DOI: 10.1097/md.0000000000049527 ISSN: 0025-7974

Body roundness index and the incidence of kidney disease: A prospective cohort study from the China Health and Retirement Longitudinal Study

Xixi Yu, Zihao Shen, Xiaofang Li, Mingcheng Liu, Xin Liu, Yincong Luo, Ying Wang, Yirong Liu

Kidney disease (KD) poses a growing global health burden, with obesity contributing to its development. The body roundness index (BRI), a novel anthropometric measure reflecting visceral adiposity, may better predict KD risk than body mass index, but longitudinal evidence is limited. In this prospective cohort study, we analyzed 8401 adults aged ≥ 45 years from the China Health and Retirement Longitudinal Study, free of KD at baseline. BRI was calculated from waist circumference and height. Incident KD was ascertained via physician-diagnosed questionnaires during 4 follow-ups (2013–2020). Cox proportional-hazards models were used to compute hazard ratios (HRs) and 95% confidence intervals (95% CIs), with adjustment for multiple covariates. Dose–response relationships were evaluated using restricted cubic splines and 2-piecewise linear regression, with subgroup analyses performed to examine effect modification. During follow-up, higher BRI was significantly associated with an increased risk of incident KD (HR = 1.10; 95% CI: 1.02–1.19; P  = .017). Participants in the highest BRI quartile had a 47% greater risk compared with the lowest quartile (HR = 1.47; 95% CI: 1.06–2.05; P  = .022), with a significant dose–response trend ( P for trend = .014). Restricted cubic spline analysis revealed a significant overall association ( P overall = .037) without evidence of nonlinearity ( P nonlinearity = .307) and a meaningful inflection point ( P for likelihood ratio test = 0.378). Subgroup analyses demonstrated generally consistent associations, with a significant interaction observed for dyslipidemia status ( P for interaction = .037). In middle-aged and older Chinese adults, higher BRI independently predicts incident KD in a linear dose–response manner. BRI, as a simple and noninvasive measure of body fat distribution, may serve as a practical tool for early identification of individuals at elevated KD risk, supporting strategies targeting central adiposity in KD prevention.

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