Prognostic associations of anthropometric indices vary by clinical outcomes

1. Prognostic associations of anthropometric indices varied according to clinical outcomes. The body roundness index showed the highest discrimination for atherosclerotic cardiovascular disease, body mass index for all-cause mortality, and waist circumference for atrial fibrillation.

Evidence Rating Level: 2 (Good)

Body mass index (BMI), waist circumference (WC), and the body roundness index (BRI) are the three most commonly used anthropometric indices for obesity and have been associated with cardiovascular and metabolic disorders and mortality. However, whether prognostic associations of these indices differ depending on specific clinical outcomes is unclear. This study thus compares the prognostic associations of BMI, WC, and BRI across multiple cardiovascular and mortality outcomes. This retrospective cohort study included Korean adults (aged ≥55 years) from the National Health Insurance Service database who underwent health screening between 2009 and 2012 and had no prior history of myocardial infarction (MI), stroke, heart failure or AF at baseline. Participants were followed for up to 10 years. The primary outcomes were atherosclerotic cardiovascular disease (ASCVD), all-cause mortality, and atrial fibrillation (AF). Among the 1,199,633 adults included (mean [SD] age, 63.5 [7.3] years, 566,526 male [47.2%], mean BMI = 24.04 ± 3.02 kg/m2, mean WC = 82.4 ± 8.3 cm, mean BRI = 82.4 ± 8.3 cm), 9.6% developed ASCVD and 4.7% developed AF. The cumulative incidence was 10.9 for all-cause mortality and 4.2% for cancer-related mortality. For ASCVD, BRI showed the highest area under the curve (AUC: 0.553), followed by WC (0.540), and BMI (0.512; P < 0.05 for all). For all-cause mortality, BMI showed the highest AUC (0.595), attributed to an inverse association in the underweight group, followed by BRI (0.595) and WC (0.506; P < 0.05 for all). For incident AF, WC showed the highest AUC (0.567), followed by BRI (0.550) and BMI (0.527). Non-linear (U-shaped or J-shaped) relationships were observed for most outcomes. Overall, this study found that the prognostic associations of anthropometric indices varied according to clinical outcomes, with BRI showing the highest discrimination for ASCVD, BMI for all-cause mortality, and WC for AF. These findings highlight the importance of considering the specific clinical outcome when selecting an anthropometric index for obesity-related risk assessment.

Click here to read this study in PLOS One

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