Association of body roundness index with cardiovascular disease among adults in the United States: A cross-sectional study based on NHANES 2005 to 2016

Cardiovascular disease (CVD) remains a global health challenge. The body roundness index (BRI) may better reflect abdominal fat distribution associated with metabolic disorders than traditional anthropometric measures. This study aimed to investigate the association between BRI and CVD, including congestive heart failure, coronary heart disease, angina, heart attack, and stroke, among adults in the United States. Data were obtained from the 2005 to 2016 National Health and Nutrition Examination Survey (NHANES). All analyses accounted for sampling weights, clustering, and stratification to ensure national representativeness. Weighted logistic regression models were used to evaluate association between BRI and CVD outcomes. Smoothing curve fitting, subgroup analyses, multiple imputation, and receiver operating characteristic curves analysis were also performed to assess robustness and predictive performance relative to body mass index. This cross-sectional study examined the association between BRI and CVD and its components, using nationally representative data from the NHANES (n = 23,812). The results revealed significant association between BRI and CVD, specifically, each 1-unit increase in BRI, the prevalence of CVD increased by 10% (odds ratio = 1.10, 95% confidence interval: 1.06-1.14, P < .001). Tertile analyses demonstrated a dose-response relationship. Compared with body mass index, BRI demonstrated superior predictive performance for CVD and its components. Smoothing curve analysis revealed a generally linear association between BRI and CVD, coronary heart disease, angina pectoris, and heart attack. Tests for nonlinearity were not significant (P for nonlinearity > .05), whereas the overall associations remained significant (P for overall < .05). However, a J-shaped association was observed between BRI and congestive heart failure. Subgroup analyses confirmed the robustness of these findings, with limited interaction effects. In this nationally representative cohort of US adults from the NHANES database, BRI demonstrated stronger, and dose-dependent associations with major cardiovascular outcomes. These findings suggested that BRI may serve as a useful marker for CVD risk assessment, however; further longitudinal validation is needed.