Association of Body Roundness Index, A Body Shape Index, and Cardiometabolic Indices With Gastric Intestinal Metaplasia Severity Assessed by OLGA Staging.

BACKGROUND AND AIM: Gastric intestinal metaplasia (IM) is a recognized precancerous lesion whose progression may be influenced by metabolic dysfunction. Novel anthropometric indices, including the Body Roundness Index (BRI) and A Body Shape Index (ABSI), have emerged as superior predictors of visceral adiposity in comparison to the conventional body mass index (BMI). However, the association of these indices with gastric precancerous lesions remains largely unexplored. This study aims to investigate the relationship between BRI, ABSI, BMI, and cardiometabolic indices (TyG, TyG-BMI) with the severity of IM, as measured by the Operative Link on Gastritis Assessment (OLGA) staging system.

METHODS

This prospective cross-sectional study included 250 patients who underwent upper gastrointestinal endoscopy with gastric biopsy. IM was assessed histopathologically and graded using the OLGA staging system (stages 0 to IV). Anthropometric indices (BMI, BRI, and ABSI) and cardiometabolic indices (TyG, TyG-BMI) were computed from standardized measurements. Receiver operating characteristic (ROC) analysis, Spearman correlation, and multivariate logistic regression were performed.

RESULTS

Of 250 patients (average age: 53.6±18.9 y; 51.6% female), 154 (61.6%) were identified as IM-positive. All anthropometric and cardiometabolic indices were significantly elevated in IM-positive individuals (P<0.001). The Body Roundness Index (BRI) exhibited the strongest correlation with OLGA stage (ρ=0.448, P<0.001) and IM grade (ρ=0.493, P<0.001). In the prediction of advanced OLGA stages (≥stage III), the triglyceride-glucose (TyG) index demonstrated the highest discriminative capacity (AUC=0.848), followed by BRI (AUC=0.815) and waist circumference (AUC=0.809). In multivariate analysis, adjusting for age, sex, and Helicobacter pylori status, BRI (odds ratio=1.665, 95% CI: 1.281-2.164, P<0.001), TyG (odds ratio=3.823, 95% CI: 1.925-7.591, P<0.001), and their combination (BRI: odds ratio=1.469; TyG: odds ratio=2.654) persisted as independent predictors of intestinal metaplasia (IM) positivity. Tertile analysis demonstrated a dose-response relationship: the prevalence of IM increased from 39.8% (T1) to 82.1% (T3) for BRI and from 42.9% (T1) to 83.1% (T3) for TyG, with P-trend values <0.001 for both.

CONCLUSIONS

BRI and TyG index are independently associated with gastric IM severity and demonstrate superior predictive performance compared with conventional BMI. These noninvasive, easily calculable indices may serve as practical tools for identifying individuals at increased risk of gastric precancerous lesions in clinical practice.