The Relationship between Visceral Fat Accumulation and Risk of Cardiometabolic Multimorbidity: The Roles of Accelerated Biological Aging

Objectives: To investigate the association between visceral fat accumulation and the risk of cardiometabolic multimorbidity (CMM) and the potential roles of accelerated biological aging in this relationship. Methods: Using data from the UK Biobank, a nationwide cohort study was conducted using the available baseline body roundness index (BRI) measurement. Biological aging was assessed using the Klemera–Doubal method for biological age and the phenotypic age algorithms. The association between the BRI and CMM was estimated using the Cox proportional hazards regression model, while the roles of biological aging were examined through interaction and mediation analyses. Results: During a median follow-up of 14.52 years, 6156 cases of CMM were identified. A significant association was observed between the BRI and CMM. The hazard ratio (HR) for CMM was 3.72 (95% confidence interval [CI]: 3.35–4.13) for individuals in the highest quartile compared with those in the lowest quartile of the BRI. More importantly, the BRI (AUC, 0.701; 95% CI, 0.694–0.707) demonstrated superior predictive performance relative to body mass index (AUC, 0.657; 95% CI, 0.650–0.664). Furthermore, the BRI exhibited additive interactions with accelerated biological aging on the risk of CMM, and accelerated biological aging partially mediated the association between the BRI and CMM. Conclusions: These findings provide evidence for the application of the BRI as a novel and readily accessible screening tool associated with CMM, suggesting that the effective management of visceral fat and biological aging deceleration may hold promise for reducing CMM risk.