# Body roundness index outperforms traditional obesity metrics in predicting cardiometabolic risk among children and adolescents: the EMSNGS study

## TL;DR

The body roundness index (BRI) is better than BMI at predicting heart and metabolic risks in children and teens, according to a study in Shenzhen.

## Contribution

This study is the first to show that BRI outperforms traditional metrics in predicting cardiometabolic risk in children and adolescents.

## Key findings

- BRI at the 75th percentile showed the best balance of sensitivity and specificity for predicting cardiometabolic risk.
- BRI remained significantly associated with elevated cardiometabolic risk after adjusting for sex and puberty.
- ABSI was not significantly associated with cardiometabolic risk in this population.

## Abstract

Novel obesity indices, the body roundness index (BRI) and a body shape index (ABSI), have been proved to be superior over body mass index (BMI) for predicting metabolic syndrome and cardiovascular events in adults. However, their performance in pediatric populations remains unexplored.

A large-scale cross-sectional study, Evaluation and Monitoring on School-based Nutrition and Growth in Shenzhen (EMSNGS) project, was conducted in 2021 including 4,794 children and adolescents aged 6–17 years. Quantile regression models were used to analyse factors influencing ABSI and BRI. Associations between the 2 novel obesity indices and cardiovascular metabolic risk index (CMRI) were evaluated using logistic regression and receiver operating characteristic (ROC) curves.

In total, 1,971 participants (1,131 boys, 840 girls) exhibited CMRI ≥1. BRI was associated with pubertal development and weight status in both sexes. ABSI was only associated with weight status. BRI was associated with CMRI ≥1, whereas ABSI was not (P > 0.05). Compared with waist-to-hip ratio, waist-to-height ratio, and BMI, BRI at the 75th percentile (BRI P75th) demonstrated optimal sensitivity–specificity balance. The area under the ROC curve (95% CI), sensitivity, specificity, and Youden index were 0.752 (0.732–0.771), 71.3%, 79.1%, and 0.504 for boys and 0.693 (0.670–0.716), 61.8%, 76.8%, and 0.386 for girls, respectively.

After adjustment for sex and pubertal stages, BRI P75th remained significantly associated with elevated cardiometabolic risk in children and adolescents, supporting its potential utility as an early screening indicator.