{
  "abstract": "Introduction\n\nThe lipid accumulation product (LAP) is a practical indicator of abdominal lipid accumulation and triglyceride-related metabolic burden, and has been linked to cardiometabolic abnormalities. Smoking and nicotine exposure may influence lipid metabolism, fat distribution, and insulin resistance, all of which could contribute to variation in LAP. Serum cotinine, a stable metabolite of nicotine, is an objective biomarker of recent nicotine intake. However, evidence on the association between serum cotinine and LAP and the potential mediating role of HOMA-IR remains limited. This study aimed to examine these associations using NHANES 2013-2018 data.Methods\n\nData from NHANES 2013-2018 were analyzed, including 6409 participants with complete data on serum cotinine, waist circumference, triglycerides, fasting glucose, and insulin. LAP was computed with sex-specific formulas. Weighted linear regression models were used to evaluate associations of cotinine and the homeostasis model assessment of insulin resistance (HOMA-IR) with LAP. Mediation analysis then assessed the extent to which HOMA-IR statistically explained the cotinine-LAP association.Results\n\nParticipants with higher LAP had elevated cotinine and HOMA-IR. After full covariate adjustment, cotinine was positively associated with LAP (β=0.019; 95% CI: 0.011-0.028; p<0.001). Compared with the lowest cotinine tertile, the highest tertile corresponded to a 3.142-unit increase in LAP (p=0.016), with a significant trend across tertiles (p-trend=0.017). HOMA-IR also showed a positive association with LAP (β=1.345; p<0.001). In mediation analysis, HOMA-IR explained 7.4% of the cotinine-LAP association (indirect effect=0.003).Conclusions\n\nSerum cotinine, a biomarker of recent nicotine intake, was positively associated with LAP in this cross-sectional NHANES analysis. HOMA-IR statistically explained only a small proportion of this association. These findings should be interpreted as associations rather than evidence of causality.",
  "abstract_shown": true,
  "affiliations": [
    "The School of Basic Medical Sciences, Fujian Medical UniversityFuzhouChina.",
    "Department of Rehabilitation TherapyJiangsu Second Rongjun Hospital (Jiangsu Rongjun Hospital)WuxiChina.",
    "Department of OrthopedicsZhangpu HospitalZhangzhouChina.",
    "Department of OphthalmologyFuzhou University Affiliated Provincial HospitalFuzhouChina.",
    "Department of Orthopedics Sports Injury DivisionFujian Medical University Union HospitalFuzhouChina."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Chi Zhuang"
    },
    {
      "affs": [
        1
      ],
      "name": "Dingxiang Hu"
    },
    {
      "affs": [
        2
      ],
      "name": "Lejin Hong"
    },
    {
      "affs": [
        3
      ],
      "name": "Jing Chen"
    },
    {
      "affs": [
        4
      ],
      "name": "Zhi Chen"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/7qs1pmbdkza60.bib",
  "cited_by": 0,
  "doi": "10.18332/tid/226322",
  "fulltext_url": "https://europepmc.org/articles/PMC13687715",
  "id": "7qs1pmbdkza60",
  "issns": [
    "2070-7266",
    "1617-9625"
  ],
  "landing_url": "https://europepmc.org/article/MED/42923142",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2737|Smoking Behavior and Cessation"
    ]
  ],
  "openalex": "W7223091202",
  "pdf_url": "https://europepmc.org/articles/PMC13687715?pdf=render",
  "pmcid": "PMC13687715",
  "pmid": "42923142",
  "published": "2026-10-21",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/7qs1pmbdkza60.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:33Z",
      "native_id": "MED:42923142",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42923142"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2737|Smoking Behavior and Cessation",
      "subfield": "physiology"
    }
  ],
  "title": "Serum cotinine, lipid accumulation product, and the mediating role of HOMA-IR among US adults: NHANES 2013-2018.",
  "title_text": "Serum cotinine, lipid accumulation product, and the mediating role of HOMA-IR among US adults: NHANES 2013-2018.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:33Z",
  "url": "https://research.draconitic.com/paper/7qs1pmbdkza60",
  "venue": "Tobacco induced diseases",
  "versions": []
}