Commentary: Negative association between Body Roundness Index and bone mineral density: insights from NHANES

Chenglong Wang Xuelei Zhang ^*

• Zhejiang Taizhou Hospital, Taizhou, China

We read with great interest the article by Ding et al. (1) entitled "Negative association between Body Roundness Index and bone mineral density: insights from NHANES." In this study, the authors explored the relationship between body roundness index (BRI) and total bone mineral density (BMD) in U.S. adults. BRI, a newer anthropometric measure, has been shown to more comprehensively reflect visceral fat distribution compared to other traditional indices. With the BRI, weight is not part of the equation, and waist circumference is measured along with height and plugged into a formula to estimate visceral adipose tissue. The authors constructed three weighted multivariate regression models to explore the relationship between BRI and BMD: Model 1 was unadjusted, Model 2 adjusted for key demographic variables, and Model 3 adjusted for all covariates. The key findings demonstrate a notable inverse relationship between BRI and BMD, thus authors concluded that a higher BRI is associated with lower BMD and a potentially greater risk of developing osteoporosis, advocating for the use of BRI as a valuable marker for early intervention. We commend the authors for their rigorous study design and analytical efforts; however, we would like to raise several concerns and offer suggestions for further consideration to help improve their investigations. the adverse effects of inflammation on bones. We commend the authors for their detailed discussion 57 of the potential mechanisms through which visceral fat accumulation promotes osteoporosis. 58The authors suggest using the BRI as a valuable marker for clinically assessing the risk of osteoporosis 60 and for achieving early intervention. However, the diagnostic ability of BRI was not evaluated in the 61 study. We encourage the authors to perform receiver operating characteristic curve analysis to compare 62 the predictive ability of BRI with traditional obesity assessment indicators (not limited to BMI) and 63 other novel measures, such as the Weight-adjusted Waist Index (6), A Body Shape Index (7), 64Abdominal Volume Index (8), Visceral Adiposity Index (9), and Lipid Accumulation Product index 65 (10). Beyond the receiver operating characteristic analysis, incorporating additional metrics such as 66 the net reclassification index would help establish whether BRI provides incremental diagnostic value 67 over traditional measures, thereby highlighting the significance of this study. 68Discussion 69This study provides an innovative exploration of the relationship between BRI and BMD in U.S. adults; 70 however, we believe that the findings should be interpreted with caution. Specifically, we emphasize 71 that when investigating the association between novel anthropometric measures and osteoporosis, it is 72 crucial to consider the potential collinearity with BMI. In addition, longitudinal studies that examine 73 the impact of weight loss or redistribution of body fat on BMD across BRI tertiles would provide 74 valuable insights into causal relationships. We hope that our insights will assist readers in interpreting 75 the findings more effectively and offer additional perspectives for future research. 76