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Cited by 68Diabetes, Cardiovascular Risks, and LipoproteinsBody Composition Measurement TechniquesCardiovascular Disease and Adiposity

A nonlinear association between body roundness index and all-cause mortality and cardiovascular mortality in general population

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Zhou, Dan, Liu, Xiaocong, Huang, Yuqing, Feng, Yingqing·2022·Public Health Nutrition
DOI 10.1017/s1368980022001768PMC PMC9991644
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Abstract

Objective: The aim of the study was to investigate the association between body roundness index (BRI) and all-cause mortality and cardiovascular mortality in general population. Design: A retrospective cohort study. Setting: The status of cardiovascular mortality and all-cause mortality of participants were followed through 31 December 2015. Multivariate adjusted Cox restricted cubic spline regression models and Kaplan–Meier survival curves were used to evaluate the relationship between BRI and cardiovascular mortality and all-cause mortality. Participants: A sample of 47 356 participants from the National Health and Nutrition Examination Surveys 1999–2014 with aged ≥18 years. Results: Mean age was 47 years and female were 49·9 %. During a median follow-up of 92 months, 4715 participants died from any cause, with 985 died of CVD. In multivariate adjusted Cox regression, compared with the lowest quartile of Body roundness index (BRI), the hazard ratios (HR) for all-cause mortality from other quartiles were 0·83, 95 % CI (0·75, 0·92), 0·73, 95 % CI (0·65, 0·81) and 0·80, 95 % CI (0·72, 0·89), respectively ( P for trend < 0·05) and the HR for cardiovascular mortality from other quartiles were 0·79, 95 % CI (0·62, 1·00), 0·78, 95 % CI (0·62, 0·99) and 0·79, 95 % CI (0·62, 1·01), respectively ( P for trend > 0·05). In the restricted cubic spline regression models, the relationship was showed U-shaped between BRI and all-cause mortality and cardiovascular mortality. In Kaplan–Meier survival curves, the lowest cumulative survival rate of cardiovascular mortality and all-cause mortality was recorded in the highest BRI quartile. Conclusions: The U-shaped association between BRI and all-cause mortality and cardiovascular mortality in a large population-based cohort was observed.

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  • BRI incorporates waist circumference, offering a more comprehensive perspective on body shape than BMI.

    “Unlike the BMI, which is based solely on height and weight, the BRI incorporates waist circumference, offering a more comprehensive perspective on body shape17.”

    From The nonlinear association between body roundness index and infertility in married women (2025) · cites this paper as [17]

    The Methods (Data collection; page unavailable) state that BMI is calculated from weight and height and describe measuring waist circumference, but our copy omits the variables in the printed BRI formula. The Discussion says BMI does not account for fat distribution and that BRI reflects abdominal obesity or body shape, supporting the broader comparison. The copy does not explicitly establish that waist circumference is an input to BRI. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • 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 [25]

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Authors
Zhou, D., Liu, X., Huang, Y., & Feng, Y.
Affiliations
Guangdong Academy of Medical Sciences (CN)
Corresponding author
Feng, Yingqing
ORCID
Venue
Public Health Nutrition
Publisher
Cambridge University Press (CUP)
Published
2022-08-19
Volume
25
Issue
11
Pages
3008-3015
ISSN
  • 1368-9800 (ISSN-L)
  • 1475-2727
DOI
10.1017/s1368980022001768
PMC
PMC9991644
OpenAlex
W4292372591
Cited by
68
References
1
Citations by year
2026: 17 · 2025: 34 · 2024: 12 · 2023: 5
FWCI
9.45
Type
journal article
Language
en
Open access
Licence
Locations
  • Public Health Nutrition (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Funders
  • Guangdong Provincial People's Hospital (DFJH2020022, Y012018085)
  • Centers for Disease Control and Prevention
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Disease and Adiposity
Keywords
body roundness index, all-cause mortality, cardiovascular mortality, U-shaped relationship, body composition, adiposity, mortality risk
MeSH terms
Adolescent, Adult, Cardiovascular Diseases, Cardiovascular System, Female, Humans, Middle Aged, Nutrition Surveys, Retrospective Studies, Proportional Hazards Models

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