# Association between the body roundness index and all-cause mortality in patients with metabolic dysfunction- associated steatotic liver disease

**Authors:** Zechao He, Fei Tian, Jianguo Jia, Hong Ji, Yunpeng Li, Xinyu Ge, Shuanghao Zhou, Jiahui Zou, Ze Wang, Yurui Du, Xueying Ma, Xiangming Ma

PMC · DOI: 10.3389/fpubh.2026.1765588 · Frontiers in Public Health · 2026-02-20

## TL;DR

This study finds that a body shape measure called the body roundness index is linked to higher risk of death in patients with a liver disease called MASLD in northern China.

## Contribution

The study is the first to investigate the association between BRI and mortality in a northern Chinese MASLD population.

## Key findings

- Each standard deviation increase in BRI was associated with a 13% higher risk of all-cause mortality.
- Patients in the highest BRI quartiles had significantly increased mortality risk compared to the lowest quartile.

## Abstract

The body roundness index (BRI) is a novel anthropometric measure derived from waist circumference and height that reflects abdominal adiposity. Previous studies have demonstrated that BRI has predictive value for all-cause mortality in the general population and in individuals with metabolic dysfunction–associated steatotic liver disease (MASLD) in the United States. However, the association between BRI and all-cause mortality in patients with MASLD from northern Chinese populations remains unclear.

In this population-based prospective cohort study, we analyzed 28,898 MASLD patients (mean age 52.3 ± 12.2 years) from the Kailuan Study, an ongoing longitudinal investigation of Chinese industrial workers. The primary outcome was all-cause mortality. The Cox proportional hazards regression model was utilized to assess the association between BRI and the risk of all-cause mortality in the MASLD population by calculating hazard ratios (HR) with 95% confidence intervals (CI).

During a median follow-up of 13.62 years (interquartile range 12.85–15.16), 3,895 deaths were occurred. After adjustment for confounders, each standard deviation increase in BRI was associated with a 13% increased risk of all-cause mortality (HR = 1.13, 95% CI: 1.07–1.19, P < 0.001). Multivariable Cox regression analysis revealed that compared with subjects in the lowest BRI quartile (Q1), those in the third (Q3) and fourth (Q4) quartiles had hazard ratios for all-cause mortality of 1.14 (95% CI: 1.02–1.28) and 1.21 (95% CI: 1.06–1.37) (P for trend < 0.001), respectively.

BRI demonstrated a positive association with all-cause mortality in the MASLD population.

## Linked entities

- **Diseases:** metabolic dysfunction–associated steatotic liver disease (MONDO:0013209), MASLD (MONDO:0013209)

## Full-text entities

- **Genes:** CRP (C-reactive protein) [NCBI Gene 1401] {aka PTX1}
- **Diseases:** adiposity (MESH:D018205), kidney disease (MESH:D007674), abdominal adiposity (MESH:D000007), type 2 diabetes (MESH:D003924), liver condition (MESH:D017093), BRI (MESH:D018208), Cardiovascular diseases (MESH:D002318), insulin resistance (MESH:D007333), end-stage liver disease (MESH:D058625), viral hepatitis (MESH:D014777), smoker (MESH:C000719328), death (MESH:D003643), malnutrition (MESH:D044342), hypertension (MESH:D006973), Metabolic dysfunction (MESH:D008659), visceral adiposity (MESH:D007418), obesity (MESH:D009765), Hepatic steatosis (MESH:D005234), fatigue (MESH:D005221), cancer (MESH:D009369), NAFLD (MESH:D065626), reduced exercise (MESH:D001523), liver cirrhosis (MESH:D008103), cardiometabolic diseases (MESH:D024821), MASLD (MESH:D008107), inflammatory (MESH:D007249), muscle wasting (MESH:D009133)
- **Chemicals:** alcohol (MESH:D000438), glucose (MESH:D005947), Cr (MESH:D003404), BP (MESH:C038809), lipid (MESH:D008055), BRI (-), ethanol (MESH:D000431), UA (MESH:D014527), triglyceride (MESH:D014280)
- **Species:** Homo sapiens (human, species) [taxon 9606]

## Full text

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## Figures

3 figures with captions in the complete paper: https://tomesphere.com/paper/PMC12962941/full.md

## References

40 references — full list in the complete paper: https://tomesphere.com/paper/PMC12962941/full.md

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Source: https://tomesphere.com/paper/PMC12962941