TOPLINE

A measure of visceral adiposity and a simple triglyceride-glucose-based marker of insulin resistance independently predicted the presence and histologic severity of precancerous gastric mucosal changes, including advanced stages defined by the Operative Link on Gastritis Assessment (OLGA), and did so more accurately than BMI. Both markers showed clear dose-response gradients across tertiles, supporting a graded link between visceral obesity, metabolic dysfunction, and the severity of gastric precancerous disease.

METHODOLOGY

• Gastric intestinal metaplasia is a precancerous condition potentially affected by metabolic dysfunction; although newer anthropometric indices such as the Body Roundness Index (BRI) and A Body Shape Index (ABSI) are better indicators of visceral adiposity than BMI, their link to this gastric precancerous lesion has remained largely unstudied.
• To investigate the relationship between BRI, ABSI, BMI, and cardiometabolic indices and the severity of intestinal metaplasia, researchers conducted a prospective cross-sectional study at a hospital in Turkey between January 2023 and December 2024, enrolling 250 adult patients (mean age, 53.6 years; 51.6% women) undergoing esophagogastroduodenoscopy with gastric biopsy.
• Anthropometric indices, including BMI, BRI, and ABSI, and cardiometabolic indices, including the Triglyceride-Glucose Index (TyG) and TyG-BMI, were calculated using standardized measurements of height, weight, waist circumference, and triglyceride and fasting glucose levels.
• Gastric biopsy specimens were obtained according to the updated Sydney protocol — with at least two biopsies from the antrum, two from the corpus, and one from the incisura angularis — and were evaluated by an experienced gastrointestinal pathologist blinded to clinical and metabolic data.
• Intestinal metaplasia and atrophy grades were scored 0-3 at each biopsy location, and the OLGA staging system was applied to yield stages 0-IV, with advanced OLGA defined as stage ≥ III.

TAKEAWAY

• BRI demonstrated the strongest correlation with OLGA stage (Spearman correlation coefficient, 0.448; P < .001) and histologic intestinal metaplasia grade (Spearman correlation coefficient, 0.493; P < .001), outperforming BMI, which showed corresponding Spearman correlation coefficients of 0.303 and 0.360. TyG also outperformed BMI for both measures.
• For predicting advanced OLGA stages (≥ stage III), TyG achieved the highest area under the curve of 0.848 (95% CI, 0.773-0.923), followed by BRI (area under the curve, 0.815); both indices outperformed BMI (area under the curve, 0.755).
• In multivariate analysis adjusted for age, sex, Helicobacter pylori status, and smoking, BRI (odds ratio [OR], 1.665; P < .001) and TyG (OR, 3.823; P < .001) independently predicted intestinal metaplasia positivity.
• When patients were categorized according to BRI and TyG tertiles, the prevalence of intestinal metaplasia increased from about 40% in the lowest tertile to more than 80% in the highest tertile (P for trend < .001 for both).

IN PRACTICE

“The finding that BRI outperformed BMI in predicting gastric mucosal pathology is consistent with the established understanding that visceral adiposity, rather than overall body mass, is more closely related to obesity-associated disease risk,” the authors wrote.

SOURCE

The study was led by Mete Ucdal, MD, Department of Internal Medicine, Etimesgut Şehit Sait Ertürk State Hospital, Ankara, Turkey. It was published online in the Journal of Clinical Gastroenterology.

LIMITATIONS

The cross-sectional design could not determine whether elevated cardiometabolic indices caused or followed intestinal metaplasia. With only 250 patients from one hospital, the results may not be generalizable. Serum adipokines, inflammatory cytokines, and insulin levels were not directly measured.

DISCLOSURES

The authors declared that they have nothing to disclose.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.