Huai Zhang, Li-You Lian, Axing Lv, Tianyi Xia, Meili Jiang, Dianjianyi Sun, Canqing Yu, Ling Yang, Yiping Chen, Huaidong Du, Xiao-Dong Zhou, Giovanni Targher, Christopher D Byrne, Zhengming Chen, Jun Lv, Liming Li, Shenghong Ju, Yuanjie Pang, Ming-Hua Zheng, China Kadoorie Biobank Collaborative Group, International Steering Committee, International Co-ordinating Centre, Oxford, National Co-ordinating Centre, Beijing, 10 Regional Co-ordinating Centres: Qingdao CDC, Licang CDC, Heilongjiang Provincial CDC, Nangang CDC, Hainan Provincial CDC, Meilan CDC, Jiangsu Provincial CDC, Suzhou CDC, Guangxi Provincial CDC, Liuzhou CDC, Sichuan Provincial CDC, Pengzhou CDC, Gansu Provincial CDC, Maiji CDC, Henan Provincial CDC, Huixian CDC, Zhejiang Provincial CDC, Tongxiang CDC, Hunan Provincial CDC, Liuyang CDC
Higher body roundness index (BRI) was associated with increased MASLD risk, even in normal-weight individuals with moderate waist circumference; low BRI and high BMI did not increase MASLD risk, whereas high BRI and high BMI markedly increased it. Among individuals with MASLD, both excessively low and high BRI values were associated with increased all-cause mortality.
BACKGROUND & AIMS: This study aimed to examine the associations of the body roundness index (BRI) with metabolic dysfunction-associated steatotic liver disease (MASLD), and long-term mortality outcomes, given that the body mass index (BMI) does not adequately reflect visceral adiposity.
METHODS: Three large-scale, population-based cohorts in China (CKB, n=24,910), the United States (NHANES, n=19,889), and Europe (UKB, n=383,504) were included in this study. The primary outcomes were MASLD prevalence and all-cause mortality. Logistic regression, restricted cubic spline (RCS), and Weibull regression models were used to quantify associations of BRI with MASLD and subsequent mortality over a 10-year follow-up, with BMI as the comparator.
RESULTS: There was an S-shaped association between BRI and MASLD prevalence (all P<0.001). An increased risk of MASLD was observed with higher BRI (for BRI Q5, adjusted odds ratio [OR] >5.68, P<0.001), even among individuals with normal BMI and moderate waist circumference. Low BRI with high BMI did not increase the risk of MASLD, whereas the combination of high BRI and high BMI substantially elevated the risk. There was a U-shaped association between BRI and all-cause mortality in MASLD. Weibull regression analysis further indicated that both excessively low and high BRI shortened survival time, with time ratios (TR) indicating reductions ranging from 14% to 58%.
CONCLUSIONS: Higher body roundness index (BRI) was associated with increased MASLD risk, even in normal-weight individuals with moderate waist circumference; low BRI and high BMI did not increase MASLD risk, whereas high BRI and high BMI markedly increased it. Among individuals with MASLD, both excessively low and high BRI values were associated with increased all-cause mortality.