Currently submitted to: JMIR Research Protocols
Date Submitted: Nov 7, 2026
Open Peer Review Period: Nov 9, 2026 - Jan 4, 2027
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Initial Clinical Validation of the J-METRA Index (Jacob Metabolic Risk Assessment Index) for Metabolic Risk Stratification in Indian Adults: Protocol for a Multicentre Cross-sectional Observational Study
ABSTRACT
Background:
Non-communicable diseases now account for most deaths in India, and South Asian adults develop cardiometabolic disease at lower levels of adiposity than other populations. The J-METRA Index is a two-level composite metabolic-health score that combines non-laboratory (Preliminary) and laboratory (Advanced) components into an integrated 0–100 score with four risk zones, calculated on the MetraLife digital health platform. It has not been clinically validated
Objective:
This study aims to estimate the cross-sectional discrimination, construct validity, reproducibility and component redundancy of the prespecified J-METRA Index in Indian adults
Methods:
This multicentre, observational, cross-sectional methodological validation study will enrol approximately 500–600 adults aged 18–70 years from clinical and community settings across 4–8 Indian centres. Each participant will undergo one standardised assessment comprising anthropometry, blood pressure, a structured history and lifestyle assessment, and fasting laboratory tests. The primary outcome is the area under the receiver operating characteristic curve (AUC) of the integrated score for distinguishing higher from lower metabolic burden, as classified by clinician adjudicators blinded to the score. Secondary analyses will examine score distribution and completeness, known-groups and convergent validity, reproducibility in a 10% subsample, separate performance of the Preliminary and Advanced scores, redundancy, and zone behaviour. The 40:60 Preliminary-to-Advanced weighting will be evaluated without modification.
Results:
As of November 2026, the protocol (version 1.0) has been finalised, ethics review by the Wellkins Medical Center Clinical Ethics & Research Governance Committee and the participating Indian site committees is pending, and Clinical Trials Registry – India registration is in process. The study has received no external funding. Recruitment is planned from January to December 2027, with analysis in January–March 2028 and results expected in 2028.
Conclusions:
This study will provide the first clinical evidence on whether the J-METRA Index is feasible, reproducible and able to separate clinically meaningful metabolic-health strata in Indian adults, informing subsequent prospective outcome validation. Clinical Trial: Clinical Trials Registry – India (CTRI): registration in process.
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