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Background <p>Despite established individual associations of poor sleep quality and obesity with multimorbidity, their potential joint association remains inadequately characterized. This study aimed to investigate how longitudinal changes in sleep patterns, combined with Body Roundness Index (BRI), a novel abdominal obesity indicator, impact the development of multimorbidity in middle-aged and older individuals.</p> Methods <p>This longitudinal cohort study utilized data from the China Health and Retirement Longitudinal Study (CHARLS) spanning 2011 to 2018. Longitudinal changes in sleep quality and sleep duration were categorized as “Stable Good”, “Deteriorated”, “Improved”, or “Stable Poor”. Multivariable logistic regression models were employed to assess independent and joint associations with incident multimorbidity, adjusting for sociodemographic and lifestyle confounders.</p> Results <p>A total of 1,822 participants aged ≥ 45 years who were free of multimorbidity at baseline were included. During the follow-up period, 185 participants (10.2%) developed multimorbidity. In the overall population, elevated BRI change (OR = 1.31, 95% CI: 1.07–1.61) and adverse sleep trajectories were significantly associated with incident multimorbidity. Specifically, participants with “Deteriorated” and “Stable Poor” sleep quality exhibited ORs of 2.21 (95% CI: 1.17–4.12) and 2.91 (95% CI: 1.57–5.37), respectively. Similarly, “Deteriorated” (OR = 1.63, 95% CI: 1.09–2.39) and “Stable Poor” (OR = 1.59, 95% CI: 1.01–2.46) sleep duration were associated with increased risk. Crucially, stratified analyses revealed that BRI changes significantly modified these associations. In the low BRI change group, sleep quality trajectories showed no significant association with multimorbidity. Conversely, in the high BRI change group, the risk was markedly amplified for those with “Deteriorated” (OR = 2.74, 95% CI: 1.11–6.71) and “Stable Poor” (OR = 4.48, 95% CI: 1.95–10.06) sleep quality. Regarding sleep duration, a significant association was exclusively observed in the “Deteriorated” group within the high BRI change group (OR = 2.36, 95% CI: 1.09–5.05).</p> Conclusions <p>This study demonstrates that adverse sleep trajectories and increasing BRI are independent risk factors for incident multimorbidity, and their combination synergistically amplifies risk. These findings highlight the importance of integrated interventions targeting both sleep health and abdominal obesity for multimorbidity prevention in aging populations.</p>

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Body roundness index modified the association between sleep changes and multimorbidity in middle-aged and older adults: a nationwide cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月29日

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  • Jianping Liu,
  • Yang Shi,
  • Chunmei Song,
  • Shufang Wang,
  • Siyu Gu,
  • Qinghe Li,
  • Haijuan Chen

摘要

Background

Despite established individual associations of poor sleep quality and obesity with multimorbidity, their potential joint association remains inadequately characterized. This study aimed to investigate how longitudinal changes in sleep patterns, combined with Body Roundness Index (BRI), a novel abdominal obesity indicator, impact the development of multimorbidity in middle-aged and older individuals.

Methods

This longitudinal cohort study utilized data from the China Health and Retirement Longitudinal Study (CHARLS) spanning 2011 to 2018. Longitudinal changes in sleep quality and sleep duration were categorized as “Stable Good”, “Deteriorated”, “Improved”, or “Stable Poor”. Multivariable logistic regression models were employed to assess independent and joint associations with incident multimorbidity, adjusting for sociodemographic and lifestyle confounders.

Results

A total of 1,822 participants aged ≥ 45 years who were free of multimorbidity at baseline were included. During the follow-up period, 185 participants (10.2%) developed multimorbidity. In the overall population, elevated BRI change (OR = 1.31, 95% CI: 1.07–1.61) and adverse sleep trajectories were significantly associated with incident multimorbidity. Specifically, participants with “Deteriorated” and “Stable Poor” sleep quality exhibited ORs of 2.21 (95% CI: 1.17–4.12) and 2.91 (95% CI: 1.57–5.37), respectively. Similarly, “Deteriorated” (OR = 1.63, 95% CI: 1.09–2.39) and “Stable Poor” (OR = 1.59, 95% CI: 1.01–2.46) sleep duration were associated with increased risk. Crucially, stratified analyses revealed that BRI changes significantly modified these associations. In the low BRI change group, sleep quality trajectories showed no significant association with multimorbidity. Conversely, in the high BRI change group, the risk was markedly amplified for those with “Deteriorated” (OR = 2.74, 95% CI: 1.11–6.71) and “Stable Poor” (OR = 4.48, 95% CI: 1.95–10.06) sleep quality. Regarding sleep duration, a significant association was exclusively observed in the “Deteriorated” group within the high BRI change group (OR = 2.36, 95% CI: 1.09–5.05).

Conclusions

This study demonstrates that adverse sleep trajectories and increasing BRI are independent risk factors for incident multimorbidity, and their combination synergistically amplifies risk. These findings highlight the importance of integrated interventions targeting both sleep health and abdominal obesity for multimorbidity prevention in aging populations.