Most health professionals are well versed in BMI (Body Mass Index) as a health measure associated with mortality, but have you heard of BRI? BRI stands for Body Roundness Index. It’s a measure of visceral obesity that may be linked with all-cause mortality.

A recent cohort study published in JAMA Network Open with nearly 33,000 adults found that mean BRI jumped from 4.80 to 5.62 from 1999 to 2018 with a change of .95% every other year. The link between BRI and an increased risk for all-cause mortality was observed with both the lowest and highest BRI. This data suggests that BRI could be used as a novel anthropometric measure linked to all-cause mortality.

Abdominal obesity (AKA visceral obesity) is a known risk factor linked with all-cause mortality. But the lack of anthropometric measures to evaluate fat distribution requires a more complete measure such as BRI to understand population-based risk factors and possible connection with mortality risk.

To assess the trends of BRI in free-living US adults aged 20 and up, data from a cohort of 32,995 adults was used from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018 and NHANES Linked Mortality File, with mortality confirmed through December 31, 2019. Data were evaluated from April 1 and September 30, 2023.

Percentage changes in BRI every other year were calculated. Optimal cutoff points for BRI were determined using restricted cubic spine curves.

All-cause mortality was used as the survival outcome. Data on mortality was confirmed from the Centers for Disease Control and Prevention website and associated with the NHANES database utilizing the unique subject identifier. Statistical models were used to quantify the link between BRI and all-cause mortality.

The mean age of those in the cohort was 46.74 years and 16,529 of the 32,995 adults were women. From 1999 to 2018, mean BRI gradually went up from 4.8 to 5.62 with changes every other year of .95%. This trend was more consistent in women, elderly people, and those who identified as Mexican American.

After an average follow-up of nearly 10 years, 3452 (10.46%) deaths occurred from all causes. The risk increased by 25% in adults with a BRI of 3.4 or less and by nearly 50% in adults with a BRI of 6.9 or higher after adjustment of other risk factors, compared to the mid-range of BRI from 4.5 to 5.5.

An increasing trend of BRI over 20 years was observed in US adults in this national cohort study with all-cause mortality noted in those with low BRI or high BRI.

This data suggests using BRI as a noninvasive screening initiative for estimating mortality risk. It could be added to public health practice after future validation in other cohort populations.

Here are 10 Tips to Control Body Roundness:

• Measure your waist circumference each year. A healthy measure for men is below 37 inches and below 31.5 inches for women.

• Cut back on refined sugar, especially sweetened beverages. This helps reduce abdominal obesity.

• Limit or avoid alcohol. They call it a “beer belly” for a reason. 2

• Reduce dietary saturated fat as it’s linked with abdominal fat gain and risk for heart disease. 3

• Do regular aerobic and strength training exercises to manage your weight.

• Weigh yourself at least once a month and document trends. Are you going up or down?

• Reduce ultra-processed food like fried snacks and sugary treats. A recent study suggests a link between abdominal obesity and risk for several cardiometabolic conditions. 4

• Eat fewer animals and get more fiber in your diet. A vegan, high-fiber diet is associated with lower abdominal fat deposition. 5

• Get your ZZZs. Adequate sleep may prevent increases in cortisol and cravings for high-calorie treats.

• Manage stress. Recent research suggests psychological stress can wreak havoc on your waistline. 6

Lisa Andrews, MEd, RD, LD

References:

1.       Xiaoqian Zhang, MD1,2; Ning Ma, MD1,3; Qiushi Lin, MD, PhD4; et alKening Chen, MD5,6; Fangjieyi Zheng, MD7; Jing Wu, PhD7; Xiaoqun Dong, MD, PhD8; Wenquan Niu, PhD7 Body Roundness Index and All-Cause Mortality Among US Adults JAMA Netw Open. 2024;7(6):e2415051. doi:10.1001/jamanetworkopen.2024.15051

2.       Yang HJ, Kim MJ, Hur HJ, Lee BK, Kim MS, Park S. Association Between Korean-Style Balanced Diet and Risk of Abdominal Obesity in Korean Adults: An Analysis Using KNHANES-VI (2013-2016). Front Nutr. 2022 Jan 20;8:772347. doi: 10.3389/fnut.2021.772347. PMID: 35127781; PMCID: PMC8811126.

3.       Alayón AN, Rivadeneira AP, Herrera C, Guzmán H, Arellano D, Echeverri I. Metabolic and inflammatory postprandial effect of a highly saturated fat meal and its relationship to abdominal obesity. Biomedica. 2018 May 1;38(0):93-100. doi: 10.7705/biomedica.v38i0.3911. PMID: 29874712.

4.       Mambrini SP, Menichetti F, Ravella S, Pellizzari M, De Amicis R, Foppiani A, Battezzati A, Bertoli S, Leone A. Ultra-Processed Food Consumption and Incidence of Obesity and Cardiometabolic Risk Factors in Adults: A Systematic Review of Prospective Studies. Nutrients. 2023 May 31;15(11):2583. doi: 10.3390/nu15112583. PMID: 37299546; PMCID: PMC10255607.

5.       Kahleova H, Petersen KF, Shulman GI, Alwarith J, Rembert E, Tura A, Hill M, Holubkov R, Barnard ND. Effect of a Low-Fat Vegan Diet on Body Weight, Insulin Sensitivity, Postprandial Metabolism, and Intramyocellular and Hepatocellular Lipid Levels in Overweight Adults: A Randomized Clinical Trial. JAMA Netw Open. 2020 Nov 2;3(11):e2025454. doi: 10.1001/jamanetworkopen.2020.25454. Erratum in: JAMA Netw Open. 2021 Jan 4;4(1):e2035088. doi: 10.1001/jamanetworkopen.2020.35088. Erratum in: JAMA Netw Open. 2021 Feb 1;4(2):e210550. doi: 10.1001/jamanetworkopen.2021.0550. Erratum in: JAMA Netw Open. 2021 May 3;4(5):e2115510. doi: 10.1001/jamanetworkopen.2021.15510. PMID: 33252690; PMCID: PMC7705596.

6.       Kumar R, Rizvi MR, Saraswat S. Obesity and Stress: A Contingent Paralysis. Int J Prev Med. 2022 Jun 24;13:95. doi: 10.4103/ijpvm.IJPVM_427_20. PMID: 35958362; PMCID: PMC9362746.