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.
Ma G, Liu H, et al. • Behavioural neurology • 2026
An increased BRI is associated with a higher stroke risk, partially mediated by CircS, highlighting the potential role of circadian health in stroke prevention.
Key Findings
Results
Higher log(BRI) values were significantly associated with an increased risk of incident stroke after full adjustment.
HR = 2.50, 95% CI: 1.81–3.44, p < 0.001 for log(BRI) as a continuous variable
Participants in Q4 of BRI showed greater stroke risk than Q1 (HR = 2.23, 95% CI: 1.63–3.04, p < 0.001)
Analysis was conducted using Cox proportional hazards models with restricted cubic splines and Kaplan-Meier curves
Study population comprised 7535 participants from the China Health and Retirement Longitudinal Study (CHARLS)
Results
In individuals with Circadian Syndrome (CircS), no significant association was observed between BRI and stroke risk.
Log(BRI) HR = 1.23, 95% CI: 0.55–2.76, p > 0.05 in CircS patients
Q4 vs. Q1 HR = 0.61, 95% CI: 0.21–1.77, p > 0.05 in CircS patients
CircS was defined by the presence of at least four concurrent metabolic disturbances due to circadian rhythm disruption
Results
In non-CircS individuals, the association between BRI and stroke risk remained statistically significant.
Log(BRI) HR = 2.36, 95% CI: 1.61–3.47, p < 0.001 in non-CircS individuals
Q4 vs. Q1 HR = 2.08, 95% CI: 1.46–2.98, p < 0.001 in non-CircS individuals
Subgroup and sensitivity analyses bolstered the robustness of these findings
Results
Circadian Syndrome mediated 21.0% of the association between BRI and stroke risk.
Mediation proportion: 21.0%, 95% CI: 18%–91%, p < 0.001
Mediation analyses were conducted to quantify the indirect effect of CircS in the BRI–stroke pathway
The finding suggests CircS partially, but not fully, explains the BRI–stroke relationship
Results
BRI demonstrated moderate predictive capability for stroke and outperformed other anthropometric indices in ROC analysis.
BRI achieved an area under the curve (AUC) of 0.656 for stroke prediction
BRI outperformed other conventional metabolic and anthropometric indices in stroke risk prediction performance
ROC analysis was used to compare BRI against conventional metabolic indices
Ma G, Liu H, Wu H, Zhang M, Zhang Y, Fan H, et al.. (2026). 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.. Behavioural neurology. https://doi.org/10.1155/bn/1282354