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. 2025 Apr 21;17(8):1397.
doi: 10.3390/nu17081397.

The Relationship between Visceral Fat Accumulation and Risk of Cardiometabolic Multimorbidity: The Roles of Accelerated Biological Aging

Tianyu Zhu  1 , Yixing Tian  1 , Jinqi Wang  1 , Zhiyuan Wu  2 , Wenhan Xie  1 , Haotian Liu  1 , Xia Li  3 , Lixin Tao  1 , Xiuhua Guo  1   4   5
Affiliations

The Relationship between Visceral Fat Accumulation and Risk of Cardiometabolic Multimorbidity: The Roles of Accelerated Biological Aging

Tianyu Zhu et al. Nutrients. .

Abstract

Objectives: To investigate the association between visceral fat accumulation and the risk of cardiometabolic multimorbidity (CMM) and the potential roles of accelerated biological aging in this relationship.

Methods: Using data from the UK Biobank, a nationwide cohort study was conducted using the available baseline body roundness index (BRI) measurement. Biological aging was assessed using the Klemera-Doubal method for biological age and the phenotypic age algorithms. The association between the BRI and CMM was estimated using the Cox proportional hazards regression model, while the roles of biological aging were examined through interaction and mediation analyses.

Results: During a median follow-up of 14.52 years, 6156 cases of CMM were identified. A significant association was observed between the BRI and CMM. The hazard ratio (HR) for CMM was 3.72 (95% confidence interval [CI]: 3.35-4.13) for individuals in the highest quartile compared with those in the lowest quartile of the BRI. More importantly, the BRI (AUC, 0.701; 95% CI, 0.694-0.707) demonstrated superior predictive performance relative to body mass index (AUC, 0.657; 95% CI, 0.650-0.664). Furthermore, the BRI exhibited additive interactions with accelerated biological aging on the risk of CMM, and accelerated biological aging partially mediated the association between the BRI and CMM.

Conclusions: These findings provide evidence for the application of the BRI as a novel and readily accessible screening tool associated with CMM, suggesting that the effective management of visceral fat and biological aging deceleration may hold promise for reducing CMM risk.

Keywords: accelerated biological aging; body roundness index; cardiometabolic multimorbidity; visceral obesity.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The flowchart for the participants’ inclusion and exclusion. Abbreviations: WC—waist circumference; BRI—body roundness index; BMI—body mass index; CHD—coronary heart disease; T2DM—type 2 diabetes; CMD—cardiometabolic disease; CMM—cardiometabolic multimorbidity. *, Due to a high proportion (22.66%) missing of the International Physical Activity Questionnaire (IPAQ), participants with incomplete physical activity information were excluded. The remaining covariates were imputed using random forest method before analysis.
Figure 2
Figure 2
The relationship of body roundness index with cardiometabolic multimorbidity risk after full adjustment (N = 342,437). The solid curve line represents the effect-size estimates for the association, and the light shadow represents the 95% confidence interval. All models were adjusted for age (<60, ≥60 years), sex (female, male), race, education (college degree or above, high school or below), Townsend Deprivation Index (low economic level, high economic level), smoking status (never, previous, or current), moderate alcohol consumption (yes, no), IPAQ (low, moderate, or high), baseline hypertension (yes, no), and baseline dyslipidemia (yes, no).
Figure 3
Figure 3
Joint and interactive effects of body roundness index and accelerated biological aging on the risk of cardiometabolic multimorbidity (N = 234,184). Abbreviations: BRI—body roundness index; KDM-BA—Klemera–Doubal method biological age; HR—hazard ratio; CI—confidence interval; CMM—cardiometabolic multimorbidity; RERI—relative excess risk due to interaction; AP—attributable proportion; SI—synergy index; PhenoAge—phenotypic age. All models were adjusted for age (<60, ≥60 years), sex (female, male), race, education (college degree or above, high school or below), Townsend Deprivation Index (low economic level, high economic level), smoking status (never, previous, or current), moderate alcohol intake (yes, no), IPAQ (low, moderate, or high), baseline hypertension (yes, no), and baseline dyslipidemia (yes, no).
Figure 4
Figure 4
Decomposing the total association between body roundness index and cardiometabolic multimorbidity into direct and indirect associations mediated by accelerated biological aging (N = 234,184). Abbreviations: β—beta coefficient; CI—confidence interval; HR—hazard ratio; Q—quantile; KDM-BA—Klemera–Doubal method biological age; PhenoAge—phenotypic age. All models were adjusted for age (<60, ≥60 years), sex (female, male), race, education (college degree or above, high school or below), Townsend Deprivation Index (low economic level, high economic level), smoking status (never, previous, or current), moderate alcohol intake (yes, no), IPAQ (low, moderate, or high), baseline hypertension (yes, no), and baseline dyslipidemia (yes, no).
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