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Body Roundness Index Can Predict Mortality Risks Better Than BMI

New research revealed that specific body roundness index (BRI) scores are associated with an increased risk of mortality from all causes. In light of the findings, the scientists suggest that BRI may be more effective than other body composition measurements for estimating an individual's risk of death.

Obesity is a known risk factor for several health conditions, including heart disease, type 2 diabetes, and high blood pressure. However, research suggests that subcutaneous adipose tissue, or fat beneath the skin, is less impactful on a person's health than visceral adipose tissue, which is fat surrounding the internal organs.

People with excess visceral fat may be at an increased risk of metabolic disorders and overall mortality, while those with more subcutaneous fat may have a lower risk of developing insulin sensitivity and type 2 diabetes.

Determining how much visceral fat an individual has can help healthcare providers identify who's more at risk for obesity-related mortality. However, recent research shows that traditional body fat measurements, such as body mass index (BMI), may not provide enough data to estimate fat distribution.

Instead, scientists say that body roundness index (BRI)—which combines height, waist circumference (WC), and hip circumference (HC) — may be more effective at measuring visceral and subcutaneous fat percentages. Generally, people with a rounder body shape tend to have higher BRI scores.

Still, whether BRI scores can predict mortality risks is unclear.

In a study published on June 5 in JAMA Network Open, investigators took a closer look at the associations between BRI and all-cause mortality and found that BRI can better predict an individual's risk of early mortality than BMI measurements. The scientists say that if further research shows similar results, healthcare providers could incorporate BRI in their patients' health risk assessments.

Body roundness and mortality risks

To conduct the study, scientists collected nearly 20 years of data from 32,995 participants in the National Health and Nutrition Examination Survey (NHANES) — a series of studies designed to assess the health and nutritional status of children and adults in the United States. The information included the participants' biennial BRI measurements, demographics, lifestyle factors, and mortality data.

After completing the analysis, the team found that the average BRI increased from 1999 through 2018, with a more pronounced increase in women, older adults, and individuals who identified as Mexican American.

They also found that compared to participants with mid-range BRIs of 4.5 to 5.5, those with low BRI measurements of less than 3.4 had a 25% increased risk of all-cause mortality, and participants with a high BRI of 6.9 or greater had a 49% increased risk of death from any cause.

The study's authors suggest that very low BRI can be accompanied by malnutrition, fatigue, reduced activity tolerance, and muscle atrophy, while high BRI is significantly associated with an increased risk of cardiovascular disease, metabolic disorders, and cancer. These conditions may help explain the higher mortality risks observed among study participants with low or high BRI scores.

Will BRI replace BMI measurements?

According to the study, previous research found that BRI was superior to other body fat measurements in estimating cardiometabolic disease, kidney disease, and cancer risks.

Whether healthcare providers will eventually calculate body fat distribution with BRI instead of BMI is unknown. Still, the study's findings suggest that it may be a more comprehensive method to assess a person's health risks.

"Our findings provide compelling evidence for the application of BRI as a noninvasive and easy-to-obtain screening tool for estimation of mortality risk and identification of high-risk individuals, a novel concept that could be incorporated into public health practice pending consistent validation in other independent studies," the study's authors wrote.

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