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. 2025 Sep 17:288:114826.
doi: 10.1016/j.jpeds.2025.114826. Online ahead of print.

Body Roundness Index is a Stronger Predictor of Cardiometabolic Risk than Body Mass Index in Children between Ages 8 to 17 years

Afsana Jahan  1 , Mahie M Abdullah  1 , Rachel Frank  1 , Laura J Castellanos  1 , Pamela Singer  1 , Carol L Shen  1 , Abby M Basalely  1 , Christine B Sethna  2
Affiliations

Body Roundness Index is a Stronger Predictor of Cardiometabolic Risk than Body Mass Index in Children between Ages 8 to 17 years

Afsana Jahan et al. J Pediatr. .

Abstract

Objective: To determine whether body roundness index (BRI) is a stronger predictor of cardiometabolic outcomes compared with body mass index (BMI) in children.

Methods: This cross-sectional study included 3996 children aged 8-17 from the 2015-2020 National Health and Nutrition Examination Survey database. Exposures were BMI and BRI z-scores. Primary outcomes were hypertensive blood pressure (BP) and BP index; secondary outcomes were serum glucose, insulin, and triglyceride levels. Complex regression models were adjusted for age, sex, poverty index ratio, food insecurity, and energy expenditure.

Results: BRI and BMI z-scores were individually associated with systolic and diastolic blood pressure indices. The addition of BRI to the BMI model strengthened the association with diastolic BP index, but not for systolic BP index. Although BMI z-scores were not associated with hypertensive BP, BRI z-scores were significantly associated with hypertensive BP (OR 1.497, 95% CI [1.175-1.907], P < .01). Adding BRI to BMI models improved the predictive fit for hypertensive BP as well as serum glucose, insulin, and triglyceride levels.

Conclusions: BRI is a stronger predictor of cardiometabolic outcomes compared with BMI, providing incremental value in cardiovascular risk assessment in children. Future studies should validate these findings and explore the clinical utility of BRI in pediatric settings.

Keywords: NHANES; cardiovascular risk; children; hypertension; obesity.

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Conflict of interest statement

Declaration of competing interest C.B.S. is funded by NIH/NHLBI 1R01HL162912-01A1and NIH/NIDDK R01DK131091. C.L.S. reports a relationship with Nephcure Kidney International that includes funding grants. C.B.S. reports a relationship with Novo Nordisk Inc that includes: board membership. C.B.S. reports a relationship with National Institutes of Health that includes funding grants. She has served on the advisory board for Otsuka. She reports a relationship with Apellis Pharmaceuticals, Inc that includes board membership. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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