Chen Ziqi, Cheang Iokfai, Zhu Xu, Qu Qiang, Chen Sitong, Xing Yutong, Zhou Yanli, Zhang Haifeng, Li Xinli
State Key Laboratory for Innovation and Transformation of Luobing Theory, Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China.
Department of Cardiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Suzhou, China.
Diabetes Obes Metab. 2025 Jun;27(6):3285-3298. doi: 10.1111/dom.16346. Epub 2025 Mar 27.
The prevalence of metabolic syndrome (MetS) is increasing due to ageing populations and lifestyle changes, making it crucial to understand the relationship between body fat distribution and cardiovascular outcomes. Traditional measures such as body mass index (BMI) have limitations in assessing abdominal obesity. The body roundness index (BRI), a novel anthropometric measure combining waist circumference and height, has shown promise in evaluating this risk. This study aims to explore the association between BRI and cardiovascular disease (CVD) prevalence and mortality in a nationally representative sample of US adults with MetS.
This retrospective study used data from the National Health and Nutrition Examination Surveys (NHANES) 2001-2016, including 10 527 MetS-diagnosed participants. BRI was calculated and the cohort was divided into quartiles. Logistic regression and Cox proportional hazards models assessed the relationship between BRI and CVD prevalence, all-cause mortality and cardiovascular-specific mortality. Kaplan-Meier curves and restricted cubic spline analyses visualized survival patterns and non-linear relationships, with sensitivity analysis for validation.
Higher BRI quartiles were significantly associated with increased CVD prevalence (odds ratio [OR]: 1.56 [1.32-1.84], p < 0.001). In the fully adjusted model, BRI demonstrated a U-shaped relationship with all-cause and cardiovascular mortality, with a threshold value of 6.89 (p for non-linear ≤0.001). Above this threshold, each additional unit in BRI was linked to a 9% increase in cardiovascular mortality risk (hazard ratio [HR]: 1.09 [1.02-1.15], p = 0.006) and an 8% rise in overall mortality (HR: 1.08 [1.04-1.12], p < 0.001). Conversely, BMI showed a paradoxical relationship with reduced mortality risk in unadjusted models, which became insignificant after adjusting for confounders (p = 0.195; 0.144).
BRI might be a more reliable predictor of cardiovascular outcomes and mortality in MetS patients than BMI. The identified threshold value of BRI can assist clinicians in making accurate prognostic evaluations. However, findings may vary by age and gender, underscoring the need for further research in diverse populations.
由于人口老龄化和生活方式的改变，代谢综合征（MetS）的患病率正在上升，因此了解体脂分布与心血管疾病结局之间的关系至关重要。传统的测量方法，如体重指数（BMI），在评估腹部肥胖方面存在局限性。身体圆润度指数（BRI）是一种结合腰围和身高的新型人体测量指标，在评估这种风险方面显示出了前景。本研究旨在探讨在美国具有全国代表性的患有MetS的成年人样本中，BRI与心血管疾病（CVD）患病率和死亡率之间的关联。
这项回顾性研究使用了2001 - 2016年国家健康与营养检查调查（NHANES）的数据，包括10527名被诊断患有MetS的参与者。计算了BRI，并将队列分为四分位数。逻辑回归和Cox比例风险模型评估了BRI与CVD患病率、全因死亡率和心血管疾病特异性死亡率之间的关系。Kaplan - Meier曲线和受限立方样条分析直观显示了生存模式和非线性关系，并进行了敏感性分析以进行验证。
较高的BRI四分位数与CVD患病率增加显著相关（比值比[OR]：1.56[1.32 - 1.84]，p < 0.001）。在完全调整模型中，BRI与全因死亡率和心血管死亡率呈U形关系，阈值为6.89（非线性p≤0.001）。高于此阈值，BRI每增加一个单位，心血管死亡风险增加9%（风险比[HR]：1.09[1.02 - 1.15]，p = 0.006）以及总死亡率上升8%（HR：1.08[1.04 - 1.12]，p < 0.001）。相反，在未调整模型中，BMI与降低的死亡风险呈矛盾关系，在调整混杂因素后变得不显著（p = 0.195；0.144）。
对于MetS患者，BRI可能比BMI更能可靠地预测心血管疾病结局和死亡率。确定的BRI阈值可帮助临床医生进行准确的预后评估。然而，研究结果可能因年龄和性别而异，这突出了在不同人群中进一步研究的必要性。
