Higher was associated with higher all-cause, cardiovascular, and cancer mortality, partly through .
Evidence
A UK Biobank cohort analysis of 305,406 participants used Cox models and mediation analysis, finding highest versus lowest BRI quartile HRs of 1.43 for all-cause death, 1.47 for CVD death, and 1.38 for cancer death.
Caveat
The observational mediation design cannot prove that BRI or biological age acceleration caused the mortality differences.
Simplified
OBJECTIVE: This study aims to explore the association of with all-cause, cardiovascular disease (CVD)-cause, and cancer-cause mortality risk, and the role of (BAA) in mediating these associations.
METHODS: We included 305,406 participants in the UK biobank. BRI was calculated based on waist circumference (WC) and height. BAA was divided into klemera-doubal method biological age acceleration (KDM-BA) and PhenoAge acceleration. The associations of BRI, BAA with outcomes were assessed by Cox proportional hazard models. The role of BAA in this association was analyzed by mediating effect.
RESULTS: Compared with the individuals with the lowest BRI quartile, the individuals with the highest BRI quartile had a higher hazard of death, and theand 95%of all-cause death, CVD death and cancer death were (: 1.43 (95%: 1.33, 1.53)), (: 1.47 (95%: 1.25, 1.72)), (: 1.38 (95%: 1.26, 1.52)), respectively. The mediation proportion of BAA in associations of BRI with death outcomes were 10.75–42.98% (all < 0.001). HR CI HR CI HR CI HR CI p
CONCLUSION: BRI is associated with an increased hazard of all-cause death, CVD death, and cancer death, BAA partially mediated these associations. We observed that higher levels of BRI were associated with an increased hazard of death, with biological age acceleration potentially mediating this association. This suggests that maintaining a healthy lifestyle and reducing the inflammatory/immune response and lipid metabolism abnormalities associated with obesity are critical to reducing the burden of chronic disease. The future intervention targets will be maintaining WC at appropriate levels that might contribute to self-health management.
SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12937-025-01209-2.
Key numbers
1.43
Increase in Hazard of All-Cause Mortality
Hazard ratio comparing highest vs. lowest quartile.
1.47
Increase in Hazard of Mortality
Hazard ratio comparing highest vs. lowest quartile.
1.38
Increase in Hazard of Cancer Mortality
Hazard ratio comparing highest vs. lowest quartile.
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