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Cited by 19Liver Disease Diagnosis and TreatmentBody Composition Measurement TechniquesDiabetes, Cardiovascular Risks, and Lipoproteins

Effectiveness of body roundness index for the prediction of nonalcoholic fatty liver disease: a systematic review and meta-analysis

Open access
Khanmohammadi, Shaghayegh, Fallahtafti, Parisa, Habibzadeh, Amirhossein, Ezzatollahi Tanha, Ali, Alamdari, Amir Ali, Fallahtafti, Parsa, Shafi Kuchay, Mohammad·2025·Lipids in Health and Disease
DOI 10.1186/s12944-025-02544-3PMC PMC11948846
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Abstract

BACKGROUND: Several anthropometric indices, such as body mass index and waist circumference, have been used as clinical screening tools for the prediction of nonalcoholic fatty liver disease (NAFLD). To further refine these clinical tools for NAFLD, the body roundness index (BRI) has recently been evaluated. In this systematic review and meta-analysis, the objective was to evaluate the relationship and predictive capability of the BRI in identifying NAFLD. METHODS: A comprehensive search was conducted in PubMed, Embase, Web of Science, and Scopus up to December 31, 2024. Eligibility criteria included observational studies on adults (≥ 18 years old) with measured BRI and its association with NAFLD. The Joanna Briggs Institute tool was used for risk of bias assessment. Meta-analyses used random-effects models to pool data on mean difference, odds ratio, sensitivity, specificity, and the area under the curve (AUC), with heterogeneity and publication bias assessed. RESULTS: Ten studies involving 59,466 participants were included. The pooled mean difference in BRI between the NAFLD and non-NAFLD groups was 1.73 (95% confidence interval [CI]: 1.31-2.15). The pooled sensitivity and specificity of BRI for diagnosing NAFLD were 0.806 and 0.692, respectively. The pooled AUC for BRI was 0.803 (95% CI: 0.775-0.830), indicating good diagnostic accuracy. Unlike subgroup analysis by country, subgroup analysis by sex showed no significant differences. Higher BRI values were associated with increased odds of NAFLD (pooled OR = 2.87, 95% CI: 1.39; 5.96). Studies provided mixed results on the predictive ability of BRI compared to other indices like body mass index, mostly favoring BRI over conventional indices. CONCLUSION: BRI demonstrates a good diagnostic performance for NAFLD, suggesting it may be a valuable clinical tool for NAFLD assessment. Further research is necessary to validate these findings and strengthen the evidence base.

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic review and meta-analysis of 10 cross-sectional studies involving 59,466 adults found that the body roundness index (BRI) has good diagnostic accuracy for nonalcoholic fatty liver disease (NAFLD). Higher BRI was associated with greater odds of NAFLD, though heterogeneity was high and all included studies were cross-sectional.

Key findings

  • The pooled mean difference in BRI between NAFLD and non-NAFLD groups was 1.73 (95% CI: 1.31–2.15); female subgroup MD was 2.07 (95% CI: 1.42–2.73) and male subgroup MD was 1.42 (95% CI: 0.81–2.03), with no statistically significant difference between sexes.
  • Pooled sensitivity and specificity of BRI for diagnosing NAFLD were 0.806 and 0.692, respectively; pooled AUC was 0.803 (95% CI: 0.775–0.830), and the Reitsma-model AUC was 0.786 with partial AUC 0.801.
  • Higher BRI values were associated with increased odds of NAFLD: pooled OR = 2.87 (95% CI: 1.39–5.96) per unit increase.
  • Comparisons with other indices were mixed: some studies favored BRI over BMI, WC, and ABSI, while others found BMI, HSI, FLI, or TyG-related parameters had higher accuracy; country subgroup differences were significant, but sex subgroup differences were not.

Methods

  • Systematic review and meta-analysis following PRISMA, registered with PROSPERO (CRD42024554538); searched PubMed, Embase, Web of Science, and Scopus to December 31, 2024 for observational studies in adults ≥18 years with measured BRI and NAFLD.
  • Included 10 cross-sectional studies totaling 59,466 participants from the USA (n = 4), China (n = 2), Japan (n = 1), Taiwan (n = 1), Italy (n = 1), and Iran (n = 1); NAFLD was diagnosed by transient elastography in 4 studies and ultrasound in 6.
  • Random-effects models (REML) pooled mean differences, odds ratios, sensitivity, specificity, and AUC; bivariate Reitsma model estimated AUC from sensitivity/specificity; heterogeneity assessed with I² and Cochran’s Q; subgroup analyses by sex and country, meta-regression on BMI, and Egger’s test/funnel plots for publication bias.

Limitations

  • The paper states significant heterogeneity among included studies; cross-sectional designs preclude establishing cause-and-effect; NAFLD diagnostic methods varied and none used liver biopsy; there is no consensus on optimal BRI cut-off values; and heterogeneous reporting prevented pooling all included studies.
  • Evident from the text: all included studies were cross-sectional, heterogeneity was very high (e.g., I² = 100% for the mean difference analysis and 96% for the AUC analysis), and country subgroup differences were significant, which may limit generalizability.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/s12944-025-02544-3

Cites

53 of 53 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

19 of 26 cited sources checked · 10 supported · 1 flagged · accuracy not yet measured

  • Premisecitation

    BRI outperformed other common anthropometric obesity-related measures, including BMI, WC, and ABSI, in assessing NAFLD risk.

    “Additionally, BRI outperformed other common anthropometric obesity‐related measures, including BMI, WC, and a body shape index (ABSI), in assessing NAFLD risk [13].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [13] Jiang N, et al. Association between body roundness index and non-alcoholic fatty liver disease detected by fibroscan in America. J Clin Lab Anal. 2023;37(19–20):e24973. source
  • Premisecitation

    A study using data from a large cross-sectional survey found that participants with NAFLD had a higher BRI level compared to those in the non-NAFLD group.

    “A study using data from a large cross-sectional survey found that participants with NAFLD had a higher BRI level compared to those in the non‐NAFLD group, and the prevalence of NAFLD was found to have a positive association with BRI, regardless of age, gender, and BMI.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [13] Jiang N, et al. Association between body roundness index and non-alcoholic fatty liver disease detected by fibroscan in America. J Clin Lab Anal. 2023;37(19–20):e24973. source
  • Findingcitation

    In Tian et al. [26], the OR for the 4th quartile of BRI compared to the first quartile for NAFLD was 72.08 (95% CI 48.66-106.77).

    “In the study by Tian et al. [26], each quartile of BRI was compared to the first quartile regarding association with NAFLD, and their result showed the OR for the 4th quartile was 72.08 (95%CI: 48.66-106.77).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [26] Tian X, et al. Comparison of Obesity-Related indicators for nonalcoholic fatty liver disease diagnosed by transient elastography. Turk J Gastroenterol. 2023;34(10):1078–87. source

      The Results section (Characteristics of the Study Population; page unavailable) says that NAFLD odds ratios increased across quartiles of each obesity-related index, which includes BRI. Our copy does not provide the claimed fourth-versus-first-quartile OR of 72.08 or its 95% CI of 48.66–106.77. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • Rests on an assumption: The reference standards used in the included studies (ultrasound and transient elastography with CAP cutoffs) accurately classify NAFLD.
    • Rests on an assumption: The BRI measurements and diagnostic accuracy estimates from the included studies are comparable enough to pool despite differences in populations, NAFLD diagnostic methods, and cutoffs.
  • Findingcitation

    Xie et al. [25] showed that the OR for the 4th quartile of BRI was 50.41 (28.71, 88.53) compared to the first quartile.

    “Moreover, Xie et al. [25] showed that the OR for the 4th quartile was 50.41 (28.71, 88.53) compared to the first quartile (Table 2).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [25] Xie FF, et al. Comparison of obesity-related indices for identifying nonalcoholic fatty liver disease: a population-based cross-sectional study in China. Volume 20. LIPIDS IN HEALTH AND DISEASE; 2021. 1. source
    • Rests on an assumption: The reference standards used in the included studies (ultrasound and transient elastography with CAP cutoffs) accurately classify NAFLD.
    • Rests on an assumption: The BRI measurements and diagnostic accuracy estimates from the included studies are comparable enough to pool despite differences in populations, NAFLD diagnostic methods, and cutoffs.
  • Premisecitation

    Liver biopsy is the gold standard for diagnosing and grading NAFLD.

    “Although liver biopsy is the gold standard for diagnosing and grading NAFLD, however, it can not be used as a screening tool [39].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [39] Ando Y, Jou JH. Nonalcoholic fatty liver disease and recent guideline updates. Clin Liver Dis (Hoboken). 2021;17(1):23–8. source

      In “How Should NAFLD Be Diagnosed, and How Should It Be Monitored?”, the review calls liver histology the gold standard for distinguishing steatohepatitis from simple steatosis and staging fibrosis. It also says biopsy should be considered only in select individuals because of its invasiveness and cost, supporting the screening limitation. It does not call biopsy the gold standard for diagnosing NAFLD generally; the review says diagnosis can use imaging or histology. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
  • Classified as probably not a substantial claim. 25
  • May combine two claims. 17
  • The quote only partly states this claim. 1

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Two full-text studies were excluded due to being non-English and not reporting BRI.

    “Upon conducting a thorough full-text review of these 12 studies, two were excluded due to being non-English [22] and not reporting BRI [23].”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [22] Renyuan W, et al. Predictive value of different body obesity measures for nonalcoholic fatty liver disease. Chin J Health Manage. 2023;17(8):591–7.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [23] Suvarna R, et al. Anthropometric indices and type 2 diabetes mellitus as a risk factor in predicting nonalcoholic fatty liver Disease - A prospective study in Indian population. Indian J Community Med. 2022;47(3):386–90. source

      Citation [23] is attached to the assertion that this study did not report BRI. The Results section explicitly reports a significant association between BRI and fatty-liver grade (P = 0.010) and gives a BRI correlation coefficient of 0.237. The non-English exclusion is attached to a different citation, [22]. (LLM, conf=0.94)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Another population-based cross-sectional study discovered that BRI and WHtR have stronger correlations with NAFLD compared to ABSI and WHR.

    “Another population-based cross-sectional study discovered that BRI and waist-to-height ratio (WHtR) have stronger correlations with NAFLD compared to ABSI and waist-to-hip ratio (WHR) [14].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [14] Motamed N, et al. Body roundness index and Waist-to-Height ratio are strongly associated with Non-Alcoholic fatty liver disease: A Population-Based study. Hepat Mon. 2016;16(9):e39575. source

  • May combine two claims.

    Premisecitation

    BRI has limitations including the need for further validation in diverse populations and the lack of clear evidence demonstrating its superiority over conventional biomarkers in all clinical contexts.

    “However, its limitations include the need for further validation in diverse populations and the lack of clear evidence demonstrating its superiority over conventional biomarkers in all clinical contexts [12].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [12] Kang SM, et al. Android fat depot is more closely associated with metabolic syndrome than abdominal visceral fat in elderly people. PLoS ONE. 2011;6(11):e27694. source

      The Discussion (page unavailable) calls for further study because findings about DXA-measured android fat came from a small, single cohort of older adults. Our copy does not address BRI or its validation across populations or clinical contexts; searches for BRI, diverse-population validation, and superiority over conventional biomarkers found no relevant passage. (LLM, conf=0.78)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    This systematic review and meta-analysis adhered to PRISMA guidelines.

    “This systematic review and meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [15].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [15] Page MJ, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. PLoS Med. 2021;18(3):e1003583. source

  • Classified as probably not a substantial claim.

    Premisecitation

    The prevalence of NAFLD was found to have a positive association with BRI, regardless of age, gender, and BMI.

    “A study using data from a large cross-sectional survey found that participants with NAFLD had a higher BRI level compared to those in the non‐NAFLD group, and the prevalence of NAFLD was found to have a positive association with BRI, regardless of age, gender, and BMI.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [13] Jiang N, et al. Association between body roundness index and non-alcoholic fatty liver disease detected by fibroscan in America. J Clin Lab Anal. 2023;37(19–20):e24973. source

  • May combine two claims.

    Premisecitation

    BRI offers potential advantages, such as incorporating both height and WC to provide a more comprehensive estimate of body composition, which may better reflect visceral adiposity compared to BMI alone.

    “BRI offers potential advantages, such as incorporating both height and waist circumference (WC) to provide a more comprehensive estimate of body composition, which may better reflect visceral adiposity compared to body mass index (BMI) alone.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [12] Kang SM, et al. Android fat depot is more closely associated with metabolic syndrome than abdominal visceral fat in elderly people. PLoS ONE. 2011;6(11):e27694. source

      The Results (Table 2; page unavailable) report separate correlations of BMI and waist circumference with visceral fat, while the Discussion addresses DXA and CT assessment of body composition. Searches for “body roundness index,” “BRI,” and height-and-waist-based estimation found no passage defining BRI or comparing its estimate of visceral adiposity with BMI. (LLM, conf=0.76)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In 2013, Thomas DM and colleagues presented the body roundness index (BRI) as a predictor of visceral adiposity tissue and body fat percentage.

    “In 2013, Thomas DM and colleagues presented the body roundness index (BRI) as a predictor of visceral adiposity tissue and body fat percentage [10].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [10] Thomas DM, et al. Relationships between body roundness with body fat and visceral adipose tissue emerging from a new geometrical model. Obes (Silver Spring). 2013;21(11):2264–71. source

  • May combine two claims.

    Premisecitation

    Imaging techniques are not ideal for mass screening due to significant drawbacks including high cost, lack of safety, lack of consensus, limited accessibility, and complexity.

    “However, these methods are usually used for disease diagnosis and are not ideal for mass screening due to significant drawbacks, including high cost (CT and MRI scans), lack of safety (CT scans), lack of consensus (biomarker-based indices), limited accessibility (transient elastography, MRI scans), and complexity (MRI scans) [41, 42].”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [41] Jang W, Song JS. Non-Invasive imaging methods to evaluate Non-Alcoholic fatty liver disease with fat quantification: A review. Diagnostics. 2023;13(11):1852. source

      The Conclusions (page not provided) identify MRI as costly and time-consuming and CT radiation exposure as a drawback. They do not say these methods are unsuitable for mass screening or substantiate CT cost, lack of consensus for biomarker-based indices, or limited access to transient elastography and MRI. The review instead describes CT as readily available. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [42] Kechagias S, et al. Non-invasive diagnosis and staging of non-alcoholic fatty liver disease. Hormones. 2022;21(3):349–68. source

      The Steatosis sections on computed tomography and magnetic resonance techniques (pages not provided) support CT radiation exposure and MRI’s cost, limited availability, and time demands. The serum-biomarker section says no algorithm can yet be recommended as an initial NAFLD screening tool. The copy does not identify high CT cost as a drawback, and the Clinical implications section calls VCTE the most widely available liver-stiffness measurement device, rather than describing it as having limited accessibility. (LLM, conf=0.87)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingreasoning

    Two studies [24, 25] were rated as low-quality evidence due to serious limitations in risk of bias, supporting weak recommendations.

    “Two studies [24, 25] were rated as low-quality evidence due to serious limitations in risk of bias, supporting weak recommendations.”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [24] Lin IT et al. Gender differences in the relationships among metabolic syndrome and various Obesity-Related indices with nonalcoholic fatty liver disease in a Taiwanese population. Int J Environ Res Public Health, 2021. 18(3). source
    • cites [25] Xie FF, et al. Comparison of obesity-related indices for identifying nonalcoholic fatty liver disease: a population-based cross-sectional study in China. Volume 20. LIPIDS IN HEALTH AND DISEASE; 2021. 1. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The certainty of evidence for each outcome was assessed using the GRADE framework.

    “The certainty of evidence for each outcome was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework [16].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [16] Santesso N, et al. GRADE guidelines 26: informative statements to communicate the findings of systematic reviews of interventions. J Clin Epidemiol. 2020;119:p126–135. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    BRI incorporates additional body shape dimensions, including WC and height, to evaluate obesity and its associated health risks.

    “Unlike conventional obesity-related anthropometric indices such as BMI, which primarily consider weight and height, BRI incorporates additional body shape dimensions, including WC and height, to accurately evaluate obesity and its associated health risks [10].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [10] Thomas DM, et al. Relationships between body roundness with body fat and visceral adipose tissue emerging from a new geometrical model. Obes (Silver Spring). 2013;21(11):2264–71. source

      The Introduction describes BRI as a measure of body girth relative to height, and the Results report slightly improved predictions of body fat and visceral adipose tissue compared with BMI. But the Discussion says it remains to be shown how BRI relates to mortality and other health markers, so the claim that it accurately evaluates associated health risks goes beyond the paper's findings. No page numbers are available in our copy. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingnone given

    Studies provided mixed results on the predictive ability of BRI compared to other indices like BMI, mostly favoring BRI over conventional indices.

    “Studies provided mixed results on the predictive ability of BRI compared to other indices like body mass index, mostly favoring BRI over conventional indices.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The BRI measurements and diagnostic accuracy estimates from the included studies are comparable enough to pool despite differences in populations, NAFLD diagnostic methods, and cutoffs.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    After merging and removing duplicates, 23 unique studies remained.

    “After merging the results and removing duplicate entries, the number of unique studies was reduced to 23.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The initial search yielded 70 results, with 14 from Embase, 16 from Web of Science, 17 from PubMed, and 23 from Scopus.

    “The initial search yielded a total of 70 results, with 14 results from Embase, 16 from Web of Science, 17 from PubMed, and 23 from Scopus.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    The controlled attenuation parameter (CAP) cut-off in transient elastography varied from 248 to 274 dB/m.

    “The controlled attenuation parameter (CAP) cut-off in transient elastography varied from 248 to 274 dB/m.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The meta-analysis included data on more than 59,000 individuals.

    “including data on more than 59,000 individuals”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    A consistent dose-response relationship was observed across multiple studies, with higher exposure levels associated with significantly increased odds of outcomes.

    “A consistent dose-response relationship was observed across multiple studies, with higher exposure levels associated with significantly increased odds of outcomes.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Transient elastography and ultrasound were used to diagnose NAFLD in four and six studies, respectively.

    “Transient elastography and ultrasound were used to diagnose NAFLD in four and six studies, respectively.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Twenty-three studies were screened, leading to selection of 12 studies for full-text review.

    “These 23 studies were screened for eligibility based on their titles and abstracts, leading to the selection of 12 studies for a full-text review.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Findingown data

    The meta-analysis incorporated data from 7 evaluations to evaluate the association between BRI and the odds of NAFLD.

    “The meta-analysis incorporated data from 7 evaluations to evaluate the association between the BRI and the odds of NAFLD.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The BRI measurements and diagnostic accuracy estimates from the included studies are comparable enough to pool despite differences in populations, NAFLD diagnostic methods, and cutoffs.

  • The quote only partly states this claim.

    Findingown data

    Meta-regression showed a significant positive association between BMI and the effect size for MD (β = 0.1994, SE = 0.0552, z = 3.6145, p = 0.0003; 95% CI 0.0913 to 0.3075).

    “The model revealed a significant positive association between BMI and the effect size (β = 0.1994, SE = 0.0552, z = 3.6145, p = 0.0003; 95% CI: 0.0913 to 0.3075).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The BRI measurements and diagnostic accuracy estimates from the included studies are comparable enough to pool despite differences in populations, NAFLD diagnostic methods, and cutoffs.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Ten studies from countries including the USA (n = 4), China (n = 2), Japan (n = 1), Taiwan (n = 1), Italy (n = 1), and Iran (n = 1) were included.

    “Overall, ten studies from countries including the USA (n = 4), China (n = 2), Japan (n = 1), Taiwan (n = 1), Italy (n = 1), and Iran (n = 1) were included.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Publication bias was undetected in all studies, and no significant issues with inconsistency, indirectness, or imprecision were identified in the majority of the evidence.

    “Publication bias was undetected in all studies, and no significant issues with inconsistency, indirectness, or imprecision were identified in the majority of the evidence.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Based on GRADE, 8 of 10 studies provided moderate-quality evidence, supporting strong recommendations for the association between exposure variables and outcomes in NAFLD patients.

    “Based on GRADE, the majority of studies (8 out of 10) provided moderate-quality evidence, supporting strong recommendations for the association between exposure variables and outcomes in NAFLD patients.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The meta-analysis included 14 evaluations of the association between BRI and NAFLD.

    “The meta-analysis included a total of 14 evaluations of the association between BRI and NAFLD.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The BRI measurements and diagnostic accuracy estimates from the included studies are comparable enough to pool despite differences in populations, NAFLD diagnostic methods, and cutoffs.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    BRI has been found to effectively predict metabolic syndrome in men and women from various subgroups.

    “BRI has been found to effectively predict metabolic syndrome in men and women from various subgroups [11].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11] Rico-Martín S, et al. Effectiveness of body roundness index in predicting metabolic syndrome: A systematic review and meta-analysis. Obes Rev. 2020;21(7):e13023. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    This systematic review and meta-analysis was registered with PROSPERO under registration number CRD42024554538.

    “This systematic review and meta-analysis was registered with the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42024554538.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Publication bias was evaluated using Egger's test and visual inspection of funnel plots.

    “Publication bias was evaluated using Egger’s test [21] and visual inspection of funnel plots.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [21] Egger M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–34. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Two reviewers independently assessed risk of bias using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies.

    “As the study design of all included studies was cross-sectional, two reviewers (PF and AH) independently assessed the risk of bias in the included studies using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Analytical Cross-Sectional Studies (https://jbi.global/critical-appraisal-tools).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Two independent reviewers extracted data using a standardized data extraction form, with discrepancies resolved through discussion or third reviewer.

    “Two independent reviewers (PF and SK) extracted data using a standardized data extraction form.”
    • Also stated in: § Data extraction · plain
      “Discrepancies between reviewers were resolved through discussion or consultation with the third reviewer (AH).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Various factors such as age, sex, comorbidities, and ethnicity could influence the diagnostic accuracy of anthropometric indices.

    “Various factors, such as age, sex, comorbidities, and ethnicity, could influence the diagnostic accuracy of anthropometric indices.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductnone given

    Not all studies used the same method to diagnose NAFLD, and none used liver biopsy.

    “Not all studies used the same method to diagnose NAFLD in participants, and none of them used liver biopsy, the gold standard for NAFLD diagnosis.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    This study is the first systematic review and meta-analysis of BRI in patients with NAFLD.

    “In the available literature, this study is the first systematic review and meta-analysis of BRI in patients with NAFLD.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The substantial heterogeneity could stem from variations in participants' comorbid conditions, study design, concomitant drug use, NAFLD diagnostic methods, dietary habits, adjusted covariates, and BRI threshold values.

    “This substantial heterogeneity could stem from variations in the participants’ comorbid conditions and other characteristics, variations in study design, concomitant drug use, differences in NAFLD diagnostic methods, dietary habits, different adjusted covariates, and threshold values for the BRI.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    The included studies had heterogeneous methods for reporting data, so pooling all included studies was not possible.

    “Lastly, the included studies had heterogeneous methods for reporting data; thus, pooling all included studies was not possible.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based). May combine two claims.

    Study design and conductnone given

    Extensive and rigorous methods were used to search published literature and perform meta-analysis.

    “In this study, extensive and rigorous methods were used to search published literature and perform meta-analysis.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    BRI appears to be a promising and cost-effective tool for NAFLD screening.

    “While BRI appears to be a promising and cost-effective tool for NAFLD screening, the limited number of included studies and high heterogeneity among them warrant cautious interpretation of these findings.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Non-invasive anthropometric measures are affordable, cost-effective, easily implementable, and valuable for early detection and risk stratification of NAFLD.
37 of 37

  • The paper relies on this without support.

    The reference standards used in the included studies (ultrasound and transient elastography with CAP cutoffs) accurately classify NAFLD.

    “Transient elastography and ultrasound were used to diagnose NAFLD in four and six studies, respectively.”
    “The controlled attenuation parameter (CAP) cut-off in transient elastography varied from 248 to 274 dB/m.”

  • The paper relies on this without support.

    The BRI measurements and diagnostic accuracy estimates from the included studies are comparable enough to pool despite differences in populations, NAFLD diagnostic methods, and cutoffs.

    “Since some studies have reported their data only for subgroups, the number of evaluations for each analysis differs from the included studies.”
    “The meta-analysis included 14 evaluations assessing the diagnostic accuracy of the BRI for diagnosing NAFLD.”

  • The paper relies on this without support.

    Non-invasive anthropometric measures are affordable, cost-effective, easily implementable, and valuable for early detection and risk stratification of NAFLD.

    “Non-invasive anthropometric measures offer significant advantages for the initial assessment, screening, and risk stratification of NAFLD, particularly in resource-limited settings. These tools are affordable, cost-effective, and easily implementable, making them valuable for facilitating early detection and identifying individuals at risk for NAFLD.”
3 of 3

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Consistentz = 8.1reported p < .0001 · recomputed p < .001

    “z = 8.10, p < .0001”

  • Consistentz = 6.18reported p < .0001 · recomputed p < .001

    “z = 6.18, p < .0001”

  • Consistentz = 4.55reported p < .0001 · recomputed p < .001

    “z = 4.55, p < .0001”

  • Consistentz = -1.43reported p = .1538 · recomputed p = .153

    “z = -1.43, p = .1538”

  • Consistentz = 3.6145reported p = .0003 · recomputed p < .001

    “z = 3.6145, p = .0003”

  • Consistentz = 57.16reported p < .0001 · recomputed p < .001

    “z = 57.16, p < .0001”

  • Consistentz = 33.16reported p < .0001 · recomputed p < .001

    “z = 33.16, p < .0001”

  • Consistentz = 24.42reported p < .0001 · recomputed p < .001

    “z = 24.42, p < .0001”

  • Consistentz = -0.94reported p = .3449 · recomputed p = .347

    “z = -0.94, p = .3449”

  • Consistentz = -0.1926reported p = .8472 · recomputed p = .847

    “z = -0.1926, p = .8472”

  • Consistentz = 2.84reported p = .0045 · recomputed p = .005

    “z = 2.84, p = .0045”

11 of 11

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Two different WHR odds ratios are both assigned to females

    Minor

    The same comparison of WHR with NAFLD gives two different odds ratios, 3.123 and 1.628, both labeled as female results, without distinguishing them otherwise.

  • Male odds ratio lies outside its confidence interval

    Minor

    The reported male odds ratio is 3.32, but its stated 95% confidence interval ends at 3.22.

  • Xie overall median is below both sex-specific medians

    Minor

    The reported non-NAFLD median of 3.22 is below both the female median of 21.6 and the male median of 3.24. An overall median cannot be below both subgroup medians; the table itself notes that the female value may have been inaccurately reported.

3 of 3

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. Renyuan W, et al. Predictive value of different body obesity measures for nonalcoholic fatty liver disease. Chin J Health Manage. 2023;17(8):591–7.

Cited by

Sorted by citations

Related

Authors
Khanmohammadi, S., Fallahtafti, P., Habibzadeh, A., Ezzatollahi Tanha, A., Alamdari, A. A., Fallahtafti, P., & Shafi Kuchay, M.
Affiliations
  • Children's Medical Center (IR)
  • Tehran University of Medical Sciences (IR)
  • Shahid Beheshti University (IR)
Corresponding author
Khanmohammadi, Shaghayegh
ORCID
Venue
Lipids in Health and Disease
Publisher
Springer Science and Business Media LLC
Published
2025-03-27
Volume
24
Issue
1
Pages
117-117
ISSN
1476-511X (ISSN-L)
DOI
10.1186/s12944-025-02544-3
PMC
PMC11948846
OpenAlex
W4408867690
Cited by
19
References
53
Citations by year
2026: 12 · 2025: 7
FWCI
4.63
Type
journal article
Language
en
Open access
Licence
Locations
  • Lipids in Health and Disease (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion, cc-by-nc-nd)
  • Europe PMC (PubMed Central) (submittedVersion, cc-by-nc-nd)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
  • Health Sciences › Medicine › Physiology › Body Composition Measurement Techniques
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
body roundness index, non-alcoholic fatty liver disease, anthropometric indices, diagnostic accuracy, screening, body mass index, waist circumference, sex differences
MeSH terms
Adult, Anthropometry, Female, Humans, Male, Body Mass Index, Waist Circumference, Non-alcoholic Fatty Liver Disease

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-20.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-20.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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