Key result
Body roundness index outperforms waist circumference and BMI for ASCVD discrimination.
Why the study?
Do different anthropometric indices (BMI, WC, BRI) have distinct prognostic associations with ASCVD, all-cause mortality, and atrial fibrillation in older adults?
Cohort (n=1,199,633)
Do different anthropometric indices (BMI, WC, BRI) have distinct prognostic associations with ASCVD, all-cause mortality, and atrial fibrillation in older adults?
Effect estimate: AUC 0.553
p-value: p=<0.05
Different anthropometric indices capture distinct aspects of adiposity risk, with BRI best predicting ASCVD, BMI best predicting mortality, and WC best predicting atrial fibrillation, though all offer only modest prognostic discrimination.
BRI may refine CV risk stratification beyond BMI/WC in older Koreans; leaves open whether it improves outcomes or warrants practice change.
BACKGROUND AND AIMS: The global escalation of obesity necessitates precise tools for assessing diverse health risks. This study aimed to compare the prognostic associations of body mass index (BMI), waist circumference (WC), and the body roundness index (BRI) across multiple cardiovascular and mortality outcomes in a large cohort of Korean adults using a nationwide database. METHODS: This retrospective cohort study analyzed 1,199,633 Korean adults (aged ≥55 years) from the National Health Insurance Service database. Prognostic association for atherosclerotic cardiovascular disease (ASCVD), all-cause mortality, and atrial fibrillation (AF) over a 10-year follow-up was assessed using receiver operating characteristic (ROC) analysis and multivariable Cox proportional hazards models. RESULTS: No single index consistently outperformed the others; rather, association was outcome-specific. BRI demonstrated the highest discrimination for ASCVD (AUC: 0.553) compared to WC (0.540) and BMI (0.512; P < 0.05 for all). Conversely, BMI showed the highest AUC for all-cause mortality (0.595), largely due to a significant inverse relationship in the underweight category. For incident AF, WC showed the highest AUC (0.567), followed by BRI (0.550) and BMI (0.527). Restricted cubic spline analyses revealed non-linear (U-shaped or J-shaped) relationships for most outcomes. CONCLUSIONS: These findings indicate that each anthropometric index captures distinct biological aspects of adiposity, highlighting the need to consider the specific clinical outcome when interpreting obesity-related risk.
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Jeon et al. (2026) conducted a cohort in General population (adults aged ≥55 years) (n=1,199,633). Body roundness index (BRI) vs. Body mass index (BMI) and waist circumference (WC) was evaluated on Atherosclerotic cardiovascular disease (ASCVD) (AUC 0.553, p=<0.05). The body roundness index demonstrated the highest discrimination for atherosclerotic cardiovascular disease (AUC 0.553) compared to waist circumference (0.540) and BMI (0.512), though no single index was best across all outcomes.
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