{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T06:04:41Z","timestamp":1789538681216,"version":"build-2803163510"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The Body Roundness Index (BRI) combines waist circumference and height into a single geometric measure that is intended to reflect visceral adiposity. Its ability to predict metabolic syndrome (MetS) in adolescents and the biological processes that mediate this association have not been well defined. We tested the BRI-MetS relationship in Chinese adolescents, compared BRI with body mass index (BMI), and examined whether circulating biomarkers mediated this association.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross-sectional study recruited 914 Chinese adolescents (53.2% boys) aged 11\u201316\u202fyears. MetS was defined according to Chinese pediatric guidelines (CN2025) and the International Diabetes Federation (IDF) criteria. Associations and predictive performance were assessed using logistic regression, restricted cubic splines (RCS), and receiver operating characteristic (ROC) curves. Subgroup analyses were stratified by sex and BMI category. Potential mechanistic pathways involving 22 serum biomarkers were investigated by correlation networks, hierarchical clustering, and two-stage mediation models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      BRI was positively associated with MetS (CN2025: OR\u202f=\u202f3.63 per unit, 95%CI 2.91\u20134.53; IDF: OR\u202f=\u202f2.64, 95%CI 2.14\u20133.26). RCS demonstrated non-linear dose\u2013response relationship, with an acceleration in risk beyond BRI of approximately 4.0. BRI outperformed BMI in discriminating MetS (AUC 0.873 vs. 0.835,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.005), especially among normal-weight participants (OR\u202f=\u202f3.48,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). Sex stratification showed that BRI was associated with hypertriglyceridemia and hypertension in male adolescents (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001) but not in female adolescents. We identified three biomarker co-expression modules: the upward module (ALT, FINS, and UA) mediated 52.9% of the association between BRI and hypertriglyceridemia and 54.1\u201359.5% of the association between BRI and hypertension; SFRP5 and irisin mediated the associations of BRI with fasting plasma glucose (FPG) and HDL-cholesterol, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>BRI may be a better predictor of MetS in Chinese adolescents, particularly when MetS is defined using domestic criteria. Its predictive power was greatest among normal-weight adolescents and varied by sex. Exploratory mediation analyses identified the metabolic-inflammatory axis and protective adipokines as key mediators, suggesting hypothesis-generating targets for interventions to improve adolescent metabolic health that require longitudinal validation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2026.1930822","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T05:31:27Z","timestamp":1789536687000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Body roundness index and adolescent metabolic syndrome: dose\u2013response analysis and serum biomarker mediation"],"prefix":"10.3389","volume":"13","author":[{"given":"Hui","family":"Yao","sequence":"first","affiliation":[{"name":"Department of Endocrinology, Shengjing Hospital of China Medical University","place":["Shenyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiwen","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Shengjing Hospital of China Medical University","place":["Shenyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fang","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Shengjing Hospital of China Medical University","place":["Shenyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Shengjing Hospital of China Medical University","place":["Shenyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaochen","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Liaoning Provincial People\u2019s Hospital","place":["Shenyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Runyu","family":"Du","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Shengjing Hospital of China Medical University","place":["Shenyang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"2627","DOI":"10.1016\/s0140-6736(17)32129-3","article-title":"Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128\u00b79 million children, adolescents, and adults","volume":"390","year":"2017","journal-title":"Lancet"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"402","DOI":"10.1038\/s41366-018-0129-7","article-title":"National trends in stunting, thinness and overweight among Chinese school-aged children, 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