Association between serum cotinine and muscle mass: The mediating role of systemic inflammation in NHANES 2013–2018
6 affiliations
- 1Department of Oncology, Laibin People’s Hospital, Laibin, China
- 2Department of Ophthalmology, Fuzhou University Affiliated Provincial Hospital, Fuzhou, China
- 3Department of Medicine and Nursing, Sanming Medical and Polytechnic Vocational College, Sanming, China
- 4Department of Orthopedics, Laibin People’s Hospital, Laibin, China
- 5Department of Geriatrics, Fujian Institute of Geriatrics, Fujian Key Laboratory of Vascular Aging, Fujian Clinical Research Center for Senile Vascular Aging and Brain Aging, Fujian Medical University Union Hospital, Fuzhou, China
- 6Department of Orthopedics Sports Injury Division, Fujian Medical University Union Hospital, Fuzhou, China
Abstract
INTRODUCTION: Smoking is a modifiable risk factor for muscle loss, but the underlying mechanisms are not fully understood. This study investigated the association between serum cotinine and appendicular skeletal muscle mass index (ASMI) and the mediating role of the systemic inflammation response index (SIRI).
METHODS: Data from NHANES 2013–2018 were used for secondary analysis. A total of 4174 adults with complete records of cotinine and data for calculating ASMI and SIRI were included. Weighted multiple linear regression assessed associations of cotinine with ASMI and SIRI, and univariate analysis was performed to screen relevant variables. Mediation analysis with SIRI as the mediator subsequently quantified the indirect effect. All analyses were performed after adjustment for potential confounders.
RESULTS: In females, ASMI was significantly lower in the high‑cotinine group than in the low‑cotinine group; no significant difference was observed between the two groups in males. Univariate analysis demonstrated significant negative correlations of cotinine and SIRI with ASMI. Across all weighted regression models, cotinine was negatively associated with ASMI (fully adjusted, β= ‑0.000; 95% CI: ‑0.000 – ‑0.000) and positively associated with SIRI (fully adjusted, β=0.001; 95% CI: 0.001–0.001). In the fully adjusted model, SIRI was negatively associated with ASMI (β= ‑0.003; 95% CI: ‑0.005 – ‑0.001). Mediation analysis showed that SIRI partially mediated the cotinine‑ASMI relationship, with a proportion mediated of 14.170%.
CONCLUSIONS: Elevated cotinine levels are significantly associated with decreased muscle mass, and this association is partially mediated by systemic inflammation.
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BibTeX
@article{zheng2026association,
title = {{Association between serum cotinine and muscle mass: The mediating role of systemic inflammation in NHANES 2013–2018}},
author = {Qingping Zheng and Jing Chen and Huanmin Zheng and Hao Feng and Qinyi You and Zhi Chen},
journal = {Tobacco Induced Diseases},
year = {2026},
month = oct,
doi = {10.18332/tid/231156},
url = {https://doi.org/10.18332/tid/231156},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Association between serum cotinine and muscle mass: The mediating role of systemic inflammation in NHANES 2013–2018
AU - Qingping Zheng
AU - Jing Chen
AU - Huanmin Zheng
AU - Hao Feng
AU - Qinyi You
AU - Zhi Chen
PY - 2026
DA - 2026/10/31
JO - Tobacco Induced Diseases
DO - 10.18332/tid/231156
UR - https://doi.org/10.18332/tid/231156
AB - INTRODUCTION: Smoking is a modifiable risk factor for muscle loss, but the underlying mechanisms are not fully understood. This study investigated the association between serum cotinine and appendicular skeletal muscle mass index (ASMI) and the mediating role of the systemic inflammation response index (SIRI). METHODS: Data from NHANES 2013–2018 were used for secondary analysis. A total of 4174 adults with complete records of cotinine and data for calculating ASMI and SIRI were included. Weighted multiple linear regression assessed associations of cotinine with ASMI and SIRI, and univariate analysis was performed to screen relevant variables. Mediation analysis with SIRI as the mediator subsequently quantified the indirect effect. All analyses were performed after adjustment for potential confounders. RESULTS: In females, ASMI was significantly lower in the high‑cotinine group than in the low‑cotinine group; no significant difference was observed between the two groups in males. Univariate analysis demonstrated significant negative correlations of cotinine and SIRI with ASMI. Across all weighted regression models, cotinine was negatively associated with ASMI (fully adjusted, β= ‑0.000; 95% CI: ‑0.000 – ‑0.000) and positively associated with SIRI (fully adjusted, β=0.001; 95% CI: 0.001–0.001). In the fully adjusted model, SIRI was negatively associated with ASMI (β= ‑0.003; 95% CI: ‑0.005 – ‑0.001). Mediation analysis showed that SIRI partially mediated the cotinine‑ASMI relationship, with a proportion mediated of 14.170%. CONCLUSIONS: Elevated cotinine levels are significantly associated with decreased muscle mass, and this association is partially mediated by systemic inflammation.
SN - 2070-7266
SN - 1617-9625
ER -