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Cited by 319Body Composition Measurement TechniquesObesity, Physical Activity, DietDiabetes, Cardiovascular Risks, and Lipoproteins

Body Roundness Index and All-Cause Mortality Among US Adults

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Zhang, Xiaoqian, Ma, Ning, Lin, Qiushi, Chen, Kening, Zheng, Fangjieyi, Wu, Jing, Dong, Xiaoqun, Niu, Wenquan·2024·JAMA Network Open
DOI 10.1001/jamanetworkopen.2024.15051PMC PMC11154161
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Abstract

Importance: Obesity, especially visceral obesity, is an established risk factor associated with all-cause mortality. However, the inadequacy of conventional anthropometric measures in assessing fat distribution necessitates a more comprehensive indicator, body roundness index (BRI), to decipher its population-based characteristics and potential association with mortality risk. Objective: To evaluate the temporal trends of BRI among US noninstitutionalized civilian residents and explore its association with all-cause mortality. Design, Setting, and Participants: For this cohort study, information on a nationally representative cohort of 32 995 US adults (age ≥20 years) was extracted from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018 and NHANES Linked Mortality File, with mortality ascertained through December 31, 2019. Data were analyzed between April 1 and September 30, 2023. Exposures: Biennial weighted percentage changes in BRI were calculated. Restricted cubic spline curve was used to determine optimal cutoff points for BRI. Main Outcome and Measures: The survival outcome was all-cause mortality. Mortality data were obtained from the Centers for Disease Control and Prevention website and linked to the NHANES database using the unique subject identifier. Weibull regression model was adopted to quantify the association between BRI and all-cause mortality. Results: Among 32 995 US adults, the mean (SD) age was 46.74 (16.92) years, and 16 529 (50.10%) were women. Mean BRI increased gradually from 4.80 (95% CI, 4.62-4.97) to 5.62 (95% CI, 5.37-5.86) from 1999 through 2018, with a biennial change of 0.95% (95% CI, 0.80%-1.09%; P < .001), and this increasing trend was more obvious among women, elderly individuals, and individuals who identified as Mexican American. After a median (IQR) follow-up of 9.98 (5.33-14.33) years, 3452 deaths (10.46% of participants) from all causes occurred. There was a U-shaped association between BRI and all-cause mortality, with the risk increased by 25% (hazard ratio, 1.25; 95% CI, 1.05-1.47) for adults with BRI less than 3.4 and by 49% (hazard ratio, 1.49; 95% CI, 1.31-1.70) for those with BRI of 6.9 or greater compared with the middle quintile of BRI of 4.5 to 5.5 after full adjustment. Conclusions and Relevance: This national cohort study found an increasing trend of BRI during nearly 20-year period among US adults, and importantly, a U-shaped association between BRI and all-cause mortality. These findings provide evidence for proposing BRI as a noninvasive screening tool for mortality risk estimation, an innovative concept that could be incorporated into public health practice pending consistent validation in other independent cohorts.

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  • Previous studies reported a U-shaped association between BRI and mortality similar to that observed for BMI, with both low and high BRI levels linked to increased all-cause mortality.

    “One study evaluating the association between BRI and mortality identified a U-shaped curve similar to that observed for BMI [14].”

    From The discriminatory ability of the body roundness index and body mass index for metabolic diseases in Korean adults: a comparative study (2025) · cites this paper as [14]

    The Discussion reports a U-shaped association between BRI and all-cause mortality, with increased risk at both low and high BRI levels. The Results > Sensitivity Analyses section compares BRI with BMI but does not state that BMI had a similar U-shaped curve. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • The Body Roundness Index (BRI) offers a superior estimation of body fat distribution and visceral adiposity than other traditional anthropometric measures.

    “Introduced in 2013, the Body Roundness Index (BRI) offers a superior estimation of body fat distribution and visceral adiposity than other traditional anthropometric measures15,16.”

    From The nonlinear association between body roundness index and infertility in married women (2025) · cites this paper as [16]

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Cited by

Sorted by citations

Authors
Zhang, X., Ma, N., Lin, Q., Chen, K., Zheng, F., Wu, J., Dong, X., & Niu, W.
Affiliations
  • Beijing University of Chinese Medicine (CN)
  • Sanofi Aventis, Cambridge, Massachusetts
  • Chinese Academy of Medical Sciences & Peking Union Medical College (CN)
  • Capital Institute of Pediatrics (CN)
  • Brown University (US)
Corresponding author
  • Dong, Xiaoqun
  • Niu, Wenquan
ORCID
Venue
JAMA Network Open
Publisher
American Medical Association (AMA)
Published
2024-06-05
Volume
7
Issue
6
Pages
e2415051
ISSN
2574-3805 (ISSN-L)
DOI
10.1001/jamanetworkopen.2024.15051
PMC
PMC11154161
OpenAlex
W4399363851
Cited by
319
References
1
Citations by year
2026: 112 · 2025: 181 · 2024: 26
FWCI
89.68
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JAMA Network Open (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • PubMed Central (publishedVersion, cc-by)
Topics
  • Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
body roundness index, all-cause mortality, visceral obesity, body fat distribution, obesity, temporal trends, sex differences, Mexican American adults, U-shaped relationship, mortality risk, NHANES, United States adults, anthropometric measures, older adults, socioeconomic status, body fat percentage, body mass index, waist circumference
MeSH terms
Adult, Aged, Cause of Death, Female, Humans, Male, Middle Aged, Mortality, Nutrition Surveys, Obesity, Risk Factors, United States, Cohort Studies, Body Mass Index, Young Adult

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