Recent research suggests that the Body Roundness Index (BRI) may serve as a better indicator of heart disease risk than the traditional Body Mass Index (BMI). In the United States, coronary artery bypass grafting, a common cardiac procedure, has predominantly been studied in men. This highlights the need for more inclusive research, particularly as assessments of heart disease risk evolve.
BMI, a widely-used metric, considers the height-weight relationship to gauge health. However, it does not account for body fat content and distribution or muscle and bone mass. Consequently, nearly half of individuals labeled as overweight, with a BMI between 25 and 29.9, and nearly a third of those categorized as obese, with a BMI of 30 or above, are actually in good metabolic health. Conversely, 30% of those with a BMI considered healthy (18.5 to 24.9) are in poor metabolic health.
In contrast, BRI offers a more nuanced approach by examining waist circumference and height to reflect abdominal fat proportion. This index generally ranges from 1 to 15, with most individuals scoring between 1 and 10. A study published in JAMA Network Open in June underscores BRI’s potential as a reliable predictor of mortality.
“Body roundness index is based on waist circumference and height. It has been shown in other studies that increased abdominal fat is a risk factor for other adverse health conditions such as diabetes and hypertension. If a patient has an increased body roundness index, then further investigation may be warranted to look for occult cardiovascular disease. Like other screening tools it has limitations, but still can be useful.” – Mir Ali, MD
From 1999 to 2018, BRI scores rose among a nationally representative sample of 33,000 Americans. The abdominal cavity’s fat is crucial as it envelops organs like the liver and plays a role in insulin resistance and glucose intolerance, often leading to Type 2 diabetes. BRI’s focus on central obesity and abdominal fat makes it an effective tool for assessing risks associated with Type 2 diabetes, hypertension, and heart disease.
Medical organizations are reconsidering BMI thresholds, suggesting that patients be deemed overweight at a BMI of 23 instead of 25, and obese at 27 rather than 30. This shift aligns with findings that the high-stable BRI trajectory group had a 46% increased risk for stroke and a 35% increased risk for cardiac events compared to the low-stable group.
Cheng-Han Chen, MD, emphasizes BRI’s advantages over BMI:
“By taking into account waist circumference as well as height, this metric better reflects the distribution of fat in the body than BMI does. As such, it should be better able to provide information on an individual’s health risk and indicate when intervention would be recommended to help reduce the risk. This study found an association between higher body roundness index (BRI) and increased risk of developing cardiovascular disease. This is a useful finding that might lead to wider adoption of BRI as a tool to help assess an individual’s heart disease risk.”
Despite its widespread use due to its simplicity, BMI has limitations that hinder its ability to accurately assess health. Dr. Chen elaborates on these shortcomings:
“While relatively simple to use, the body mass index has many flaws that limit its ability to assess a person’s health status. Most importantly, it does not account for body fat content and distribution, and does not account for muscle and bone mass. In addition, it does not account for racial, ethnic, and sex differences. These many limitations make BMI a relatively poor indicator of physical health.”
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