Circadian Syndrome Mediates the Association Between Body Roundness Index and Incident Stroke Risk in Middle‐Aged and Older Chinese Adults: A Nationwide Prospective Cohort Study

Mar 27, 2026Behavioural neurology

Body Shape Linked to Stroke Risk Through Daily Rhythm Disruption in Middle-Aged and Older Chinese Adults

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Abstract

Higher log (BRI) values are significantly associated with an increased risk of stroke (HR = 2.50, 95% CI: 1.81-3.44, p < 0.001).

The highest quartile of BRI (Q4) shows a greater stroke risk compared to the lowest quartile (Q1) with an HR of 2.23 (95% CI: 1.63-3.04, p < 0.001).
No significant association between BRI and stroke risk is observed in patients with circadian syndrome (CircS).
In non-CircS individuals, higher BRI values are associated with an increased stroke risk (log (BRI) HR = 2.36, 95% CI: 1.61-3.47).
CircS is found to mediate 21.0% of the association between BRI and stroke risk (95% CI: 18%-91%, p < 0.001).
BRI has a moderate predictive capability for stroke risk with an area under the curve (AUC) of 0.656, outperforming other anthropometric indices.

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BACKGROUND: Despite BRI being a novel measure for chronic disease risk, the relationship between BRI and stroke risk under varying circadian syndrome (CircS) conditions is still unclear.

METHODS: The analysis utilized data from 7535 participants involved in the China Health and Retirement Longitudinal Study (CHARLS). CircS was defined by at least four concurrent metabolic disturbances due to circadian rhythm disruption. To ensure robustness, the BRI-stroke association was assessed using Cox models, restricted cubic splines, Kaplan-Meier curves, and mediation analyses, along with subgroup and sensitivity analyses. The receiver operating characteristic (ROC) analysis was used to compare the stroke risk prediction performance of BRI with conventional metabolic indices.

RESULTS: Following full adjustment, higher log (BRI) values were significantly associated with an increased risk of stroke (HR = 2.50, 95% CI: 1.81-3.44, p < 0.001), with Q4 showing a greater risk than Q1 (HR = 2.23, 95% CI: 1.63-3.04, p < 0.001). In CircS patients, no significant association was observed (log (BRI) HR = 1.23, 95% CI: 0.55-2.76; Q4 vs. Q1 HR = 0.61, 95% CI: 0.21-1.77; all p > 0.05). However, the association remained significant in non-CircS individuals (log (BRI) HR = 2.36, 95% CI: 1.61-3.47; Q4 vs. Q1 HR = 2.08, 95% CI: 1.46-2.98; all p < 0.001). Subgroup and sensitivity analyses bolstered the robustness of our findings. CircS mediated 21.0% of the association between BRI and stroke risk (95% CI: 18%-91%, p < 0.001). With an area under the curve (AUC) of 0.656, BRI demonstrated moderate predictive capability for stroke, outperforming other anthropometric indices.

CONCLUSIONS: An increased BRI is associated with a higher stroke risk, partially mediated by CircS, highlighting the potential role of circadian health in stroke prevention.

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Circadian Syndrome Mediates the Association Between Body Roundness Index and Incident Stroke Risk in Middle‐Aged and Older Chinese Adults: A Nationwide Prospective Cohort Study

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