Background: Body mass index (BMI) is widely used as a proxy of nutritional status and related lifestyle risk patterns in public health, yet it does not capture body composition–related heterogeneity in cardiometabolic risk. Evidence on whether a more detailed body composition assessment improves population-level screening efficiency remains inconsistent, particularly in Central European populations. Methods: We conducted a cross-sectional analysis of 868 Hungarian adults participating in a nationwide mobile screening program. Locally weighted regression identified sex-specific BMI inflection points for cardiometabolic risk. Stratified receiver operating characteristic (ROC) analyses compared BMI with bioelectrical impedance-derived parameters across five outcomes. Cost- and time-effectiveness of scalable screening strategies were modeled at the population level. Results: Cardiometabolic risk increased at BMI levels below current WHO thresholds (females: 21.8–22.3 kg/m²; males: 23.8–24.3 kg/m²). Overall, body composition parameters did not outperform BMI in the full population. Subgroup-specific differences were observed, particularly among men with BMI 24–36 kg/m² for atherosclerosis risk, suggesting limited and outcome-specific added value rather than broad superiority over BMI. Together, non-linear risk patterns, stratified performance, and population-level modeling converged on mid-range BMI intervals (females: 22–30 kg/m²; males: 24–30 kg/m²) as likely screening windows of phenotypic heterogeneity. Within these ranges, targeted InBody assessment may help refine risk assessment for selected individuals. A mixed screening strategy covering 52% of the population would cost 178.4% of BMI-only screening, while reducing throughput by 24.3%. Conclusions: Population-specific BMI thresholds may more accurately reflect early deviations in nutritional and cardiometabolic risk than current universal cutoffs. BMI remains a useful first-line marker, and body composition assessment may add complementary information in selected BMI ranges. Overall, these findings support a potentially useful, subgroup-specific screening approach, but the modeled cost and time trade-offs should be considered hypothesis-generating and require further validation.

Background/Objectives: Cerebral small vessel disease (CSVD) is a major vascular component of brain aging, yet potentially modifiable systemic contributors remain incompletely understood. Growing evidence links the gut microbiome to magnetic resonance imaging (MRI)-defined CSVD, but interpretation is complicated by heterogeneity in microbiome profiling, clinical populations, analytical methods, and neuroimaging phenotypes. This review critically integrates the available human evidence with complementary multi-omics, ex vivo, and experimental findings. Methods: PubMed, Embase, Scopus, and Web of Science were searched through 4 August 2026; 12 eligible reports representing eight cohort families were included and evaluated using a structured study-level methodological appraisal. Results: Across the available literature, ecological and host-related biological processes show greater qualitative convergence than individual taxa, although this pattern has not been formally quantified across independent cohorts. Among reported alpha diversity measures, Chao/Chao1 showed the same numerical disease-versus-control direction across four cohort families, with statistical significance in two, suggesting a recurrent but still preliminary richness-related signal; Shannon and Simpson indices were less consistent. No single genus or species has been consistently replicated across the available, largely cross-sectional cohorts. Complementary studies implicate intestinal barrier, immune–metabolic, neurovascular, and perivascular clearance pathways but do not establish a unified causal pathway in human sporadic CSVD. Conclusions: These observations support a hypothesis-generating ecosystem-level framework. Because diet is an important modifiable determinant of the gut microbial ecosystem, these findings may have relevance for nutrition-based strategies targeting vascular brain aging. However, no CSVD-specific dietary or microbiome-directed intervention has yet been shown to modify disease progression or related MRI outcomes.