Abstract
BACKGROUND: Left ventricular diastolic dysfunction (LVDD) is a common complication of type 2 diabetes (T2DM), closely associated with obesity and visceral adiposity. The Body Roundness Index (BRI) is a novel anthropometric measure that may better reflect visceral fat distribution, yet its relationship with LVDD in T2DM remains unclear. OBJECTIVE: This study aims to investigate the association between BRI and LVDD risk in patients with T2DM, focusing on nonlinear relationships and potential threshold effects. METHODS: This cross-sectional study included 1,317 patients with T2DM. Multivariable logistic regression and generalized additive models (GAM) were used to assess associations, with adjustment for key confounders. Threshold effects were evaluated using a two-step recursive approach, and subgroup analyses were performed. RESULTS: After full adjustment, each one-unit increase in BRI was associated with a 30% higher risk of LVDD (OR: 1.30, 95% CI: 1.10-1.60, p < 0.001). A nonlinear relationship was identified with an inflection point at BRI = 8.1. Below this point, the association was stronger (OR: 1.50, 95% CI: 1.20-1.80, P < 0.001). Diabetic kidney disease significantly modified this association (P for interaction = 0.02). CONCLUSION: BRI is nonlinearly associated with LVDD risk in T2DM, with a threshold effect at BRI = 8.1. The association is stronger in patients with diabetic kidney disease, suggesting that BRI could serve as a valuable marker for the stratification and prevention of LVDD in high-risk populations.