Non-linear relationship between the body roundness index and incident type 2 diabetes in Japan: a secondary retrospective analysis

Background Body roundness index (BRI) is one of the obesity-related anthropometric indices. However, studies on the relationship between BRI and diabetes risk is limited. The purpose of this study was to explore the relationship between baseline BRI and incident type 2 diabetes mellitus (T2DM) in the Japanese population. Methods A retrospective longitudinal study of 15,310 participants in a physical examination program at Murakami Memorial Hospital in Japan from 2004 to 2015. The association between BRI levels and incident T2DM was analyzed by Cox proportional-hazards regression, smooth curve fitting, subgroup analyses, and a set of sensitivity analyses. Receiver operating characteristic curve analysis was used to assess the ability of BRI to predict diabetes. Result Baseline BRI levels were elevated in participants who developed T2DM. Baseline BRI levels were positively associated with incident T2DM after adjusting confounding variables (HR = 1.570, 95% CI 1.360-1.811). Additionally, we did a set of sensitivity analyses to ensure the robustness of the results. There was also a non-linear relationship between BRI and incident diabetes in both genders, and the inflection point of BRI was 4.137 in females and 3.146 in males. We found a strong positive correlation between BRI and the incidence of diabetes on the right of the inflection point (Male: HR = 1.827, 95% CI 1.449-2.303; Female: HR = 4.189, 95% CI 1.862-9.421). What's more, among the anthropometric indices, BRI showed the optimal capability to predict T2DM (Male: AUC = 0.706, 95% CI 0.674-0.738; Female: AUC = 0.735, 95% CI 0.676-0.795). Conclusion An elevated BRI level in baseline was independently associated with incident T2DM. Baseline BRI improves the identification of patients at risk of T2DM and may enable early and optimized therapy to improve their outcomes.