Association of Multiple Obesity-Related Composite Indices with All-Cause Mortality in Patients with Stage 0–3 Cardiovascular-Kidney-Metabolic Syndrome

Q: What are the key findings of this study?

Body roundness index (BRI) was the strongest predictor of all-cause mortality in CKM stages 0-3, with the highest quartile increasing mortality risk by 83% compared to the lowest quartile (HR 1.834).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Cardiovascular-kidney-metabolic (CKM) syndrome stages 0-3 (n=261742). Intervention: Body roundness index (BRI) highest quartile vs. Lowest quartile. Primary outcome: All-cause mortality (HR 1.834, 95% CI 1.721-1.954, p=<0.001).

Q: What does this research mean for the field?

Body roundness index (BRI) is the strongest predictor of all-cause mortality among obesity-related indices in patients with stage 0-3 cardiovascular-kidney-metabolic syndrome, with the highest quartile increasing mortality risk by 83% compared to the lowest quartile. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To determine the predictive ability of eight obesity-related composite indices for all-cause mortality in individuals with stages 0–3 cardiovascular-kidney-metabolic syndrome.

Jianmin Lu; Jie Yang; Zhuoyi Peng; Cilu Huang; Yue Chen; C J Zhang; Baohua Hou; Xiaoqing He; S H. M. Huang

doi:10.3803/enm.2025.2711

May 7, 2026Endocrinology and MetabolismOpen Access

Association of Multiple Obesity-Related Composite Indices with All-Cause Mortality in Patients with Stage 0–3 Cardiovascular-Kidney-Metabolic Syndrome

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Key result

Highest body roundness index quartile linked to ~83% greater all-cause mortality in CKM stages 0-3.

HR 1.834
95% CI 1.721-1.954
P<0.001
n=261,742

Why the study?

Conventional anthropometric measures are inadequate, leading to an open question regarding the predictive ability of eight composite obesity-related indices for all-cause mortality in adults with CKM stages 0-3.

Do composite obesity-related indices predict all-cause mortality in adults with CKM syndrome stages 0-3?

Key Points

To determine the predictive ability of eight obesity-related composite indices for all-cause mortality in individuals with stages 0–3 cardiovascular-kidney-metabolic syndrome.
Prospective cohort study analyzing 261,742 adults with baseline cardiovascular-kidney-metabolic syndrome stages 0–3 from the UK Biobank.
Evaluated eight indices (body mass index, relative fat mass, body roundness index, lipid accumulation product, visceral adiposity index, cardiometabolic index, atherogenic index of plasma, and triglyceride-glucose index) using multivariable logistic regression, Cox proportional hazards models, and receiver operating characteristic analysis.
During follow-up, 13,437 deaths (5.1%) occurred, and all eight indices showed a statistically significant positive association with all-cause mortality (P<0.001).
Body roundness index demonstrated the highest discriminatory accuracy for mortality (AUC=0.658; 95% CI, 0.653 to 0.662; optimal cutoff=4.515), outperforming lipid accumulation product (AUC=0.616) and cardiometabolic index (AUC=0.610), whereas relative fat mass had the lowest discrimination (AUC=0.502; 95% CI, 0.497 to 0.507).
Compared with the lowest quartile, individuals in the highest quartile had significantly elevated mortality risk for relative fat mass (HR, 2.355; 95% CI, 2.202 to 2.518), body roundness index (HR, 1.834; 95% CI, 1.721 to 1.954), and body mass index (HR, 1.459; 95% CI, 1.378 to 1.545; all P<0.001).

Study Design

Type

Cohort (n=261,742)

Multicenter

Yes

Structured PICO

Do composite obesity-related indices predict all-cause mortality in adults with CKM syndrome stages 0-3?

P

Population

261,742 adults with cardiovascular-kidney-metabolic (CKM) syndrome stages 0-3 at baseline from the UK Biobank

I

Intervention

Eight composite obesity-related indices (body mass index, relative fat mass [RFM], body roundness index [BRI], lipid accumulation product [LAP], visceral adiposity index, cardiometabolic index [CMI], atherogenic index of plasma, and triglyceride-glucose index)

O

Outcome

All-cause mortalityhard clinical

Main Result

Effect estimate: HR 1.834 (95% CI 1.721-1.954)

p-value: p=<0.001

Limitations

Cohort primarily included UK residents aged 40 to 69 years of predominantly European descent, limiting generalizability to other ethnicities and age groups.
Observational design leaves potential for residual confounding from lifestyle differences and self-report bias.
Clinical data and disease staging within the database are subject to temporal lag.
Mortality outcomes were limited to all-cause death without detailed cause-specific information.
BRI as a single anthropometric indicator cannot capture all biological and clinical factors contributing to mortality.

Implication

Body roundness index (BRI) is the strongest predictor of all-cause mortality among obesity-related indices in patients with CKM syndrome stages 0-3, offering a robust tool for early risk stratification.

Abstract

Background: This study aimed to determine the predictive ability of eight composite obesity-related indices for all-cause mortality in adults with cardiovascular-kidney-metabolic (CKM) syndrome stages 0-3, given the inadequacy of conventional anthropometric measures. Methods: We conducted a prospective cohort study using UK Biobank data, including 261,742 adults with CKM stages 0-3 at baseline. Eight indices (body mass index, relative fat mass [RFM], body roundness index [BRI], lipid accumulation product [LAP], visceral adiposity index, cardiometabolic index [CMI], atherogenic index of plasma, and triglyceride-glucose index) were evaluated using multivariable logistic regression, Cox proportional hazards models, receiver operating characteristic analysis, and restricted cubic spline (RCS) modeling to examine their associations with, and predictive ability for, all-cause mortality. Results: During follow-up, 13,437 deaths (5.1%) occurred. All eight indices were positively associated with mortality (P<0.001). BRI was the strongest predictor (area under the curve [AUC]=0.658; optimal cutoff=4.515), outperforming LAP (AUC=0.616) and CMI (AUC=0.610). RFM exhibited the lowest discriminative ability (AUC=0.502). Higher quartiles of most indices were associated with progressively increased mortality risk, with BRI demonstrating consistent predictive value across subgroups in RCS analyses. Conclusion: BRI showed the strongest and most consistent association with all-cause mortality in CKM stages 0-3, suggesting that it may act as a robust tool for early risk stratification and support targeted prevention strategies.

Discussion

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Cite This Study

Lu et al. (2026) conducted a cohort in Cardiovascular-kidney-metabolic (CKM) syndrome stages 0-3 (n=261,742). Body roundness index (BRI) highest quartile vs. Lowest quartile was evaluated on All-cause mortality (HR 1.834, 95% CI 1.721-1.954, p=<0.001). Body roundness index (BRI) was the strongest predictor of all-cause mortality in CKM stages 0-3, with the highest quartile increasing mortality risk by 83% compared to the lowest quartile (HR 1.834).

synapsesocial.com/papers/69fed0c1b9154b0b82877d3f https://doi.org/10.3803/enm.2025.2711

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Association of Multiple Obesity-Related Composite Indices with All-Cause Mortality in Patients with Stage 0–3 Cardiovascular-Kidney-Metabolic Syndrome

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Association of Multiple Obesity-Related Composite Indices with All-Cause Mortality in Patients with Stage 0–3 Cardiovascular-Kidney-Metabolic Syndrome

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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