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Article(id=1240730060995489967, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240730050669113883, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202412160, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1733760000000, receivedDateStr=2024-12-10, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773742698191, onlineDateStr=2026-03-17, pubDate=1745510400000, pubDateStr=2025-04-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773742698191, onlineIssueDateStr=2026-03-17, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773742698191, creator=13701087609, updateTime=1773742698191, updator=13701087609, issue=Issue{id=1240730050669113883, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='8', pageStart='1345', pageEnd='1536', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773742695728, creator=13701087609, updateTime=1773742807836, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240730520988995837, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240730050669113883, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240730520988995838, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240730050669113883, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1525, endPage=1532, ext={EN=ArticleExt(id=1240730061293285579, articleId=1240730060995489967, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=A cohort study of body roundness index and arthritis in middle-aged and elderly Chinese and the mediating role of blood lipids, columnId=1228016569138213037, journalTitle=Modern Preventive Medicine, columnName=Clinical Medicine and Prevention, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the relationship between body roundness index (BRI) and new onset arthritis, and provide a new perspective for the prevention and treatment of arthritis.

Methods

A cohort study design was adopted, using the data of 2011 and 2020 in the China longitudinal study on the China Health and Retirement Longitudinal Study (CHARLS), taking BRI as the exposure factor, high-density lipoprotein cholesterol (HDL-C), total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL-C) as the intermediary variables, including demographic characteristics such as age and gender, smoking, alcohol consumption and other health behaviors as confounding factors, and new onset arthritis as the outcome. Statistical analysis was carried out using multiple model logistic regression strategy, restricted cubic spline, subgroup analysis and intermediary analysis. Compared with relevant studies, the main purpose of the dose-response relationship we explored is to study whether there is a nonlinear relationship between exposure and outcome, that is, whether the risk of outcome will change accordingly with the change of exposure level.

Results

A total of 5 166 participants were included, and BRI was positively correlated with arthritis, with an OR value of 1.196 (95% CI: 1.047-1.367). The prevalence of new onset arthritis increased by 19.6% when BRI increased by a quartile range; The dose-response relationship showed that BRI > 3.943 was positively correlated with the incidence of arthritis; Subgroup analysis showed that the positive correlation between BRI and new onset arthritis was not affected by many factors; Mediation analysis showed that HDL-C had a protective effect on arthritis, mediating about 6.84% of the impact of BRI on the incidence of arthritis. The mediation effect of total cholesterol, triglycerides and LDL-C was not significant; The AUC of BRI for predicting new onset arthritis (0.546) was higher than that of BMI (0.527).

Conclusion

The increased level of BRI may lead to an increased risk of arthritis, and HDL-C may alleviate this risk. In the future, its clinical application potential and regulatory strategies should be explored to reduce the incidence of arthritis and improve the prognosis.

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目的

本研究旨在探索身体圆度指数（Body Roundness Index, BRI）与新发关节炎之间的联系，为关节炎的预防和治疗提供新视角。

方法

采用队列研究设计，利用中国健康与退休纵向研究（CHARLS）数据库中2011与2020年的数据，以BRI为暴露因素，高密度脂蛋白胆固醇（High-Density Lipoprotein Cholesterol, HDL-C）、总胆固醇、甘油三酯、低密度脂蛋白胆固醇（Low-Density Lipoprotein Cholesterol，LDL-C）为中介变量，纳入年龄、性别等人口学特征和吸烟、饮酒等健康行为作为混杂因素，新发关节炎为结局，采用多模型logistic回归策略、限制性立方样条、亚组分析及中介分析等方法进行统计分析。对照相关研究，本研究探讨的剂量-反应关系主要目的是研究暴露与结局之间是否存在非线性关系，即随着暴露水平的变化，结局的风险是否会发生相应的改变。

结果

共纳入5 166名参与者，BRI与关节炎呈正相关，OR值为1.196（95% CI:1.047~1.367），BRI增加一个四分位数范围，关节炎发病率上升19.6%；剂量反应关系显示BRI>3.943时与关节炎发病率呈线性正相关；亚组分析表明BRI与新发关节炎的正相关不受多种因素影响；中介分析显示HDL-C对关节炎有保护作用，介导了BRI对关节炎发病率影响的约6.84%，总胆固醇、甘油三酯与LDL-C的中介效应并不显著；BRI预测新发关节炎的AUC（0.546）高于BMI（0.527）。

结论

BRI水平升高可能导致关节炎发病风险增加，HDL-C可能缓解该风险，未来应探索其临床应用潜力及调控策略以降低关节炎发病率和改善预后。

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王彤，E-mail：
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董家瑜（2001—），女，硕士在读，研究方向：关节炎的多维度研究

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Biomedecine & Pharmacotherapie, 2024, 177: 117139., articleTitle=Obesity induces osteoimmunology imbalance: Molecular mechanisms and clinical implications, refAbstract=null)], funds=[Fund(id=1241070738363445998, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730060995489967, awardId=CYSF2029, language=CN, fundingSource=北京市朝阳区科技计划项目(CYSF2029), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241070732592083284, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730060995489967, xref=null, ext=[AuthorCompanyExt(id=1241070732600471893, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730060995489967, companyId=1241070732592083284, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Traditional Chinese Medicine,Beijing University of Traditional Chinese Medicine, Beijing 100029, China), AuthorCompanyExt(id=1241070732604666198, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730060995489967, companyId=1241070732592083284, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=北京中医药大学中医学院，北京　100029)])], figs=[ArticleFig(id=1241070735360324173, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730060995489967, language=EN, label=Fig.1, caption=Dose-response relationship between BRI and new-onset arthritis, figureFileSmall=a51lkkD6OVbGab5DR+U1iw==, figureFileBig=d1thmf/NH/dlt8MZlJpknA==, tableContent=null), ArticleFig(id=1241070735460987479, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730060995489967, language=CN, label=图1, caption=BRI与新发关节炎之间的剂量-反应关系, figureFileSmall=a51lkkD6OVbGab5DR+U1iw==, figureFileBig=d1thmf/NH/dlt8MZlJpknA==, tableContent=null), ArticleFig(id=1241070736564089444, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730060995489967, language=EN, label=Fig.2, caption=ROC curve of body roundness index, figureFileSmall=ZOlqi3gJQp9IEajIs/Jidw==, figureFileBig=84vOF7aZsR9Se2m4KfSqzw==, tableContent=null), ArticleFig(id=1241070736652169834, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730060995489967, language=CN, label=图2, caption=身体圆度指数的ROC曲线, figureFileSmall=ZOlqi3gJQp9IEajIs/Jidw==, figureFileBig=84vOF7aZsR9Se2m4KfSqzw==, tableContent=null), ArticleFig(id=1241070736773804655, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730060995489967, language=EN, label=Fig.3, caption=ROC curve for Body Mass Index, figureFileSmall=h+Ulq48bO9VxGXS4I+ou/A==, figureFileBig=HfdnlX1CXCcfnn3IMG22vw==, tableContent=null), ArticleFig(id=1241070736903828094, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730060995489967, language=CN, label=图3, caption=体质指数的ROC曲线, figureFileSmall=h+Ulq48bO9VxGXS4I+ou/A==, figureFileBig=HfdnlX1CXCcfnn3IMG22vw==, tableContent=null), ArticleFig(id=1241070737004491401, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730060995489967, language=EN, label=Table 1, caption=

Baseline Characteristics of Study Populations Classified on the Basis of Whether Arthritis Occurred

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总计 (n=5 166)未患关节炎 (n=4 061)患关节炎 (n=1 105)统计量P
HDL-C（mg/dL）*49.10(40.21, 59.92)49.10(40.21, 59.92)51.03(41.37, 59.92)Z=-1.910.056
年龄（岁）57.00(50.00, 63.00)57.00(50.00, 63.00)57.00(51.00, 63.00)Z=-0.860.388
睡眠时间（h）7.00(5.00, 8.00)7.00(5.00, 8.00)6.00(5.00, 8.00)Z=-2.700.007
BMI（kg/m2）23.18(20.96, 25.59)23.12(20.89, 25.52)23.55(21.25, 25.83)Z=-2.760.006
性别χ2=19.56<0.001
女2 636(51.03)2 007(49.42)629(56.92)
男2 530(48.97)2 054(50.58)476(43.08)
婚姻χ2=0.000.973
其他511(9.89)402(9.90)109(9.86)
已婚4 655(90.11)3 659(90.10)996(90.14)
教育χ2=28.63<0.001
小学以下2 277(44.09)1 725(42.50)552(49.95)
小学1 102(21.34)865(21.31)237(21.45)
中学1 177(22.79)954(23.50)223(20.18)
高中及以上608(11.77)515(12.69)93(8.42)
居住地χ2=13.04<0.001
农村1 813(35.09)1 476(36.35)337(30.50)
城市3 353(64.91)2 585(63.65)768(69.50)
饮酒χ2=8.090.004
否3 352(64.89)2 595(63.90)757(68.51)
是1 814(35.11)1 466(36.10)348(31.49)
吸烟χ2=3.720.054
否3 504(67.99)2 729(67.33)775(70.39)
是1 650(32.01)1 324(32.67)326(29.61)
高血压χ2=0.000.948
否2 845(55.18)2 239(55.20)606(55.09)
是2 311(44.82)1 817(44.80)494(44.91)
糖尿病χ2=0.100.751
否4 558(88.71)3 581(88.64)977(88.98)
是580(11.29)459(11.36)121(11.02)
), ArticleFig(id=1241070737100960401, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730060995489967, language=CN, label=表1, caption=

根据是否发生关节炎分类的研究人群基线特征

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总计 (n=5 166)未患关节炎 (n=4 061)患关节炎 (n=1 105)统计量P
HDL-C（mg/dL）*49.10(40.21, 59.92)49.10(40.21, 59.92)51.03(41.37, 59.92)Z=-1.910.056
年龄（岁）57.00(50.00, 63.00)57.00(50.00, 63.00)57.00(51.00, 63.00)Z=-0.860.388
睡眠时间（h）7.00(5.00, 8.00)7.00(5.00, 8.00)6.00(5.00, 8.00)Z=-2.700.007
BMI（kg/m2）23.18(20.96, 25.59)23.12(20.89, 25.52)23.55(21.25, 25.83)Z=-2.760.006
性别χ2=19.56<0.001
女2 636(51.03)2 007(49.42)629(56.92)
男2 530(48.97)2 054(50.58)476(43.08)
婚姻χ2=0.000.973
其他511(9.89)402(9.90)109(9.86)
已婚4 655(90.11)3 659(90.10)996(90.14)
教育χ2=28.63<0.001
小学以下2 277(44.09)1 725(42.50)552(49.95)
小学1 102(21.34)865(21.31)237(21.45)
中学1 177(22.79)954(23.50)223(20.18)
高中及以上608(11.77)515(12.69)93(8.42)
居住地χ2=13.04<0.001
农村1 813(35.09)1 476(36.35)337(30.50)
城市3 353(64.91)2 585(63.65)768(69.50)
饮酒χ2=8.090.004
否3 352(64.89)2 595(63.90)757(68.51)
是1 814(35.11)1 466(36.10)348(31.49)
吸烟χ2=3.720.054
否3 504(67.99)2 729(67.33)775(70.39)
是1 650(32.01)1 324(32.67)326(29.61)
高血压χ2=0.000.948
否2 845(55.18)2 239(55.20)606(55.09)
是2 311(44.82)1 817(44.80)494(44.91)
糖尿病χ2=0.100.751
否4 558(88.71)3 581(88.64)977(88.98)
是580(11.29)459(11.36)121(11.02)
), ArticleFig(id=1241070737193235098, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730060995489967, language=EN, label=Table 2, caption=

Study population classified according to BRI quartile

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总计(n=5 166)1(n=1 292)2(n=1 291)
HDL-C（mg/dL）a49.10(40.21, 59.92)54.90(44.85,64.18)52.58(43.30,62.24)
年龄（岁）57.00(50.00, 63.00)57.00(50.00,63.00)56.00(50.00,62.00)
睡眠时间（h）7.00(5.00, 8.00)7.00(5.00,8.00)7.00(5.50,8.00)
BMI（kg/m2）23.18(20.96, 25.59)20.13(18.88,21.48)22.23(20.90,23.40)
新发关节炎
否4 061(78.61)1 047(81.04)1 034(80.09)
是1 105(21.39)245(18.96)257(19.91)
性别
女2 636(51.03)441(34.13)565(43.76)
男2 530(48.97)851(65.87)726(56.24)
婚姻
其他511(9.89)130(10.06)128(9.91)
已婚4 655(90.11)1 162(89.94)1 163(90.09)
教育
小学以下2 277(44.09)540(41.83)539(41.75)
小学1 102(21.34)305(23.63)282(21.84)
中学1 177(22.79)298(23.08)305(23.63)
高中及以上608(11.77)148(11.46)165(12.78)
居住地
农村1 813(35.09)381(29.49)425(32.92)
城市3 353(64.91)911(70.51)866(67.08)
饮酒
否3 352(64.89)718(55.57)776(60.11)
是1 814(35.11)574(44.43)515(39.89)
吸烟
否3 504(67.99)676(52.53)815(63.13)
是1 650(32.01)611(47.47)476(36.87)
高血压
否2 845(55.18)895(69.60)800(62.11)
是2 311(44.82)391(30.40)488(37.89)
糖尿病
否4 558(88.71)1 204(94.21)1 176(91.38)
是580(11.29)74(5.79)111(8.62)
变量3(n=1 291)4(n=1 292)统计量P
HDL-C（mg/dL）a47.17(39.05,57.80)44.46(36.34,52.96)H=380.51<0.001
年龄（岁）56.00(49.00,62.00)58.00(52.00,65.00)H=33.00<0.001
睡眠时间（h）7.00(5.00,8.00)7.00(5.00,8.00)H=1.890.596
BMI（kg/m2）24.25(22.83,25.56)27.07(25.20,28.97)H=2884.68<0.001
新发关节炎χ2=23.62<0.001
否1 025(79.40)955(73.92)
是266(20.60)337(26.08)
性别χ2=408.52<0.001
女699(54.14)931(72.06)
男592(45.86)361(27.94)
婚姻χ2=2.350.503
其他115(8.91)138(10.68)
已婚1 176(91.09)1 154(89.32)
教育χ2=38.67<0.001
小学以下540(41.86)658(50.93)
小学268(20.78)247(19.12)
中学310(24.03)264(20.43)
高中及以上172(13.33)123(9.52)
居住地χ2=38.70<0.001
农村491(38.03)516(39.94)
城市800(61.97)776(60.06)
饮酒χ2=145.07<0.001
否866(67.08)992(76.78)
是425(32.92)300(23.22)
吸烟χ2=298.83<0.001
否951(73.89)1 062(82.39)
是336(26.11)227(17.61)
高血压χ2=296.55<0.001
否660(51.12)490(37.96)
是631(48.88)801(62.04)
糖尿病χ2=96.59<0.001
否1 109(86.24)1 069(83.06)
是177(13.76)218(16.94)
), ArticleFig(id=1241070737302287008, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730060995489967, language=CN, label=表2, caption=

根据BRI四分位数分类的研究人群

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总计(n=5 166)1(n=1 292)2(n=1 291)
HDL-C（mg/dL）a49.10(40.21, 59.92)54.90(44.85,64.18)52.58(43.30,62.24)
年龄（岁）57.00(50.00, 63.00)57.00(50.00,63.00)56.00(50.00,62.00)
睡眠时间（h）7.00(5.00, 8.00)7.00(5.00,8.00)7.00(5.50,8.00)
BMI（kg/m2）23.18(20.96, 25.59)20.13(18.88,21.48)22.23(20.90,23.40)
新发关节炎
否4 061(78.61)1 047(81.04)1 034(80.09)
是1 105(21.39)245(18.96)257(19.91)
性别
女2 636(51.03)441(34.13)565(43.76)
男2 530(48.97)851(65.87)726(56.24)
婚姻
其他511(9.89)130(10.06)128(9.91)
已婚4 655(90.11)1 162(89.94)1 163(90.09)
教育
小学以下2 277(44.09)540(41.83)539(41.75)
小学1 102(21.34)305(23.63)282(21.84)
中学1 177(22.79)298(23.08)305(23.63)
高中及以上608(11.77)148(11.46)165(12.78)
居住地
农村1 813(35.09)381(29.49)425(32.92)
城市3 353(64.91)911(70.51)866(67.08)
饮酒
否3 352(64.89)718(55.57)776(60.11)
是1 814(35.11)574(44.43)515(39.89)
吸烟
否3 504(67.99)676(52.53)815(63.13)
是1 650(32.01)611(47.47)476(36.87)
高血压
否2 845(55.18)895(69.60)800(62.11)
是2 311(44.82)391(30.40)488(37.89)
糖尿病
否4 558(88.71)1 204(94.21)1 176(91.38)
是580(11.29)74(5.79)111(8.62)
变量3(n=1 291)4(n=1 292)统计量P
HDL-C（mg/dL）a47.17(39.05,57.80)44.46(36.34,52.96)H=380.51<0.001
年龄（岁）56.00(49.00,62.00)58.00(52.00,65.00)H=33.00<0.001
睡眠时间（h）7.00(5.00,8.00)7.00(5.00,8.00)H=1.890.596
BMI（kg/m2）24.25(22.83,25.56)27.07(25.20,28.97)H=2884.68<0.001
新发关节炎χ2=23.62<0.001
否1 025(79.40)955(73.92)
是266(20.60)337(26.08)
性别χ2=408.52<0.001
女699(54.14)931(72.06)
男592(45.86)361(27.94)
婚姻χ2=2.350.503
其他115(8.91)138(10.68)
已婚1 176(91.09)1 154(89.32)
教育χ2=38.67<0.001
小学以下540(41.86)658(50.93)
小学268(20.78)247(19.12)
中学310(24.03)264(20.43)
高中及以上172(13.33)123(9.52)
居住地χ2=38.70<0.001
农村491(38.03)516(39.94)
城市800(61.97)776(60.06)
饮酒χ2=145.07<0.001
否866(67.08)992(76.78)
是425(32.92)300(23.22)
吸烟χ2=298.83<0.001
否951(73.89)1 062(82.39)
是336(26.11)227(17.61)
高血压χ2=296.55<0.001
否660(51.12)490(37.96)
是631(48.88)801(62.04)
糖尿病χ2=96.59<0.001
否1 109(86.24)1 069(83.06)
是177(13.76)218(16.94)
), ArticleFig(id=1241070737432310443, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730060995489967, language=EN, label=Table 3, caption=

Association between BRI and new-onset arthritis

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组别Model1Model2Model3
OR(95% CI)POR(95% CI)POR(95% CI)P
BRI（连续变量）1.22(1.12,1.33)<0.0011.19(1.09,1.30)<0.0011.20(1.05,1.37)0.009
Q1refrefref
Q21.06(0.87, 1.29)0.5441.06(0.87, 1.29)0.5511.08(0.88, 1.32)0.471
Q31.11(0.91, 1.35)0.2951.10(0.90, 1.34)0.3391.11(0.89, 1.39)0.354
Q41.51(1.25, 1.82)<0.0011.44(1.18, 1.75)<0.0011.45(1.11, 1.91)0.007
P趋势<0.001<0.0010.018
), ArticleFig(id=1241070737558139572, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730060995489967, language=CN, label=表3, caption=

BRI与新发关节炎之间的关系

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组别Model1Model2Model3
OR(95% CI)POR(95% CI)POR(95% CI)P
BRI（连续变量）1.22(1.12,1.33)<0.0011.19(1.09,1.30)<0.0011.20(1.05,1.37)0.009
Q1refrefref
Q21.06(0.87, 1.29)0.5441.06(0.87, 1.29)0.5511.08(0.88, 1.32)0.471
Q31.11(0.91, 1.35)0.2951.10(0.90, 1.34)0.3391.11(0.89, 1.39)0.354
Q41.51(1.25, 1.82)<0.0011.44(1.18, 1.75)<0.0011.45(1.11, 1.91)0.007
P趋势<0.001<0.0010.018
), ArticleFig(id=1241070737671385789, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730060995489967, language=EN, label=Table 4, caption=

Results of subgroup analysis between BRI and new-onset arthritis

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变量n(%)OR (95% CI)PP for interaction
性别0.659
女2 636(51.03)1.10(1.03~1.17)0.002
男2 530(48.97)1.07(0.99~1.17)0.093
年龄（岁）0.412
<603 219(62.31)1.14(1.07~1.21)<0.001
≥601 947(37.69)1.09(1.02~1.17)0.016
婚姻0.326
其他511(9.89)1.04(0.90~1.20)0.570
已婚4 655(90.11)1.13(1.07~1.18)<0.001
教育0.286
小学以下2 277(44.09)1.12(1.05~1.19)<0.001
小学1 102(21.34)1.14(1.03~1.27)0.014
中学1 177(22.79)1.01(0.91~1.13)0.791
高中及以上608(11.77)1.20(1.01~1.43)0.038
居住地0.560
农村1 813(35.09)1.10(1.02~1.20)0.016
城市3 353(64.91)1.14(1.07~1.21)<0.001
饮酒0.372
否3 352(64.89)1.12(1.06~1.18)<0.001
是1 814(35.11)1.07(0.97~1.17)0.177
吸烟0.575
否3 504(67.99)1.10(1.04~1.16)<0.001
是1 650(32.01)1.14(1.03~1.26)0.011
BMI（kg/m2）0.899
<18.5289(5.59)1.12(0.77~1.63)0.554
18.5~<242 805(54.30)1.15(1.04~1.27)0.006
24~<281 527(29.56)1.12(0.99~1.25)0.063
≥28545(10.55)1.08(0.94~1.24)0.297
睡眠时间（h）0.883
<72 427(46.98)1.11(1.04~1.19)0.001
≥72 739(53.02)1.12(1.05~1.20)0.001
), ArticleFig(id=1241070737801409222, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730060995489967, language=CN, label=表4, caption=

BRI与新发关节炎的亚组分析结果

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变量n(%)OR (95% CI)PP for interaction
性别0.659
女2 636(51.03)1.10(1.03~1.17)0.002
男2 530(48.97)1.07(0.99~1.17)0.093
年龄（岁）0.412
<603 219(62.31)1.14(1.07~1.21)<0.001
≥601 947(37.69)1.09(1.02~1.17)0.016
婚姻0.326
其他511(9.89)1.04(0.90~1.20)0.570
已婚4 655(90.11)1.13(1.07~1.18)<0.001
教育0.286
小学以下2 277(44.09)1.12(1.05~1.19)<0.001
小学1 102(21.34)1.14(1.03~1.27)0.014
中学1 177(22.79)1.01(0.91~1.13)0.791
高中及以上608(11.77)1.20(1.01~1.43)0.038
居住地0.560
农村1 813(35.09)1.10(1.02~1.20)0.016
城市3 353(64.91)1.14(1.07~1.21)<0.001
饮酒0.372
否3 352(64.89)1.12(1.06~1.18)<0.001
是1 814(35.11)1.07(0.97~1.17)0.177
吸烟0.575
否3 504(67.99)1.10(1.04~1.16)<0.001
是1 650(32.01)1.14(1.03~1.26)0.011
BMI（kg/m2）0.899
<18.5289(5.59)1.12(0.77~1.63)0.554
18.5~<242 805(54.30)1.15(1.04~1.27)0.006
24~<281 527(29.56)1.12(0.99~1.25)0.063
≥28545(10.55)1.08(0.94~1.24)0.297
睡眠时间（h）0.883
<72 427(46.98)1.11(1.04~1.19)0.001
≥72 739(53.02)1.12(1.05~1.20)0.001
), ArticleFig(id=1241070737927238351, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730060995489967, language=EN, label=Table 5, caption=

Mediating role of HDL-C in BRI effects on new-onset arthritis

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BRI-(HDL-C)-关节炎Estimate值（95% CI）P
总效应0.013（0.007~0.020）<0.001
间接效应-0.001（-0.002~0.000）0.040
直接效应0.014（0.008~0.020）<0.001
中介效应-0.068（-0.229~-0.010）0.040
), ArticleFig(id=1241070738027901653, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240730060995489967, language=CN, label=表5, caption=

高密度脂蛋白胆固醇在 BRI对新发关节炎影响中的中介作用

, figureFileSmall=null, figureFileBig=null, tableContent=
BRI-(HDL-C)-关节炎Estimate值（95% CI）P
总效应0.013（0.007~0.020）<0.001
间接效应-0.001（-0.002~0.000）0.040
直接效应0.014（0.008~0.020）<0.001
中介效应-0.068（-0.229~-0.010）0.040
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中国中老年人身体圆度指数与关节炎的队列研究及血脂的中介作用
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董家瑜 , 沈新艳 , 王彤
现代预防医学 | 临床与预防 2025,52(8): 1525-1532
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现代预防医学 | 临床与预防 2025, 52(8): 1525-1532
中国中老年人身体圆度指数与关节炎的队列研究及血脂的中介作用
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董家瑜, 沈新艳, 王彤
作者信息
  • 北京中医药大学中医学院，北京　100029

    • 董家瑜（2001—），女，硕士在读，研究方向：关节炎的多维度研究

通讯作者:

王彤，E-mail：
A cohort study of body roundness index and arthritis in middle-aged and elderly Chinese and the mediating role of blood lipids
Jia-yu DONG, Xin-yan SHEN, Tong WANG
Affiliations
  • School of Traditional Chinese Medicine,Beijing University of Traditional Chinese Medicine, Beijing 100029, China
出版时间: 2025-04-25 doi: 10.20043/j.cnki.MPM.202412160
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摘要
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目的

本研究旨在探索身体圆度指数（Body Roundness Index, BRI）与新发关节炎之间的联系，为关节炎的预防和治疗提供新视角。

方法

采用队列研究设计，利用中国健康与退休纵向研究（CHARLS）数据库中2011与2020年的数据，以BRI为暴露因素，高密度脂蛋白胆固醇（High-Density Lipoprotein Cholesterol, HDL-C）、总胆固醇、甘油三酯、低密度脂蛋白胆固醇（Low-Density Lipoprotein Cholesterol，LDL-C）为中介变量，纳入年龄、性别等人口学特征和吸烟、饮酒等健康行为作为混杂因素，新发关节炎为结局，采用多模型logistic回归策略、限制性立方样条、亚组分析及中介分析等方法进行统计分析。对照相关研究，本研究探讨的剂量-反应关系主要目的是研究暴露与结局之间是否存在非线性关系，即随着暴露水平的变化，结局的风险是否会发生相应的改变。

结果

共纳入5 166名参与者，BRI与关节炎呈正相关，OR值为1.196（95% CI:1.047~1.367），BRI增加一个四分位数范围，关节炎发病率上升19.6%；剂量反应关系显示BRI>3.943时与关节炎发病率呈线性正相关；亚组分析表明BRI与新发关节炎的正相关不受多种因素影响；中介分析显示HDL-C对关节炎有保护作用，介导了BRI对关节炎发病率影响的约6.84%，总胆固醇、甘油三酯与LDL-C的中介效应并不显著；BRI预测新发关节炎的AUC（0.546）高于BMI（0.527）。

结论

BRI水平升高可能导致关节炎发病风险增加，HDL-C可能缓解该风险，未来应探索其临床应用潜力及调控策略以降低关节炎发病率和改善预后。

关节炎  /  身体圆度指数  /  CHARLS数据库  /  队列研究
Objective

To explore the relationship between body roundness index (BRI) and new onset arthritis, and provide a new perspective for the prevention and treatment of arthritis.

Methods

A cohort study design was adopted, using the data of 2011 and 2020 in the China longitudinal study on the China Health and Retirement Longitudinal Study (CHARLS), taking BRI as the exposure factor, high-density lipoprotein cholesterol (HDL-C), total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL-C) as the intermediary variables, including demographic characteristics such as age and gender, smoking, alcohol consumption and other health behaviors as confounding factors, and new onset arthritis as the outcome. Statistical analysis was carried out using multiple model logistic regression strategy, restricted cubic spline, subgroup analysis and intermediary analysis. Compared with relevant studies, the main purpose of the dose-response relationship we explored is to study whether there is a nonlinear relationship between exposure and outcome, that is, whether the risk of outcome will change accordingly with the change of exposure level.

Results

A total of 5 166 participants were included, and BRI was positively correlated with arthritis, with an OR value of 1.196 (95% CI: 1.047-1.367). The prevalence of new onset arthritis increased by 19.6% when BRI increased by a quartile range; The dose-response relationship showed that BRI > 3.943 was positively correlated with the incidence of arthritis; Subgroup analysis showed that the positive correlation between BRI and new onset arthritis was not affected by many factors; Mediation analysis showed that HDL-C had a protective effect on arthritis, mediating about 6.84% of the impact of BRI on the incidence of arthritis. The mediation effect of total cholesterol, triglycerides and LDL-C was not significant; The AUC of BRI for predicting new onset arthritis (0.546) was higher than that of BMI (0.527).

Conclusion

The increased level of BRI may lead to an increased risk of arthritis, and HDL-C may alleviate this risk. In the future, its clinical application potential and regulatory strategies should be explored to reduce the incidence of arthritis and improve the prognosis.

Arthritis  /  Body roundness index  /  CHARLS database  /  Cohort study
董家瑜, 沈新艳, 王彤. 中国中老年人身体圆度指数与关节炎的队列研究及血脂的中介作用. 现代预防医学, 2025 , 52 (8) : 1525 -1532 . DOI: 10.20043/j.cnki.MPM.202412160
Jia-yu DONG, Xin-yan SHEN, Tong WANG. A cohort study of body roundness index and arthritis in middle-aged and elderly Chinese and the mediating role of blood lipids[J]. Modern Preventive Medicine, 2025 , 52 (8) : 1525 -1532 . DOI: 10.20043/j.cnki.MPM.202412160
正文
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关节炎是由炎症、感染、退化或其他因素引起的，发生在人体关节及其周围组织的一种炎性疾病，临床表现为关节的红、肿、热、痛、功能障碍和关节畸形。其中最为常见的是骨关节炎和类风湿关节炎。在全球范围内，2017 年关节炎的年龄标准化点患病率和年发病率分别比 1990 年增加 9.3%和8.2%[1]。关节炎会导致患者关节疼痛和活动不利，行动受限，严重者影响日常生活起居和心理健康；对家庭而言，主要劳动人口丧失劳动力，加重家庭经济负担；对社会而言，关节炎导致大量劳动力丧失，社会生产力下降，造成国家经济损失。因而，关节炎已成为一项亟需解决重要的公共卫生安全问题[2]。
关节炎是一种由多种因素驱动的复杂疾病，其中肥胖被认为是主要危险因素之一。肥胖会增加关节负担，引起关节结构病理性改变，包括关节负荷异常、关节力线不良和肌无力。此外，肥胖会影响体内参与关节炎的免疫细胞的作用，从而影响关节炎的发展[3]。体质指数（Body Mass Index, BMI）常作为衡量肥胖的指标，但是它无法区分BMI相似但体脂程度不同的个体，会出现肥胖的错误分类；此外，它无法提供脂肪的分布信息。为此，有学者提出一个新的体型测量指标：身体圆度指数（Body Roundness Index, BRI）[4]。BRI考虑了体宽和身高的比率，对个体体型有更详细的评估，包括脂肪的分布情况，更能够准确地反映肥胖情况及其潜在的风险[5]。
有研究表明，BRI和全因死亡率之间存在U形关联，BRI在估计死亡风险和识别高位个体方面有强有力的证据[6]。越来越多的研究表明BRI与各类疾病之间存在相关性，比如心血管类疾病和抑郁症等[7-8]。因此，本研究通过分析中国健康与退休纵向研究 （CHARLS）的数据来探讨BRI和关节炎的关系，同时选取高密度脂蛋白胆固醇（High-Density Lipoprotein Cholesterol, HDL-C）、总胆固醇、甘油三酯、低密度脂蛋白胆固醇（Low-Density Lipoprotein Cholesterol，LDL-C）作为中介变量进行中介分析。
1　材料与方法
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1.1　研究设计
本研究采用队列研究设计，数据来源于CHARLS数据库，包括对社区居民的社会、经济和健康状况的评估，各轮调查已获得了北京大学生物医学伦理委员会的批准（IRB00001052-11015）[9]。基线数据收集始于2011年，随访数据则获取于2020年，总随访期长达九年。在基线阶段，研究纳入了身高和腰围的测量值，用于计算暴露BRI。同时，为了探究暴露因素与最终健康结果间的潜在中介机制，研究选取HDL-C、总胆固醇、甘油三酯、LDL-C作为中介变量进行中介分析。对于协变量的纳入，本研究综合参考了其他相似研究，选取了其中最为常见的几个协变量：年龄、性别、居住地（城市或乡村）、教育水平（小学以下、小学、初中或高中及以上）、婚姻状况（已婚或非已婚）等人口学特征和饮酒习惯、吸烟状况、睡眠时长、BMI、高血压和糖尿病等健康行为因素，旨在通过控制这些变量来提高研究结论的准确性和可靠性。最后，为确保研究终点事件的新发性，即首次诊断为关节炎的情况，研究分别记录了基线和随访时受试者关节炎的发生情况，以随访时的情况作为主要结局指标。本研究选择45岁及以上的人群作为研究对象，共17 060人，在此基础上的排除标准如下：1）缺少2011年身高、腰围数据，排除6 868人；2）缺少2011年关节炎数据，排除34人；2）缺少2020年关节炎数据，排除2 298人；3）2011年已经患关节炎的人群，排除2 694人。最终一共纳入5 166名参与者。缺失值>20%的变量选择删除，其余变量的缺失值使用多重插补法进行填补。
1.2　测量
BRI的计算需要身高（BH）和腰围（WC）两个测量值，计算公式如下[4]，其中π取3.141 592 6：
参考类似的CHARLS研究方法获取结局指标[10]：关节炎的确定基于基线与随访调查的自我报告，调查人员询问受访者“是否有医生曾经告诉过您有关节炎？”，受访者回答“是”即患有关节炎。
1.3　统计分析
数据清洗与统计分析基于R软件(4.3.3版本)完成。在对数据进行描述性分析时，偏态分布的连续变量采用中位数（四分位数）表示，分类变量通过百分比表示。连续变量使用Mann-Whitney test或Kruskal-waills test进行分析，分类变量采用卡方检验或Fisher确切概率法。为探究暴露与结局之间的关系，本研究采用多模型logistic回归策略，应用三个回归模型（Model1、Model2、Model3）进行分析。Model1为粗模型，仅纳入暴露；Model2在Model1的基础上纳入了性别、年龄、婚姻状况、教育水平、居住地等人口学特征变量；Model3则在Model2的基础上进一步纳入了健康行为相关变量，包括吸烟饮酒情况、高血压、糖尿病、睡眠和BMI。计算各模型的OR及其95% CI，以评估暴露对关节炎发病风险的影响。同时进行趋势检验，以判断暴露的变化趋势是否与关节炎发病风险的变化趋势相关。限制性立方样条（Restricted Cubic Splines，RCS）探索BRI与关节炎之间是否存在非线性关系，并寻找阈值。此外，进行亚组分析以探索各个亚组的关联，选择性别、年龄、结婚、教育情况、居住地、BMI和睡眠时间作为亚组变量，并通过似然比检验以评估变量之间的交互作用是否有统计学意义。中介分析使用 “mediation”R 包，以测试HDL-C是否参与BRI与新发关节炎之间的关联。最后，使用MedCalc软件20.0.4版本（MedCalc Software Ltd, Ostend, Belgium; https://www.medcalc.org; 2021)绘制ROC曲线以比较BRI与BMI预测关节炎的能力。检验水准α=0.05。
2　结果
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2.1　研究人群基线特征
本研究共计5 166名参与者，随访时未患关节炎的参与者4 061名，关节炎患者1 105名。详细基线特征如表1所示。与非关节炎参与者相比，关节炎患者中女性比例更高，且通常年龄较大。他们还表现为更高水平的HDL-C、BMI。此外，关节炎还与睡眠情况、受教育程度、居住地及饮酒情况相关。当暴露由连续变量转变为分组变量时（表2），HDL-C总体中位数为49.10 ，四分位数范围为40.21至 59.92，组间差异具有统计学意义（P<0.001）；随访时关节炎总体发病率为21.39%，组间差异具有统计学显著性（P<0.001），且随着BRI的升高，发病率从18.96%上升到26.08%。此外，年龄、BMI、性别、教育程度、居住地、饮酒吸烟情况、高血压、糖尿病的组间差异均具有统计学显著性。
2.2　BRI与新发关节炎之间的关系
为研究BRI与新发关节炎之间的关系，我们使用了多模型logistic回归分析，如表3所示。结果显示，BRI与新发关节炎之间存在正相关关系。即使调整了所有混杂因素后，Model3仍存在正相关（OR=1.196，95% CI:1.047~1.367）。当BRI增加一个四分位距(IQR)时，关节炎的发病率上升19.6%。
当BRI从连续变量转换为分类变量时，BRI与新发关节炎之间的正相关在所有三个调整模型中保持一致。Q1作为参考组，从Q2到Q4，随着BRI水平的提高，新发关节炎的OR值从1.08（95% CI：0.88~ 1.32）上升至1.45(95% CI：1.11~1.91)。
2.3　BRI与新发关节炎的剂量反应关系
RCS分析显示BRI与新发关节炎发病率之间存在线性关系（Pfor overall<0.001，P for nonlinear=0.179），如图1所示。阈值效应分析确定了新发关节炎组的断点在BRI=3.943。结果表明，在BRI>3.943时，BRI与关节炎发病率呈正相关。
2.4　BRI与新发关节炎的亚组分析结果
通过亚组分析以检查和确定BRI与新发关节炎之间的稳定性，如表4。亚组分析结果显示，BRI与新发关节炎之间的关联不受性别、年龄、婚姻情况、教育水平、居住地、饮酒情况、吸烟情况、BMI和睡眠情况的影响（交互作用均P>0.05），各亚组之间无统计学差异。这一发现表明，BRI与新发关节炎之间的正相关在所有情况下都保持稳定。
2.5　HDL-C在BRI对新发关节炎的影响中的中介作用
为了探究暴露因素与最终健康结果间的潜在中介机制，研究选取HDL-C、总胆固醇、甘油三酯、LDL-C作为中介变量进行中介分析。总胆固醇、甘油三酯与LDL-C的中介效应并不显著（P>0.05）。HDL-C分析结果见表5，BRI与关节炎发病率之间存在部分间接效应，间接效应β值为-0.001，这表明HDL-C对关节炎有保护作用，即较高的HDL-C水平可以降低关节炎的风险。直接效应的β为0.014，这说明除了通过提高HDL-C水平间接影响关节炎外，BRI还存在直接增加关节炎风险的效果。总效应的β值为0.013，即BRI总体上增加了关节炎的风险。在BRI与关节炎发病率之间存在显著关联的情况下，HDL-C介导了BRI对关节炎发病率影响的大约6.84%，但方向为负，即HDL-C在一定程度上减弱了BRI对关节炎的不利影响。
2.6　BRI和BMI预测新发关节炎的比较
通过计算ROC曲线下面积来评估BRI和BMI对新发关节炎的预测效能（图2和图3）。结果表明，BRI的AUC（0.546）高于BMI的AUC（0.527）。相比于BMI，BRI在特异性更优秀，最佳阈值低，在预测新发关节炎方面更优。
3　讨论
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本研究结果显示，在调整了年龄、性别、居住地等潜在混杂因素后，随着BRI水平的增加，关节炎的发病风险也在增加，这种关联在多种统计模型中均保持稳健，提示BRI可能是关节炎发病的一个独立危险因素。当BRI>3.943时，随着BRI的升高关节炎的发病率呈线性上升，提示可以针对这部分人群进行重点监测和干预。此外，HDL-L作为中介变量在BRI对关节炎的影响中起了一定作用，占了6.84%的中介效应。因此，控制BRI水平和提高HDL-C水平可能是预防关节炎的有效措施。既往研究发现，BMI是关节炎的危险因素[11-12]，而BRI对关节炎的预测能力要优于BMI。
既往研究结果与本研究结果具有一致性。使用NHANES数据库进行研究的结果显示，BRI和骨关节炎在美国成年人中显著相关，BRI 水平升高可能会增加患骨关节炎的风险[13]。一项使用CHARLS与NHANES数据库的研究发现，两项肥胖指标TyG-BMI和TyG-WHtR与中国和美国人群的关节炎患病率呈正相关[14]。一项荟萃分析研究表明，BRI在预测代谢综合征方面优于BMI、腰臀比、体型指数和体型肥胖指数[15]。本研究同样表明，在预测关节炎方面BRI优于BMI。
与此同时，本研究还探讨了HDL-C在BRI与关节炎关系中的调节作用。结果表明，HDL-C可以部分抵消BRI对关节炎的不利影响。BRI与HDL-C水平之间存在显著的负相关关系[16]，与本研究结果一致（见表2），即随着BRI的增加，HDL-C水平降低。一项队列研究发现，较高水平的 HDL-C与随访中较低的手骨关节炎发病率相关[17]。我们推测，高密度脂蛋白的抗炎功能可能是其发挥对关节炎保护作用的机制。HDL通过多种机制发挥抗炎作用[18]：抑制Toll样受体（TLR）介导的信号通路；诱导抗炎转录因子ATF3的表达；促进胆固醇外流和逆转胆固醇运输；影响T细胞的激活和功能；清除自由基、抑制氧化酶的活性以及减少氧化修饰的脂蛋白等机制，降低氧化应激水平，从而减轻炎症反应。实验证明，HDL可以降低胶原诱导性关节炎(CIA)小鼠血清中促炎因子TNF-α以及特异性抗体IgG2α表达水平[19]。除此之外，HDL还可以通过调节微小RNA（miRs）的表达来抑制炎症反应，例如在乳腺癌患者中，HDL中的miR-223-3p和miR-375-3p的表达增加，显示出其抗炎活性[20]。
关于BRI如何影响关节炎的发生，目前暂无定论。我们推测，高水平的BRI可能导致体内炎症反应增强，并影响免疫系统的功能，从而直接或间接促进关节组织的损伤，增加关节炎的风险。一方面，脂肪组织是促炎细胞因子的重要来源，如 IL-1β、IL-6、TNF-α、细胞间粘附分子 1 （ICAM1）、单核细胞趋化蛋白 1 （MCP-1），并且脂肪组织的特点是从活化的 M2 巨噬细胞转变为经典的活化 M1 巨噬细胞，从而导致炎症环境[21]。并且，BRI与高敏C反应蛋白、TNF-α与IL-6三种炎症因子水平存在正相关[22]。另一方面，一项横断面分析结果表明，肥胖加剧了C反应蛋白对膝关节疼痛的作用[23]。脂肪组织功能障碍通过局部和全身性炎症、免疫功能障碍以及促炎细胞因子和脂肪因子的产生，影响骨关节炎的相关疼痛[24]。而老年肥胖患者骨折和骨愈合延迟的风险较高，这可能是由于在肥胖条件下，破骨细胞、成骨细胞和骨细胞等骨细胞的平衡功能被异常和长期的免疫反应破坏[25]。
尽管本研究采用了大型队列设计，并通过多种统计方法确保结果的可靠性，但仍存在一些局限性。由于研究性质为观察性研究，我们不能完全排除残余混杂因素的影响。其次，BRI的测量是在基线进行的，无法反映随时间变化的情况。最后，由于本研究中关节炎的确定依赖于基线与随访调查期间的自我报告，且没有对不同类型的关节炎进行明确与分类，故而在判定过程中可能产生偏差，期望今后CHARLS可以明确疾病的诊断标准与类型。未来的研究需要进一步探索这些潜在的生物学途径，以明确BRI与关节炎之间的因果关系。
4　结论
收起
综上所述，本研究表明中国中老年人BRI的升高可以增加关节炎的发病风险，HDL-C介导了这个过程。
基金
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  • 北京市朝阳区科技计划项目(CYSF2029)
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doi: 10.20043/j.cnki.MPM.202412160
  • 接收时间：2024-12-10
  • 首发时间：2026-03-17
  • 出版时间：2025-04-25
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  • 收稿日期：2024-12-10
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北京市朝阳区科技计划项目(CYSF2029)
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    北京中医药大学中医学院，北京　100029

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
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