1.北京中医药大学第二临床医学院,北京
2.北京中医药大学东方医院心内科,北京
DONG Qiaozhi, E-mail: 310864364@qq.com
Received:26 January 2026,
Revised:2026-05-08,
Accepted:12 May 2026,
Published:15 July 2026
移动端阅览
袁杭滔,林博,隆小燕,等.累积身体圆度指数每增一档,绝经后心脏代谢性共病风险翻倍:基于CHARLS的队列研究与公共卫生筛查启示[J].陆军军医大学学报,2026,48(13):1897-1907.DOI:10.16016/j.2097-0927.202601107.
YUAN H T,LIN B,LONG X Y,et al.Every one-grade increase in body roundness index doubles the risk of postmenopausal cardiometabolic multimorbidity: a CHARLS-based cohort study and its implications for public health screening[J].J Army Med Univ,2026,48(13):1897-1907.DOI:10.16016/j.2097-0927.202601107.
袁杭滔,林博,隆小燕,等.累积身体圆度指数每增一档,绝经后心脏代谢性共病风险翻倍:基于CHARLS的队列研究与公共卫生筛查启示[J].陆军军医大学学报,2026,48(13):1897-1907.DOI:10.16016/j.2097-0927.202601107. DOI:
YUAN H T,LIN B,LONG X Y,et al.Every one-grade increase in body roundness index doubles the risk of postmenopausal cardiometabolic multimorbidity: a CHARLS-based cohort study and its implications for public health screening[J].J Army Med Univ,2026,48(13):1897-1907.DOI:10.16016/j.2097-0927.202601107. DOI:
目的
2
心脏代谢性共病(cardiometabolic multimorbidity,CMM)与严重健康结局相关;绝经是女性心血管疾病的独立危险因素,该阶段中心性肥胖风险增加;身体圆度指数(body roundness index,BRI)能有效反映内脏肥胖。探讨BRI的累积暴露水平与我国绝经后女性CMM风险的关联强度,以评估累积BRI(cumulative body roundness index,cuBRI)作为CMM长期风险标志物和简易筛查工具的潜力。
方法
2
基于中国健康与养老追踪调查(China Health and Retirement Longitudinal Study,CHARLS)2011—2020年数据,纳入3 780名绝经后女性作为研究对象。采用多因素Logistic回归模型分析cuBRI、BRI动态轨迹与CMM风险的关联;利用限制性立方样条(restricted cubic splines,RCS)曲线检验剂量-反应关系;通过亚组分析考察效应修饰,并采用Bonferroni及错误发现率(false discovery rate,FDR)校正控制假阳性;使用ROC曲线比较cuBRI与BMI的预测能力。
结果
2
完全调整模型显示,cuBRI每增加1个四分位间距(interquartile range,IQR),CMM风险增加112.4%(
OR
=2.124,95%
CI
:1.901~2.373,
P
0.001);与cuBRI最低IQR组相比,最高IQR组的CMM风险显著升高(
OR
=4.701,95%
CI
:3.661~6.081,
P
0.001)。逐步Logistic回归结果进一步证实,cuBRI、BMI、年龄、血脂异常、肾脏疾病、抑郁评分、C反应蛋白(C-reactive protein,CRP)是CMM的独立危险因素(均
P
0.01);RCS曲线分析进一步显示,cuBRI与CMM风险呈线性正相关关系(
P
overall
0.001,
P
nonlinear
=0.224),当cuBRI18.346时,CMM呈显著持续上升趋势。ROC曲线显示,cuBRI(AUC=0.742)预测CMM的能力与BMI(AUC=0.747)相当。亚组分析显示,经FDR校正和Bonferroni校正后,在年龄45~60岁、年龄≥60岁、无血脂异常、无肾脏疾病、流调中心抑郁量表(center for epidemiologic studies depression scale,CES-D)评分10分以及BMI为18.5~24.0 kg/m
2
的亚组中,cuBRI与CMM的正向关联仍保持稳健(
P
Bonferroni
均0.05)。
结论
2
cuBRI水平升高与我国绝经后女性CMM患病风险呈显著正向关联,其预测效能与BMI相当,提示其可能有助于反映长期中心性肥胖负荷,用于识别CMM高危人群。 对策 依托“健康中国2030”及国家基本公共卫生服务框架,建议将cuBRI纳入绝经后女性基层随访内容,识别高危人群(cuBRI18.346),实施生活方式干预及代谢指标综合管理;cuBRI与BMI联合应用或可优化风险分层,其因果效应及最优切点尚需干预性研究验证。
Objective
2
Cardiometabolic multimorbidity(CMM) is associated with severe health outcomes; menopause is an independent risk factor for cardiovascular disease in women
and the risk of central obesity is also increased during this phase. Body roundness index(BRI) can effectively reflect visceral obesity. This study aims to investigate the of strength association between cumulative exposure to BRI and CMM risk in postmenopausal Chinese women
and to evaluate the potential of cumulative(cuBRI) as a long-term risk marker and a simple screening tool for CMM.
Methods
2
Based on data from the China Health and Retirement Longitudinal Study(CHARLS) from 2011 to 2020
3 780 postmenopausal women were enrolled as study participants. Multivariate logistic regression models were used to analyze the association of cuBRI and BRI trajectories with CMM risk; restricted cubic splines(RCS) curves were employed to examine the dose-response relationship; subgroup analyses were conducted to determine effect modification
and Bonferroni and false discovery rate(FDR) corrections were applied to control false positives. ROC curves were plotted to compare the predictive performance of cuBRI with that of BMI.
Results
2
The fully adjusted model showed that for every 1-interquartile range(IQR) increase in cuBRI
the risk of CMM increased by 112.4%(
OR
=2.124
95%
CI
: 1.901 to 2.373
P
0.001); compared with the lowest cuBRI IQR group
the risk of CMM was significantly higher in the highest cuBRI IQR group(
OR
=4.701
95%
CI
: 3.661 to 6.081
P
0.001). Results from stepwise logistic regression further confirmed that cuBRI
BMI
age
dyslipidemia
kidney disease
depression scores
and C-reactive protein(CRP) were independent risk factors for CMM(all
P
0.01). RCS analysis further demonstrated a linear positive correlation between cuBRI and CMM risk(
P
overall
0.001
P
nonlinear
=0.224).When cuBBI18.346
CMM risk shows a significant and sustained upward trend. ROC curve analysis indicated that cuBRI(AUC=0.742) showed a predictive performance for CMM comparable to that of BMI(AUC=0.747). Subgroup analyses revealed that
after FDR and Bonferroni corrections
the positive association between cuBRI and CMM remained robust in the following subgroups: those aged 45 to 60 years
those aged ≥60 years
those without dyslipidemia
those without kidney disease
those with a score of center f
or epidemiologic studies depression scale(CES-D) 10
and BMI of 18.5 to 24.0 kg/m² (all
P
Bonferroni
0.05).
Conclusion
2
Elevated cuBRI levels are significantly and positively associated with the risk of CMM in postmenopausal Chinese women
and their predictive performance is comparable to that of BMI
suggesting that it may help reflect long-term central obesity burden
and can be used to identify high-risk populations for CMM. Countermeasures Under the framework of “Healthy China 2030” initiative and the national framework for basic public health services
it is recommended that cuBRI be incorporated into primary-care follow-up protocols for postmenopausal women to identify high-risk populations(cuBRI 18.346)
and to implement lifestyle interventions and comprehensive management of metabolic indicators. The combined application of cuBRI and BMI may optimize risk stratification
and its causal effects and optimal cutoff point require validation through intervention studies.
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