Yi Yanshan, Yang Li
Department of Occupational Health and Environmental Health, School of Public Health, Guangxi Medical University, Nanning, China.
Front Nutr. 2025 Jul 8;12:1604398. doi: 10.3389/fnut.2025.1604398. eCollection 2025.
Visceral obesity is an important risk factor for the development and progression of metabolic dysfunction-associated steatotic liver disease (MASLD). The body roundness index (BRI) is a novel indicator that demonstrates a stronger correlation with visceral fat than other anthropometric indices. However, the association between the BRI and mortality risk in patients with MASLD remains unclear. Therefore, this study investigated the relationship between the BRI and the risks of all-cause and cardiovascular disease mortality among patients with MASLD.
This study included 7,428 adults aged ≥18 years with MASLD, utilizing data from the National Health and Nutrition Examination Survey (NHANES) database spanning from 1999 to 2018. The assessment of MASLD was conducted based on the fatty liver index (FLI). To examine the relationship between the BRI and mortality risks, multivariable Cox proportional hazards regression models, trend analysis, and restricted cubic spline curves were employed. Additionally, subgroup analyses were conducted to assess whether the association between the BRI and mortality varied across different subgroups.
In total, 1,249 participant deaths were recorded during a median follow-up period of 115 months, of which 404 were attributed to cardiovascular disease. After adjusting for multiple covariates in the fully adjusted model, the risk of all-cause mortality was increased by 27% (HR: 1.27; 95% CI: 1.00-1.60) and 52% (HR: 1.52; 95% CI: 1.18-1.96) in BRI quartiles 3 to 4 (Q3-Q4) compared with Q1, respectively. Similarly, the risk of cardiovascular disease mortality was increased by 61% (HR, 1.61; 95% CI, 1.05-2.46), 62% (HR, 1.62; 95% CI, 1.03-2.53), and 144% (HR, 2.44; 95% CI, 1.46-4.09) in BRI quartiles 2 to 4 (Q2-Q4) compared with Q1, respectively. The restricted cubic spline curves indicated a linear relationship between the BRI and both all-cause and cardiovascular disease mortality ( for non-linearity >0.05).
In this nationally representative sample of adults with MASLD from the non-institutionalized civilian population in the United States, the BRI served as an independent predictor of both all-cause and cardiovascular disease mortality. Specifically, higher BRI values were associated with increased risks of both all-cause and cardiovascular disease mortality among patients with MASLD.
内脏肥胖是代谢功能障碍相关脂肪性肝病（MASLD）发生和进展的重要危险因素。身体圆润度指数（BRI）是一种新型指标，与内脏脂肪的相关性比其他人体测量指标更强。然而，BRI与MASLD患者死亡风险之间的关联仍不清楚。因此，本研究调查了BRI与MASLD患者全因死亡和心血管疾病死亡风险之间的关系。
本研究纳入了7428名年龄≥18岁的患有MASLD的成年人，利用了1999年至2018年美国国家健康和营养检查调查（NHANES）数据库中的数据。基于脂肪肝指数（FLI）对MASLD进行评估。为了研究BRI与死亡风险之间的关系，采用了多变量Cox比例风险回归模型、趋势分析和受限立方样条曲线。此外，还进行了亚组分析，以评估BRI与死亡率之间的关联在不同亚组中是否存在差异。
在中位随访期115个月期间，共记录了1249例参与者死亡，其中404例归因于心血管疾病。在完全调整模型中对多个协变量进行调整后，与第一四分位数（Q1）相比，BRI第三至第四四分位数（Q3-Q4）的全因死亡风险分别增加了27%（风险比：1.27；95%置信区间：1.00-1.60）和52%（风险比：1.52；95%置信区间：1.18-1.96）。同样，与Q1相比，BRI第二至第四四分位数（Q2-Q4）的心血管疾病死亡风险分别增加了61%（风险比，1.61；95%置信区间，1.05-2.46）、62%（风险比，1.62；95%置信区间，1.03-2.53）和144%（风险比，2.44；95%置信区间，1.46-4.09）。受限立方样条曲线表明BRI与全因死亡和心血管疾病死亡之间均呈线性关系（非线性检验P>0.05）。
在美国非机构化平民人口中具有全国代表性的患有MASLD的成年人样本中，BRI是全因死亡和心血管疾病死亡的独立预测指标。具体而言，较高的BRI值与MASLD患者全因死亡和心血管疾病死亡风险增加相关。
