Association of body roundness index, serum α-Klotho and osteoarthritis: A nationwide population-based study of middle-aged and older adults

Previous research has identified associations between the body roundness index (BRI), a novel marker of abdominal obesity, and serum α-Klotho levels with osteoarthritis (OA). However, the interplay between BRI, α-Klotho and OA has been understudied. We aimed to investigate the association between BRI and OA, as well as the potential mediating role of α-Klotho in the bidirectional relationships between BRI and OA among middle-aged and older adults METHODS: This study enrolled 8275 participants from the National Health and Nutrition Examination Survey (NHANES). Weighted logistic regressions and restricted cubic splines were utilized to assess the relationships between BRI, α-Klotho, and OA. Subgroup analyses, interaction effects, and mediation analyses were also conducted RESULTS: After adjusting for all covariates, higher BRI was associated with lower odds of OA (OR = 1.40, 95 % CI: 1.29 to 1.52, P < 0.001), whereas lower α-Klotho corresponded to higher odds of OA incidence (OR = 0.90, 95 % CI: 0.83 to 0.97, P = 0.009). Moreover, BRI was negatively correlated with serum α-Klotho (β = -0.045, P < 0.001). Notably, α-Klotho partially mediated the relationship between BRI and OA (mediation proportion: 1.46 %, P = 0.004), as well as the relationship between OA and BRI (mediation proportion: 1.56 %, P = 0.001) CONCLUSION: The associations between higher BRI and lower α-Klotho levels among individuals with OA was observed. These findings contribute to a better understanding of the bidirectional associations between BRI, α-Klotho levels, and OA among middle-aged and older adults, which may help inform future hypothesis-driven or mechanistic studies.