Previously submitted to: JMIR Research Protocols (no longer under consideration since Oct 15, 2025)
Date Submitted: Jan 23, 2025
Warning: This is an author submission that is not peer-reviewed or edited.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.
Body Roundness Index as a Screening Tool for Early Diagnosis of Non-alcoholic Fatty Liver Disease among the Obese Population: A Protocol for Systematic Review and Meta-analysis
ABSTRACT
Background:
Non-alcoholic fatty liver disease (NAFLD) represents a significant global health issue associated with obesity and metabolic syndrome, serving as the leading cause of chronic liver disease across the world. The progression from hepatic steatosis to more severe conditions such as non-alcoholic steatohepatitis (NASH), fibrosis, and cirrhosis highlights the critical importance of early diagnosis of this condition. Traditional diagnostic techniques, including liver biopsy and imaging, are often invasive, expensive, and unsuitable for widespread screening. This has led to an increased interest in using non-invasive and cost-effective anthropometric measures as screen tools. The Body Roundness Index (BRI) has gained attention as a potential predictor of NAFLD due to its association with body fat distribution. Nevertheless, its diagnostic accuracy in comparison to conventional indices such as BMI, waist circumference (WC), waist-to-height ratio (WHtR), and waist-to-hip ratio (WHR) remains uncertain.
Objective:
This protocol for systematic review and meta-analysis aims to evaluate the effectiveness of BRI in predicting NAFLD compared to other body measurement indices and determine a potential BRI cut-off point for screening purposes.
Methods:
The protocol includes a comprehensive search and predefined inclusion and exclusion criteria. Data synthesis will involve a meta-analysis of diagnostic accuracy employing advanced statistical models to evaluate sensitivity, specificity, and heterogenicity, with results analyzed using R software.
Results:
The findings of this study will be submitted for publication in an international peer-reviewed journal.
Conclusions:
Strengths: • Innovative Focus and Clinical Relevance: The protocol explores the diagnostic utility of the Body Roundness Index (BRI), providing a novel perspective compared to traditional indices like BMI and waist-to-height ratio. The study aims to identify a non-invasive, cost-effective screening tool for NAFLD, addressing a critical need in resource-limited settings and potentially reducing reliance on invasive procedures like liver biopsies. • Comprehensive Methodology: The systematic review follows PRISMA guidelines, includes rigorous inclusion/exclusion criteria, and employs advanced statistical techniques like bivariate modeling and hierarchical ROC analysis, ensuring robust and reliable results. Limitations: • Data Heterogeneity: Variations in study designs, population characteristics, and diagnostic criteria for NAFLD across included studies may introduce heterogeneity and impact the consistency of findings. • Limited Scope of Populations: Exclusion of special populations (e.g., individuals with type 2 diabetes or polycystic ovary syndrome) may restrict the generalizability of the results to broader obese populations. • Potential Publication Bias: Despite efforts to assess publication bias, reliance on peer-reviewed studies in English may limit the inclusion of relevant studies from non-English literature.
Citation
