Non-linear relationship between the body roundness index and incident type 2 diabetes in Japan: a secondary retrospective analysis

Prognostic effect of body roundness index on all-cause mortality among US older adults

The Body Rounds Index (BRI) is an anthropometric indicator specifically developed to evaluate an individual's obesity level, particularly emphasizing central or abdominal obesity. This study aimed to explore the relationship between BRI and all-cause mortality in older U.S. adults. The research sample comprised individuals aged 65 and older from the National Health and Nutrition Examination Survey (NHANES), eligible for mortality analyses between 1999 and 2018. We utilized Cox regression analyses, restricted cubic spline (RCS), threshold effects analysis, Kaplan-Meier curves, and subgroup analyses were conducted to assess how the BRI correlates with all-cause mortality among older adults in the U.S. To further ensure the robustness of our findings, we conducted sensitivity analyses. Among 5371 U.S. older adults (age ≥ 65), with an average age of 72.45 (standard deviation [SD]:5.65) years, 2884 (60%) were women. During the follow-up period, there were 2781 deaths from all causes among the 5371 participants. After adjusting for all covariates, a U-shaped association was identified between BRI and the all cause mortality. Compared to a BRI of less than 4.457, a BRI between 4.457 and 5.538 was associated with a 19% reduction in the likelihood of mortality from any cause (HR = 0.81, 95% CI = 0.69-0.95). A BRI between 5.538 and 6.888 was linked to a 8% reduction in mortality risk (HR = 0.92, 95% CI = 0.79-1.07), while a BRI exceeding 6.888 showed a 1% increase in this risk (HR = 1.01, 95% CI = 0.87-1.17). RCS analysis indicated a U-shaped relationship between BRI and all-cause mortality. The turning point was located at 4.546, with correlations observed both before and after this point. This NHANES-based study highlights the U-shaped relationship between BRI and all-cause mortality among U.S. older adults, suggesting that the BRI has predictive value for mortality outcomes. The findings offer compelling support for utilizing BRI as a non-invasive mortality risk screening tool.

Association of the body roundness index with new-onset cardiovascular disease in middle-aged and older adults with and without diabetes: evidence from the China Health and Retirement Longitudinal Study

BACKGROUND

Among 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.

METHODS

Data 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.

RESULTS

This 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.

CONCLUSIONS

Our 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 NUMBER

Not applicable.

The relationship between body roundness index (BRI) and suicidal ideation: evidence from NHANES 2013-2018

IMPORTANCE

Emerging research suggests a complex interplay between physical health metrics and mental health outcomes, including suicidal ideation. The body roundness index (BRI), a novel measure of body size, may offer insights into this relationship. This study seeks to investigate the intricate connection between BRI and suicidal ideation in a sample that reflects the entire U.S. population-working to validate the potential of BRI as a predictor of suicidal ideation.

METHODS

Data from the NHANES spanning 2013 to 2018 was used in this cross-sectional study to analyze a sample of 14,058 participants. BRI was calculated based on height and waist circumference measurements. Suicidal ideation was assessed using the Mental Health-Depression Screener Questionnaire ninth question. To investigate potential non-linear relationships between BRI and suicidal ideation, we employed generalized additive models and smooth curve fitting, and used ROC curves to compare the predictive ability of BMI and BRI for suicidal ideation. Subgroup analyses and interaction tests were utilized to study the moderating effects of categorical covariates.

RESULTS

Multiple logistic regression analysis revealed a significant positive correlation between increased BRI and heightened suicidal ideation, with a nonlinear pattern persisting even after adjustment for covariates. This nonlinear relationship was reinforced by a sharp increase in the prevalence of suicidal ideation when the BRI exceeded 6.7. Based on ROC curve analysis, BRI demonstrates a slightly stronger predictive ability for suicide ideation compared to BMI. Subgroup analyses confirmed the relative robustness of this association across populations, including age, education and PRI, etc. However, the interaction between the two was influenced by gender, coronary artery disease and angina pectoris.

CONCLUSION

In conclusion, our cross-sectional study reveals a significant positive correlation between increased BRI and heightened suicidal ideation, with a sharp increase in prevalence when BRI exceeds 6.7. It is recommended that appropriate BRI be maintained to minimize suicidal ideation.

The association between body roundness index and mortality in diabetes

BACKGROUND

The association between body roundness index (BRI) and all-cause mortality and the occurrence of cardiovascular disease (CVD) in patients with diabetes is unknown. This study aimed to determine the association between BRI and all-cause/CVD mortality in a diabetic cohort.

METHODS

A total of 8227 individuals with diabetes from the 1999-2018 National Health and Nutrition Examination Survey (NHANES) database were included. Multifactorial Cox regression models were used to analyze the association between BRI and mortality in patients with diabetes. Multivariate-adjusted restricted cubic spline (RCS) regression was used to test for nonlinearity.

RESULTS

During a median follow-up of 7.25 years, a total of 27.22% died, with 9.18% of these deaths due to CVD. After fully adjusting for potential confounders, BRI remained significantly associated with all-cause/CVD mortality in the diabetic population. The restricted cubic splines revealed no significant nonlinear relationship between BRI and all-cause mortality (P = 0.29) or CVD mortality (P = 0.73). BRI was better associated with all-cause/CVD mortality in patients with diabetes compared to other body metabolic indices.

CONCLUSIONS

In patients with diabetes, we found an association between BRI and all-cause/CVD mortality.

The association between body roundness index and sarcopenia in older adults: a population-based study

Background

Sarcopenia, defined by the gradual decline in skeletal muscle mass and functionality, is a common disorder in the aging population and is linked to an elevated risk of falls and osteoporotic fractures. The contemporary diagnosis of sarcopenia depends on intricate and expensive techniques, such as computed tomography (CT) scans or dual-energy X-ray absorptiometry (DXA), which hinder the timely prevention of sarcopenia.

Objective

This study seeks to explore the association between the Body Roundness Index (BRI) and sarcopenia in the older adult cohort, utilizing data from the National Health and Nutrition Examination Survey (NHANES) in the United States.

Methods

Our study adopted a cross-sectional design, encompassing 9,411 older individuals, of which 1,147 were diagnosed with sarcopenia. After weighting, the number of individuals with sarcopenia was 23,985,011. The study employed multivariate logistic regression analysis to evaluate the association between BRI and sarcopenia, incorporating stepwise adjustments for potential confounders.

Results

The outcomes of the multivariate logistic regression analysis revealed that, in contrast to individuals without sarcopenia, those with sarcopenia exhibited significantly higher mean BRI values and a greater prevalence of comorbid conditions, including hypertension and diabetes. A significant positive correlation was observed between BRI and the likelihood of developing sarcopenia. Specifically, after controlling for all covariates, each one-unit increase in BRI was linked to a 64% elevation in the risk of sarcopenia (OR = 1.64, 95% CI = 1.58-1.71). Furthermore, the receiver operating characteristic (ROC) curve analysis indicated that BRI is a robust predictor for diagnosing sarcopenia, with an AUC of 0.744.

Conclusion

These findings suggest that, within the U.S. older adult population, an elevated BRI is associated with a heightened risk of sarcopenia. BRI can function as a practical and cost-effective anthropometric index for more precise prediction of sarcopenia risk in older adults.

Relationship between body roundness index and obstructive sleep apnea: a population-based study

Objectives

This study aimed to assess the relationship between body roundness index (BRI) and obstructive sleep apnea (OSA) risk and the difference in the ability of BRI and body mass index (BMI) to identify people at high risk for OSA in different conditions.

Methods

This study was based on the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2008 and 2015 to 2018. Participants were categorized into OSA high-risk and OSA low-risk groups via questionnaires about sleep. The potential relationship between BRI and high risk for OSA was explored using several statistical methods, including weighted logistic regression models, receiver operating characteristic curves (ROC), restricted cubic spline curves (RCS), interaction tests, and subgroup analyses.

Results

A total of 9,495 participants were included in this study, including 3,155 in the high-risk group and 6,340 in the low-risk group. In the crude model, BRI was positively associated with a high risk for OSA (OR = 1.23; 95% CI: 1.20-1.27). After adjusting for all covariates, higher BRI quartiles (Q4) were positively associated with high risk for OSA (OR = 3.22; 95% CI: 2.57-4.04). The RCS demonstrated that BRI was non-linearly associated with OSA risk. ROC analyses showed that BRI was better at identifying those at high risk for OSA in the normal-weight population than BMI. Subgroup analyses revealed stronger correlations in non-hypertensive and non-smoking populations.

Conclusions

There is a non-linear positive correlation between BRI and OSA risk, and early monitoring and managing BRI can help to identify people at high risk for OSA as early as possible and reduce the risk.

The J-shaped relationship between body roundness index and adult asthma: insights from NHANES 2001-2018

Background

Many studies have used Body Mass Index (BMI) to define obesity and examine its potential link to adult asthma. However, BMI overlooks body fat distribution, which may significantly impact health. Unlike BMI, the Body Roundness Index (BRI) can more accurately reflect body fat distribution. Therefore, this study examined BRI's relationship with asthma prevalence in U.S. adults.

Methods

This study was based on data from the National Health and Nutrition Examination Survey (NHANES) between 2001 and 2018 and covered 40,052 adult participants. Participants were categorized into four quartile groups based on their BRI levels: Quartile 1 (1.05, 3.80); Quartile 2 (3.80, 5.06); Quartile 3 (5.06, 6.61); Quartile 4 (6.61, 23.48). The association between BRI and asthma prevalence was assessed via weighted multivariate logistic regression, smoothed curve fitting, threshold effects, subgroup, and sensitivity analysis. BRI's predictive power was compared to BMI and waist circumference using z-scores.

Results

Of the study population, 5,605 participants had asthma (13.99% prevalence). After adjusting for possible confounders, the results showed that higher BRI was linked to greater asthma prevalence (OR = 1.41, 95% CI:1.27, 1.56, p < 0.0001). A J-shaped relationship between BRI and asthma prevalence (p-nonlinearity = 0) was found, with asthma prevalence rising significantly when BRI surpassed 4.34. BRI outperformed BMI and waist circumference in predicting asthma (BRI: OR = 1.180; BMI: OR = 1.169; W.C.: OR = 1.166). Subgroup and sensitivity analyses confirmed our results' robustness.

Conclusion

Adult asthma prevalence increases with increasing BRI levels, showing a J-shaped relationship. Keeping BRI under 4.34 is vital for lowering asthma prevalence, especially for overweight or obese individuals. In addition, BRI outperformed BMI and waist circumference in predicting asthma occurrence.

Association between the body roundness index and female infertility: a cross-sectional study from NHANES

Background

Infertility is strongly associated with obesity. The body roundness index (BRI) is a more accurate assessment of visceral fat content than the body mass index (BMI). However, current evidence on the association between visceral fat accumulation and infertility remains insufficient and controversial. Therefore, we utilized the 2017-2020 National Health and Nutrition Examination Survey (NHANES) database to explore the correlation between BRI and infertility.

Methods

We used multiple logistic regression, smoothed curve fitting, subgroup analyses, and interaction tests to investigate the potential association between BRI and infertility. Additionally, we assessed the ability of BRI and BMI to predict infertility risk using receiver operating curve (ROC) analysis and calculate the area under the curve (AUC),sensitivity, and specificity.

Results

In the study, 1463 women aged 20 to 45 participated, and 172 of them were found to be infertile. After adjusting for all factors except body measurements, the findings indicated that for each one-unit increase in BRI, there was a 19% increase in the risk of infertility (OR = 1.19, 95% CI 1.05, 1.34). The analysis also revealed a positive nonlinear relationship between BRI and infertility. Furthermore, based on the ROC curves, it was observed that BRI was a more reliable predictor of infertility risk compared to BMI (BRI AUC = 0.5773, BMI AUC = 0.5681).

Conclusion

This study demonstrated a positive association between higher BRI values and infertility among adult women in the United States and showed a stronger association than BMI.

The L-shaped association between body roundness index and all-cause mortality in osteoporotic patients: a cohort study based on NHANES data

Purpose

This study aims to investigate the relationship between the body roundness index (BRI) and overall mortality rates in individuals with osteoporosis (OP), utilizing information sourced from the NHANES database, in order to assess BRI's capability as an indicator for predicting mortality risk.

Methods

Data from NHANES (2005 to 2010, 2013-2014, and 2017-2018) were analyzed, including 1,596 osteoporotic individuals aged 50 and above. BRI was calculated based on waist circumference (WC) and height, categorizing participants into high (>4.07) and low (≤4.07) BRI groups. To analyze the relationship between BRI and mortality while accounting for important covariates, we employed weighted Cox proportional hazards models, conducted Kaplan-Meier survival analyses, and utilized restricted cubic splines (RCS).

Results

Higher BRI was significantly associated with better long-term survival, showing an "L"-shaped nonlinear inverse relationship with mortality, with a threshold at BRI = 5. In subgroup analyses, this association remained relatively stable.

Conclusion

The "L"-shaped association between BRI and mortality indicates that BRI may serve as a useful indicator for evaluating mortality risk in patients with OP, thereby informing clinical interventions and public health approaches.

Association between body roundness index and osteoarthritis: a cross-sectional analysis of NHANES 2011-2018

OBJECTIVE

The objective of this study was to investigate the potential association between body roundness index (BRI) and the risk of osteoarthritis (OA) in US adults.

METHODS

A cross-sectional analysis consisting of 20,232 participants was conducted using data from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2018. Participants (≥20 years of age) were included and divided into OA and non-OA groups. Then, the demographics and characteristics of the participants were compared between the two groups. The relationship between BRI and OA was assessed using a multivariate logistic regression model with fitted smoothed curve techniques. Additionally, subgroup analyses on the correlation between BRI and OA were performed.

RESULTS

The BRI scores in OA group were significantly higher than in the non-OA group (6.60 ± 2.62 vs. 5.46 ± 2.34, p < 0.001). Multivariate logistic analysis revealed that a significantly positive association between BRI and OA (OR = 1.12, 95% CI: 1.09-1.14, p < 0.001). In the subgroup analysis, only the race subgroup showed a significant difference between BRI and OA (p < 0.001).

CONCLUSION

Our findings highlight a significantly positive association between BRI and OA prevalence in the general US population.

The joint effect of cumulative metabolic parameters on the risk of type 2 diabetes: a population-based cohort study

BACKGROUND AND AIMS

This study aimed to examine the cumulative effects of body mass index (BMI), body roundness index (BRI), pulse pressure (PP), triglycerides (TG), high-density lipoprotein cholesterol (HDL) and fasting plasma glucose (FPG) on Type 2 diabetes (T2D) morbidity.

METHODS

A total of 78,456 participants aged older than 45 years were extracted from basic public health services in China. During the 2-year follow-up, 6,942 individuals had developed T2D. The binary logistic regression models and multinomial logistic regression models were conducted to investigate the effects of cumulative metabolic parameters on incident T2D, prediabetes regression and progression.

RESULTS

We found statistically deleterious impacts of exposure to high cumulative BMI, BRI, PP, TG and low cumulative HDL on T2D morbidity and prediabetes progression. Compared to the group with low cumulative of all five parameters, the adjusted ORs for new-onset T2D for participants presenting with 1-2, 3, and 4-5 elevated metabolic parameters were 1.41(1.31,1.52), 1.93(1.74,2.13) and 2.21(1.94,2.51), respectively. There was additive interaction between FPG level and cumulative metabolic parameters with T2D. Compared with participants with the lowest quartile of FPG and low cumulative of all 5 parameters, those with the highest quartile of FPG and high cumulative of 4-5 parameters had a 14.63 [95% CI (12.27, 17.42)] higher risk of incident T2D.

CONCLUSIONS

Participants with more numbers of high-cumulative metabolic parameters were associated with a higher risk of incident T2D and prediabetes progression. A high level of normal FPG could enhance these risks.

Accuracy of novel anthropometric indices for assessing the risk for progression of prediabetes to diabetes; 13 years of results from Isfahan Cohort Study

Objective

We examined the accuracy of novel anthropometric indices in predicting the progression of prediabetes to diabetes.

Subjects and methods

This study was performed on the pre-diabetic sub-population from Isfahan Cohort Study (ICS). Participants were followed up from 2001 to 2013. During every 5-year follow-up survey, patients' data regarding the incidence and time of incidence of diabetes were recorded. We evaluated the association between the risk of developing diabetes and novel anthropometric indices including: visceral adiposity index (VAI), lipid accumulation products (LAP), deep abdominal adipose tissue (DAAT), abdominal volume index (AVI), A body shape index (ABSI), body roundness index (BRI) and weight-adjusted waist index (WWI). We categorized the indices into two groups according to the median value of each index in the population. We used Cox regression analysis to obtain hazard ratios (HR) using the first group as the reference category and used receiver operating characteristics (ROC) curve analysis for comparing the predictive performance of the indices.

Results

From 215 included subjects, 79 developed diabetes during the 13-year follow-up. AVI, LAP, BRI, and VAI indicated statistically significant HR in crude and adjusted regression models. LAP had the greatest association with the development of diabetes HR = 2.18 (1.36-3.50) in multivariable analysis. ROC curve analysis indicated that LAP has the greatest predictive performance among indices (area under the curve = 0.627).

Conclusion

Regardless of baseline confounding variables, prediabetic patients with a higher LAP index may be at significantly higher risk for developing diabetes.

Association of body roundness index with diabetes and prediabetes in US adults from NHANES 2007-2018: a cross-sectional study

OBJECTIVE

The present study examined the ability of the body roundness index (BRI) to predict the incidence of diabetes and prediabetes among adults in the USA.

METHOD

The study enrolled 11,980 adults aged ≥ 20 years from the National Health and Nutrition Examination Survey (NHANES). Logistic regression served as the primary method for analyzing the relevant link between BRI and the incidence of diabetes and prediabetes, including univariate analysis, multivariate regression analysis, smooth curve fitting analysis, and subgroup analysis. What's more, receiver operating characteristic (ROC) analysis was applied to confirm the predictive values of BRI for diabetes and prediabetes.

RESULTS

Each unit higher than BRI was associated with a 17% increased risk of diabetes and prediabetes after covariate adjustments (OR: 1.17, 95% CI: 1.07-1.27). Those with BRI in the high scores (Q4) possessed an increased likelihood of having diabetes and prediabetes than individuals in the reference group (OR: 1.83, 95% CI: 1.29-2.58). A smooth curve fitting analysis revealed a non-linear trend. The results across all population subgroups were uniform to those of the total population. The ROC curve indicated that the BRI was the best predictor of diabetes and prediabetes among other anthropometric indices.

CONCLUSIONS

Diabetes and prediabetes occurrence rates and BRI have a positive and non-linear relationship in American adults. The BRI indices could function as predictive markers for diabetes and prediabetes.

Non-linear relationship between the body roundness index and metabolic syndrome: data from National Health and Nutrition Examination Survey (NHANES) 1999-2018

Obesity is an important characteristic manifestation of metabolic syndrome (MetS), and body roundness index (BRI) is one of the anthropometric indicators associated with obesity. However, studies on the relationship between BRI and MetS risk are limited. We aimed to explore the relationship between baseline BRI and MetS in the USA population. Our study used data from the National Health and Nutrition Examination Survey from 1999 to 2018, ultimately enrolling and analysing 47 303 participants. Data-driven tertiles were used to categorise BRI levels, and multivariate logistic regression models were fitted to investigate the association of BRI with MetS in adults. In addition, receiver operating characteristic curve analysis was used to assess the ability of BRI to predict MetS. The distribution of BRI was different across ethnic groups with a gradual decrease in the proportion of non-Hispanic Whites and other races. In addition, BRI was significantly associated with traditional cardiovascular risk factors. Univariate regression analysis indicated BRI to be a moderate risk factor for MetS, and multivariate logistic regression analysis found that BRI remained an independent risk factor for MetS. After adjusting for confounding variables, a non-linear relationship was found between BRI levels and the prevalence of MetS. More importantly, BRI predicted MetS with the largest AUC among anthropometric measures. In summary, elevated baseline BRI levels are independently associated with the development of MetS, and baseline BRI may assist in identifying patients at risk for MetS, leading to early and optimal treatment to improve their outcomes.

Atherogenic Index of Plasma as a Mediator in the association between Body Roundness Index and Depression: insights from NHANES 2005-2018

BACKGROUND

Previous studies have shown a correlation between depression and obesity, as well as between depression and the Atherogenic Index of Plasma (AIP). However, there is limited research on the association between visceral obesity and depression, as well as the potential mediating role of AIP in this relationship.

METHODS

This study included 13,123 participants from the 2005-2018 National Health and Nutrition Examination Survey. Visceral obesity was measured with the Body Roundness Index (BRI), while depression was evaluated with the Patient Health Questionnaire-9. The AIP served as a marker for lipid disorders. To investigate the association between the BRI and depression, multivariate logistic regressions, restricted cubic spline models, subgroup analyses, and interaction tests were used. Additionally, a mediation analysis was conducted to explore the role of AIP in mediating the effect of BRI on depression.

RESULTS

There was a positive linear correlation between the BRI and depression. After controlling for all covariates, individuals in the highest BRI (Q4) group had an OR of 1.42 for depression (95% CI: 1.12-1.82) in comparison with individuals in the lowest BRI (Q1) group. Moreover, the AIP partially mediated the association between the BRI and depression, accounting for approximately 8.64% (95% CI: 2.04-16.00%) of the total effect.

CONCLUSION

The BRI was positively associated with depression, with the AIP playing a mediating role. This study provides a novel perspective on the mechanism that connects visceral obesity to depression. Managing visceral fat and monitoring AIP levels may contribute to alleviating depression.

Association between body roundness index (BRI) and gallstones: results of the 2017-2020 national health and nutrition examination survey (NHANES)

BACKGROUND

Gallstones are associated with obesity, and the BRI is a new obesity index that more accurately reflects body fat and visceral fat levels. The relationship between BRI and gallstone risk is currently unknown, and we aimed to explore the relationship between BRI and gallstone prevalence.

METHODS

A cross-sectional study was conducted utilizing data from the 2017-2020 NHANES involving a total of 5297 participants. To assess the association between BRI and gallstones, we used logistic regression analysis, subgroup analysis, and interaction terms. In addition, we performed restricted cubic spline (RCS) analysis and threshold effects analysis to characterize nonlinear relationships. We assessed the ability of BRI and Body mass index (BMI) to identify gallstones using receiver operating curve (ROC) analysis and area under the curve (AUC), and compared them using the Delong test.

RESULTS

Of the 5297 participants aged 20 years and older included in the study, 575 had gallstones. In fully adjusted models, a positive association between BRI and gallstone prevalence was observed (OR = 1.16, 95% CI: 1.12-1.20, P < 0.0001). Individuals in the highest quartile of BRI had a 204% increased risk of gallstones compared with those in the lowest quartile (OR = 3.04, 95% CI: 2.19-4.22, P < 0.0001). The correlation between BRI and gallstones persisted in subgroup analyses. RCS analyses showed a nonlinear relationship between BRI and gallstones. The inflection point was further found to be 3.96, and the correlation between BRI and gallstones was found both before and after the inflection point. ROC analysis showed that BRI (AUC = 0.667) was a stronger predictor of gallstones than BMI (AUC = 0.634).

CONCLUSIONS

Elevated BRI is associated with an increased risk of gallstones in the U.S. population, and BRI is a stronger predictor of gallstones than BMI. Maintaining an appropriate BRI is recommended to reduce the incidence of gallstones.

Body Roundness Index and All-Cause Mortality Among US Adults

Importance

Obesity, especially visceral obesity, is an established risk factor associated with all-cause mortality. However, the inadequacy of conventional anthropometric measures in assessing fat distribution necessitates a more comprehensive indicator, body roundness index (BRI), to decipher its population-based characteristics and potential association with mortality risk.

Objective

To evaluate the temporal trends of BRI among US noninstitutionalized civilian residents and explore its association with all-cause mortality.

Design, Setting, and Participants

For this cohort study, information on a nationally representative cohort of 32 995 US adults (age ≥20 years) was extracted from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018 and NHANES Linked Mortality File, with mortality ascertained through December 31, 2019. Data were analyzed between April 1 and September 30, 2023.

Exposures

Biennial weighted percentage changes in BRI were calculated. Restricted cubic spline curve was used to determine optimal cutoff points for BRI.

Main Outcome and Measures

The survival outcome was all-cause mortality. Mortality data were obtained from the Centers for Disease Control and Prevention website and linked to the NHANES database using the unique subject identifier. Weibull regression model was adopted to quantify the association between BRI and all-cause mortality.

Results

Among 32 995 US adults, the mean (SD) age was 46.74 (16.92) years, and 16 529 (50.10%) were women. Mean BRI increased gradually from 4.80 (95% CI, 4.62-4.97) to 5.62 (95% CI, 5.37-5.86) from 1999 through 2018, with a biennial change of 0.95% (95% CI, 0.80%-1.09%; P < .001), and this increasing trend was more obvious among women, elderly individuals, and individuals who identified as Mexican American. After a median (IQR) follow-up of 9.98 (5.33-14.33) years, 3452 deaths (10.46% of participants) from all causes occurred. There was a U-shaped association between BRI and all-cause mortality, with the risk increased by 25% (hazard ratio, 1.25; 95% CI, 1.05-1.47) for adults with BRI less than 3.4 and by 49% (hazard ratio, 1.49; 95% CI, 1.31-1.70) for those with BRI of 6.9 or greater compared with the middle quintile of BRI of 4.5 to 5.5 after full adjustment.

Conclusions and Relevance

This national cohort study found an increasing trend of BRI during nearly 20-year period among US adults, and importantly, a U-shaped association between BRI and all-cause mortality. These findings provide evidence for proposing BRI as a noninvasive screening tool for mortality risk estimation, an innovative concept that could be incorporated into public health practice pending consistent validation in other independent cohorts.

Associations of body roundness index with cardiovascular and all-cause mortality: NHANES 2001-2018

Body roundness index (BRI) was associated with cardiovascular diseases. But the relationship between BRI with cardiovascular disease (CVD) mortality and all-cause mortality remains largely unknown in hypertensive patients. This prospective cohort study included patients with hypertension who participated in the National Health and Nutrition Examination Survey (NHANES) from 2001 through 2018, and aimed to evaluate the association between BRI with CVD mortality and all-cause mortality. A total of 15570 patients were included. Over a median follow-up of 8.0 years (interquartile range, 4.3-12.6 years), 3445 individuals died, including 1166 CVD deaths. Weighted restricted cubic spline regression results showed a nonlinear association between BRI and CVD mortality and all-cause mortality (both P for nonlinear trend <0.001). The weighted multivariate Cox proportional hazards regression showed the hazard ratio (HRs) for CVD mortality were 0.93 (95% CI: 0.84-1.03, P = 0.160) in the low levels of BRI (≤5.9) and 1.11 (95% CI: 1.05-1.19, P < 0.001) in the high levels of BRI (>5.9). Similar associations were observed for all-cause mortality, the HRs were 0.91 (95% CI: 0.87-0.96, P < 0.001) in the low levels of BRI (≤6.3) and 1.09 (95% CI: 1.05-1.13, P < 0.001) in the high levels of BRI (>6.3). This cohort study supported that BRI was nonlinearly associated with CVD mortality and all-cause mortality among patients with hypertension. The thresholds of 5.9 and 6.3 for CVD mortality and all-cause mortality, respectively, may represent intervention targets for lowering the risk of premature death, but this needs to be confirmed in large clinical trials.

The nonlinear correlation between alanine aminotransferase to high-density lipoprotein cholesterol ratio and the risk of diabetes: a historical Japanese cohort study

BACKGROUND

Low levels of high-density lipoprotein cholesterol (HDL-C) and high levels of alanine aminotransferase (ALT) are related to insulin resistance, metabolic syndrome, and diabetes mellitus (DM). However, evidence on the connection between the alanine aminotransferase to high-density lipoprotein cholesterol (ALT/HDL-C) ratio and diabetes mellitus (DM) risk was limited. The study aimed to investigate the relationship between baseline ALT/HDL-C ratio and DM among Japanese individuals.

METHODS

This second analysis was based on a cohort study using open-source data. Data from 15,342 individuals who participated in the medical examination program were recorded at Murakami Memorial Hospital in Japan between 2004 and 2015. Smooth curve fitting, subgroup analysis, Cox proportional-hazards regression, and a series of sensitivity analyses were conducted to examine the relationship between ALT/HDL-C ratio and incident diabetes. The ability of the ALT/HDL-C ratio to predict diabetes was evaluated using a receiver operating characteristic curve analysis.

RESULTS

After controlling for confounding covariates, the ALT/HDL-C ratio was found to be positively correlated to the DM risk in Japanese adults (HR: 1.01, 95%CI: 1.00-1.02, P = 0.049). This study also found a stable relationship between ALT/HDL-C ratio and diabetes after employing a series of sensitivity analyses. Additionally, there was a non-linear association between the ALT/HDL-C ratio and incident diabetes, and the ALT/HDL-C ratio inflection point was 30.12. When the ALT/HDL-C ratio was below 30.12, the present study discovered a significant positive association between the ALT/HDL-C ratio and incident diabetes (HR: 1.04, 95%CI: 1.02-1.06, P = 0.001). Furthermore, among liver enzymes, blood lipids, and anthropometric indicators, the ALT/HDL-C ratio best predicts DM (AUC = 0.75, 95%CI: 0.73-0.78).

CONCLUSION

Increased ALT/HDL-C ratio levels at baseline correlated to incident DM. The relationship between ALT/HDL-C ratio and incident DM was also non-linear. When the ALT/HDL-C ratio is below 30.12, there is a statistically significant positive correlation between the ALT/HDL-C ratio and incident DM.

Associations of obesity-related indices with prediabetes regression to normoglycemia among Chinese middle-aged and older adults: a prospective study

Background

Prediabetes is associated with increased cardiovascular risk and all-cause mortality, while its regression will decrease the risks. This study investigated the associations of six obesity-related indices (waist-to-height ratio (WHtR), body roundness index (BRI), conicity index (CI), body shape index (ABSI), Chinese visceral adiposity index (CVAI), and triglyceride glucose (TyG) index) with prediabetes regression based on the China Health and Retirement Longitudinal Study (CHARLS), enrolling middle-aged and older adults.

Methods

We included 2,601 participants with prediabetes from CHARLS, who were followed up from 2011-2012 to 2015-2016, with blood samples collected for measuring fasting plasma glucose and hemoglobin A1c. All the obesity-related indices at baseline and their dynamic changes were calculated and categorized into tertiles. Logistic regression analysis was applied to obtain the odds ratio (OR) and 95% confidence intervals (CIs). Attributable fractions (AFs) and 95% CIs of these indices and the dynamic changes were calculated with the AF package in R software, and the cutoff values of initial obesity-related indices were obtained by the receiver operating characteristic (ROC) analysis.

Results

During the 4-year follow-up period, 562 (21.61%) participants regressed from prediabetes to normoglycemia. They had lower initial BRI, WHtR, CI, ABSI, CVAI, and TyG than those who did not (P < 0.05). After multivariable adjustment, participants in the first tertile of initial BRI (OR, 1.45, 95%CIs, 1.09-1.93), WHtR (OR, 1.46, 95%CIs, 1.10-1.95), and CVAI (OR, 1.47, 95%CIs, 1.11-1.93) had increased odds of prediabetes regression compared with those in the highest tertile. Participants with decreased TyG (OR, 2.08; 95%CIs, 1.61-2.70) also had increased odds of prediabetes regression compared with those with increased TyG. The cutoff values of initial obesity-related indices were 4.374 for BRI, 0.568 for WHtR, 8.621 for TyG, 1.320 for CI, 0.083 for ABSI, and 106.152 for CVAI, respectively. The AFs were 21.10% for BRI < 4.374, 20.85% for WHtR < 0.568, 17.48% for CVAI < 107.794, and 17.55% for ΔTyG < 0, respectively.

Conclusion

Low initial BRI, WHtR, and CVAI, as well as TyG reduction, were significantly related to prediabetes regression to normoglycemia, and the AFs were around 20%. Less abdominal fat and insulin resistance reduction would benefit future health outcomes among people with prediabetes.

The relationship between the CUN-BAE body fatness index and incident diabetes: a longitudinal retrospective study

BACKGROUND

The Clínica Universidad de Navarra-Body Adiposity Estimator (CUN-BAE) index has been recommended as an ideal indicator of body fat and exhibited significant correlation with cardiometabolic risk factors. However, whether the CUN-BAE index correlates with incident diabetes in Asian populations is unknown. Therefore, this longitudinal study was designed to evaluate the association between baseline CUN-BAE index and type 2 diabetes mellitus (T2DM).

METHODS

This retrospective longitudinal study involved 15,464 participants of 18-79 years of age in the NAGALA (NAfld in the Gifu Area Longitudinal Analysis) study over the period of 2004-2015. Cox proportional hazards regression was performed to test the relationship between the baseline CUN-BAE index and diabetes incidence. Further stratification analysis was conducted to ensure that the results were robust. The diagnostic utility of the CUN-BAE index was tested by the receiver operating characteristic (ROC) curve.

RESULTS

Over the course of an average follow-up of 5.4 years, 373 (2.41%) participants developed diabetes. A higher diabetes incidence was associated with higher CUN-BAE quartiles (P for trend< 0.001). Each 1 unit increase in CUN-BAE index was associated with a 1.08-fold and 1.14-fold increased risk of diabetes after adjustment for confounders in males and females, respectively (both P < 0.001). Stratification analysis demonstrated a consistent positive correlation between baseline CUN-BAE and diabetes incidence. Moreover, based on ROC analysis, CUN-BAE exhibited a better capacity for diabetes prediction than both body mass index (BMI) and waist circumference (WC) in both sexes.

CONCLUSIONS

The baseline CUN-BAE level was independently related to the incidence of diabetes. Increased adiposity determined by CUN-BAE could be used as a strong nonlaboratory predictor of incident diabetes in clinical practice.

Associations of Traumatic Injury with Abnormal Glucose Metabolism: A Population-Based Prospective Cohort Study

Purpose

Empirical data on the association between traumatic injury and abnormal glucose metabolism risk is limited. This study aimed to investigate the association between traumatic injury and abnormal glucose metabolism.

Patients and Methods

This study included 153,162 participants in the Kailuan Study from 2006 to 2013. Participants with abnormal glucose metabolism at baseline were excluded. All participants were monitored every two years until December 31, 2019. During follow-up, 1915 subjects with a first traumatic injury (defined as a physical injury caused by an external force) were identified. For each subject with traumatic injury, one control subject was randomly selected and matched for age (± 3 years) and sex. A total of 3830 subjects were included in the final analysis. Cox proportional hazards models were used to examine the association between traumatic injury and the subsequent risk of abnormal glucose metabolism.

Results

During a median follow-up of 6.91 (3.57-9.41) years, 990 abnormal glucose metabolism events occurred. After adjustment for demographics, lifestyle behaviors, and traditional risk factors, those who had traumatic injury compared to controls were 32% more likely to develop any abnormal glucose metabolism (hazard ratio [HR] 1.32; 95% confidence interval [CI]1.16-1.49), including impaired fasting glucose (IFG) (HR 1.29; 95% CI 1.12-1.48) and diabetes (HR 1.37; 95% CI 1.10-1.70). The risks for abnormal glucose metabolism, IFG, and diabetes in subjects with moderate-severe injury were higher than in subjects with mild injury for the 1-year follow-up period, while the association was not significantly different by injury severity for the whole follow-up period.

Conclusion

Traumatic injury was associated with an increased risk of abnormal glucose metabolism. However, the risks of outcome events decreased as the follow-up period extended. Improved short- and long-term prevention and management strategies for controlling glucose are needed for individuals with traumatic injury.

Non-linear relationship between albumin-corrected calcium and 30-day in-hospital mortality in ICU patients: A multicenter retrospective cohort study

OBJECTIVE

Albumin-corrected calcium is usually calculated to reflect the real serum calcium level of the whole body by physicians. However, studies on the association between albumin-corrected calcium and 30-day in-hospital mortality in Intensive Care Unit (ICU) patients are rare. The purpose of our study was to explore the association between baseline albumin-corrected calcium and 30-day in-hospital mortality in the American ICU population.

METHODS

A multicenter retrospective cohort study of 102,245 ICU patients in the eICU-CRD v2.0 from the USA during 2014-2015 was performed. The average age was 63.7 ± 16.9 years, of which 55,313 (53.7%) were men and 47,758 (46.3%) were women. The association between albumin-corrected calcium and 30-day in-hospital mortality was analyzed by Cox proportional-hazards regression, smooth curve fitting, piecewise linear regression, subgroup analyses, and a series of sensitivity analyses.

RESULTS

We found that among ICU patients with calcium abnormalities, more than 95% were mild hypocalcemia or mild hypercalcemia. The risk of 30-day in-hospital mortality will increase by 10% in the ≥7.5-< 8.5 mg/dl subgroup (OR=1.1, 95% CI 1.0-1.3) or 20% in the ≥10.3-<12 mg/dl subgroup (OR=1.2, 95% CI 1.1-1.3) when the albumin-corrected calcium level increases by 1 mg/dl. Additionally, the relationship between albumin-corrected calcium and 30-day in-hospital mortality was U shaped; the inflection point was 8.9 mg/dl (log likelihood ratio test P = 0.005). Finally, after a series of sensitivity analyses, we found that the relationship between albumin-corrected calcium and 30-day in-hospital mortality remained significant.

CONCLUSION

In a large nationally representative cohort of ICU patients, abnormalities in albumin-corrected calcium, particularly slight hypocalcemia or slight hypercalcemia, were associated with an increased 30-day in-hospital mortality risk, and yet the findings in this study need to be further confirmed by prospective studies.