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BMI has long been the go-to metric for obesity risk, but new research says it's missing the mark for patients with liver disease. A 30-year study found that body roundness index (BRI) — which factors in waist circumference and height — better predicts long-term mortality in MASLD patients, especially those who appear "lean" by BMI standards but still carry dangerous levels of central fat.
BMI has long been medicine's shorthand for metabolic risk, but a major new study suggests it's leaving some of the most vulnerable MASLD patients undetected. Presented at the ACG Annual Scientific Meeting, research from Yale New Haven Health analyzed nearly 3,500 adults with MASLD over a median 29 years and found that body roundness index (BRI) — a measure incorporating waist circumference and height — was a stronger predictor of all-cause and cardiovascular mortality than BMI.
The findings are especially striking for "lean" patients (BMI < 25 kg/m²): BRI flagged elevated mortality risk in this group, while BMI showed no meaningful signal at all. Among nonobese MASLD patients, those in the highest BRI quartile faced a 46% greater risk of death than those in the lowest — a difference BMI quartiles failed to capture.
By the Numbers:
Why it matters: For clinicians managing MASLD, this research challenges the assumption that a normal BMI equals low metabolic risk. Adding BRI to routine assessments could help identify high-risk patients who would otherwise fly under the radar — potentially enabling earlier intervention and better outcomes.
