Diabetes, obesity & metabolism · 2026
Body Roundness Index and All-Cause Mortality in Metabolic Dysfunction-Associated Steatotic Liver Disease: A Dual-Cohort Study.
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Li Zijian, Yin Shishu, Cui Jian, Shi Jinxin, Ma Fuhai, Ma Tianming, An Qi, Yu Tao, Tang Danian, Cao Xianglong, Zhao Gang
Аннотация
BACKGROUND: Whether associations between the body roundness index (BRI) and mortality differ across population settings in metabolic dysfunction-associated steatotic liver disease (MASLD) remains unclear.
METHODS: We analysed two nationally representative cohorts: NHANES (1999-2018; n = 7723; US population) and CHARLS (2011-2020; n = 6553; Chinese population). Cox proportional hazards regression with restricted cubic splines was used to assess dose-response relationships. Between-cohort heterogeneity was evaluated using I2 statistics.
RESULTS: In NHANES (mean BMI, 31.99 kg/m2; 924 deaths over median follow-up of 8.9 years), BRI demonstrated a significant linear association with all-cause mortality (hazard ratio [HR], 1.18 per SD; 95% confidence interval [CI], 1.049-1.327; p = 0.006). In CHARLS (mean BMI, 25.73 kg/m2; 110 deaths over median follow-up of 7.3 years), no significant association was observed (HR, 0.91; 95% CI, 0.749-1.101; p = 0.327). Between-cohort heterogeneity was substantial (I2 = 80.7%; p = 0.023). In NHANES, the triglyceride-glucose (TyG) index was associated with 33.8% (95% CI, 18.2%-52.4%) statistical attenuation of the BRI-mortality association. The null finding in CHARLS likely reflects insufficient power (14% to detect HR = 1.18) rather than evidence against an association, highlighting the need for adequately powered studies.
CONCLUSIONS: BRI demonstrates a significant linear association with mortality in the US MASLD population. In the Chinese elderly MASLD population, statistical power was insufficient to draw definitive conclusions about BRI-mortality associations. The observed between-cohort heterogeneity likely reflects multiple factors, including differences in age structure, obesity phenotype, mortality ascertainment methods, and potentially genuine population-specific characteristics. These findings underscore the importance of population-specific validation before extrapolating Western-derived BRI thresholds to Asian populations.
METHODS: We analysed two nationally representative cohorts: NHANES (1999-2018; n = 7723; US population) and CHARLS (2011-2020; n = 6553; Chinese population). Cox proportional hazards regression with restricted cubic splines was used to assess dose-response relationships. Between-cohort heterogeneity was evaluated using I2 statistics.
RESULTS: In NHANES (mean BMI, 31.99 kg/m2; 924 deaths over median follow-up of 8.9 years), BRI demonstrated a significant linear association with all-cause mortality (hazard ratio [HR], 1.18 per SD; 95% confidence interval [CI], 1.049-1.327; p = 0.006). In CHARLS (mean BMI, 25.73 kg/m2; 110 deaths over median follow-up of 7.3 years), no significant association was observed (HR, 0.91; 95% CI, 0.749-1.101; p = 0.327). Between-cohort heterogeneity was substantial (I2 = 80.7%; p = 0.023). In NHANES, the triglyceride-glucose (TyG) index was associated with 33.8% (95% CI, 18.2%-52.4%) statistical attenuation of the BRI-mortality association. The null finding in CHARLS likely reflects insufficient power (14% to detect HR = 1.18) rather than evidence against an association, highlighting the need for adequately powered studies.
CONCLUSIONS: BRI demonstrates a significant linear association with mortality in the US MASLD population. In the Chinese elderly MASLD population, statistical power was insufficient to draw definitive conclusions about BRI-mortality associations. The observed between-cohort heterogeneity likely reflects multiple factors, including differences in age structure, obesity phenotype, mortality ascertainment methods, and potentially genuine population-specific characteristics. These findings underscore the importance of population-specific validation before extrapolating Western-derived BRI thresholds to Asian populations.