence in CircS patients. In this study, we investigated the association between BRI and CVD occurrence among CircS participants. We conducted a retrospective cohort study involving 8,888 participants aged ≥45 years from the China Health and Retirement Longitudinal Study (CHARLS 2011-2020 wave). CircS was evaluated with a combination of the International Diabetes Federation (IDF) MetS, along with short sleep duration and depression. The threshold for CircS was established at ≥4. In the first phase, the receiver operating characteristic (ROC) curves were used to evaluate the accuracy of diagnosing CircS according to baseline BRI. During the 9-year follow-up, the associations between BRI and CVD incidence in CircS patients were explored by employing logistic regression, restricted cubic spline (RCS) analysis, and subgroup analysis. BRI demonstrated an independent association with CircS, and multivariable-adjusted restricted cubic spline analyses suggested "J-shaped" associations between BRI and risk of CircS. BRI demonstrated better diagnostic performance in diagnosing CircS compared to general obesity indices such as ABSI (AUC: 0.617), BMI (AUC: 0.746), and WC (AUC: 0.722), with an AUC of 0.760. After a 9-year follow-up, BRI was found to be independently associated with the occurrence of CVD in CircS patients, and the associations between incident CVD and the second, third, and fourth BRI quartiles were 1.30 (95% CI: 0.99~1.69), 1.32 (95% CI: 1.01~1.72), and 1.59 (95% CI: 1.21~2.08), respectively, relative to the first BRI quartile. Then, we assessed the relationship between other obesity indices and the CVD occurrence, and likewise observed a significant effect in the fourth quartile. BRI was independently associated with CircS, outperforming obesity indices such as BMI and WC in identifying individuals with CircS. During the 9-year follow-up, elevated BRI levels was significantly associated with CVD incidence among CircS patients, especially in men. Thus, early identification of high-risk populations with CircS and elevated BRI levels may help promote healthy aging among middle-aged and elderly individuals.

Associations of longitudinal trajectories in body roundness index with mortality and cardiovascular outcomes: a cohort study

The body roundness index (BRI) has good predictive ability for both body fat and visceral adipose tissue. Longitudinal BRI trajectories can reveal the potential dynamic patterns of change over time. This prospective study assessed potential associations between BRI trajectories and incident cardiovascular disease (CVD) in rural regions of Northeast China. In total, 13,209 participants (mean age: 49.0 ± 10.3 years, 6,856 [51.9%] male) were enrolled with three repeated times of BRI measurements at baseline (2004-2006), 2008, and 2010, and followed up until 2017 in this prospective study. Using latent mixture model, the BRI trajectories were determined based on the data from baseline, 2008 and 2010. Composite CVD events (myocardial infarction, stroke, and CVD death combined) was the primary endpoint. Cox proportional-hazards models were used to analyze the longitudinal associations between BRI trajectories and incident CVD. Three distinct BRI trajectories were identified: high-stable (n = 538), moderate-stable (n = 1,542), and low-stable (n = 11,129). In total, 1,382 CVD events were recorded during follow-up. After adjustment for confounders, the moderate-stable and high-stable BRI groups had a higher CVD risk than did the low-stable BRI group, and the HR (95%CI) were 1.346 (1.154, 1.571) and 1.751 (1.398, 2.194), respectively. Similar associations were observed between the trajectories of BRI and the risk of stroke and CVD death. The high-stable group was also significantly and independently associated with CVD, myocardial infarction, stroke, and CVD death in participants aged <50 years. BRI trajectory was positively associated with incident CVD, providing a novel possibility for the primary prevention of CVD in rural regions of China.

This study aimed to characterize the longitudinal trajectory of the body roundness index (BRI) in a multinational cohort and to investigate its association with cardiovascular disease (CVD) events. We pooled individual-level data from three prospective cohort studies across the United States, the United Kingdom, and China, covering 2004 to 2019. The trajectory of BRI was determined using latent class growth mixed models, and the relationship between BRI trajectory and CVD risk was evaluated using Cox models. Three longitudinal BRI trajectories were characterized: inverse-U (7.2%), low-increasing (44.4%), and middle-increasing (48.4%). The risk of CVD in the middle-increasing group and the inverse-U group was 1.25 times (95% CI: 1.12-1.35) and 1.86 times (1.53-2.36) higher than that in the low-increasing group, respectively. The historical maximum BRI, area under the curve, and time-weighted BRI all showed a nonlinear risk of CVD in the dose-response relationship (p < 0.05). The effect of BRI growth rate on CVD decreased with age. The BRI trajectories were significantly associated with CVD risk, independent of baseline BRI and BMI. This emphasizes the long-term and persistent effects of visceral fat accumulation and may provide a reference for personalized CVD risk assessment and early impact.

Anthropometric indices in predicting 10-year cardiovascular risk among males and females aged 40–74 years in south and southeast Asia: analysis of 12 WHO STEPS survey data

Background Obesity, especially visceral obesity, plays an important role in the progression of cardiovascular disease (CVD). The body roundness index (BRI) is a new measure of obesity that is considered to reflect visceral obesity more comprehensively than other measures. This study aims to evaluate the relationship between BRI and CVD risk in hypertensive patients with obstructive sleep apnea (OSA) and explore its superiority in predicting CVD. Methods The Cox proportional hazards model was used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for incident CVD. The area under the curve (AUC), continuous net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were used to assess which measures of obesity had the best predictive value for CVD risk. Results During a median follow-up period of 6.8 years, 324 participants suffered a CVD event. After multivariable adjustment, compared with the reference group (the first tertile), the HRs (95% CI) of CVD were 1.25 (95% CI, 0.93–1.70) and 1.74 (95% CI, 1.30–2.33) for subjects in the tertile 2 and tertile 3 groups, respectively. Compared with other measurement indicators, BRI has the highest predictive value for CVD risk [AUC: 0.627, 95% CI: 0.593–0.661]. The addition of the BRI to the fully adjusted multivariate model improved the predictive power for CVD, which was validated in the continuous NRI and the IDI (all P < .05). Conclusions BRI was significantly associated with the risk of CVD in hypertensive patients with OSA. Furthermore, BRI may improve CVD risk prediction in hypertensive patients with OSA.