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Background <p>As the global prevalence of obesity rises, the clinical focus is shifting from simple BMI to a systemic perspective that integrates body composition and metabolic health. This study evaluates the association between Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and the combined influence of insulin resistance and obesity-related body shape indices.</p> Methods <p>Utilizing the KoGES cohort (<i>n</i> = 3,196), participants were categorized into four groups based on the median values of HOMA-IR and the Body Roundness Index (BRI). MASLD was defined by an HSI score &gt; 36, at least one metabolic component, and controlled alcohol consumption (&lt; 30&#xa0;g/day for men, &lt; 20&#xa0;g/day for women). Cox proportional hazard regression was conducted to assess the risk across groups, including interaction and subgroup analyses to determine the independence of these markers.</p> Results <p>Both HOMA-IR and BRI were significant predictors of MASLD risk even when fully adjusted, with Hazard Ratios (HR) of 1.80 (95% CI: 1.52–2.12) and 2.33 (95% CI: 1.96–2.76), respectively. In the joint analysis, the group with both high HOMA-IR and high obesity-related body shape index (BRI) showed a 3.58-fold (95% CI: 2.84–4.51) increased risk compared to the reference group. Notably, no significant additive or multiplicative interactions were found, confirming that these two factors serve as independent and distinct predictive markers.</p> Conclusions <p>Combining HOMA-IR with body shape-related obesity markers like BRI provides a more robust prediction of MASLD risk than individual indices. These findings suggest that integrated monitoring of metabolic and morphological profiles is essential for the early identification of high-risk populations.</p>

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Joint association of body roundness index and HOMA-IR with risk of MASLD in Korean populations

  • 期刊论文

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  • 发表日期：

    2026年6月27日

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  • Kyo-sun Lee,
  • Sung-Ho Ahn,
  • Da-Hye Son,
  • Yong-Jae Lee

摘要

Background

As the global prevalence of obesity rises, the clinical focus is shifting from simple BMI to a systemic perspective that integrates body composition and metabolic health. This study evaluates the association between Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and the combined influence of insulin resistance and obesity-related body shape indices.

Methods

Utilizing the KoGES cohort (n = 3,196), participants were categorized into four groups based on the median values of HOMA-IR and the Body Roundness Index (BRI). MASLD was defined by an HSI score > 36, at least one metabolic component, and controlled alcohol consumption (< 30 g/day for men, < 20 g/day for women). Cox proportional hazard regression was conducted to assess the risk across groups, including interaction and subgroup analyses to determine the independence of these markers.

Results

Both HOMA-IR and BRI were significant predictors of MASLD risk even when fully adjusted, with Hazard Ratios (HR) of 1.80 (95% CI: 1.52–2.12) and 2.33 (95% CI: 1.96–2.76), respectively. In the joint analysis, the group with both high HOMA-IR and high obesity-related body shape index (BRI) showed a 3.58-fold (95% CI: 2.84–4.51) increased risk compared to the reference group. Notably, no significant additive or multiplicative interactions were found, confirming that these two factors serve as independent and distinct predictive markers.

Conclusions

Combining HOMA-IR with body shape-related obesity markers like BRI provides a more robust prediction of MASLD risk than individual indices. These findings suggest that integrated monitoring of metabolic and morphological profiles is essential for the early identification of high-risk populations.