Serum cotinine, lipid accumulation product, and the mediating role of HOMA-IR among US adults: NHANES 2013-2018.
5 affiliations
- 1The School of Basic Medical Sciences, Fujian Medical UniversityFuzhouChina.
- 2Department of Rehabilitation TherapyJiangsu Second Rongjun Hospital (Jiangsu Rongjun Hospital)WuxiChina.
- 3Department of OrthopedicsZhangpu HospitalZhangzhouChina.
- 4Department of OphthalmologyFuzhou University Affiliated Provincial HospitalFuzhouChina.
- 5Department of Orthopedics Sports Injury DivisionFujian Medical University Union HospitalFuzhouChina.
Abstract
Introduction
The 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
Data 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
Participants 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
Serum 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.
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BibTeX
@article{zhuang2026serum,
title = {{Serum cotinine, lipid accumulation product, and the mediating role of HOMA-IR among US adults: NHANES 2013-2018.}},
author = {Chi Zhuang and Dingxiang Hu and Lejin Hong and Jing Chen and Zhi Chen},
journal = {Tobacco induced diseases},
year = {2026},
month = oct,
doi = {10.18332/tid/226322},
url = {https://europepmc.org/article/MED/42923142},
note = {CC BY},
}
RIS
TY - JOUR
TI - Serum cotinine, lipid accumulation product, and the mediating role of HOMA-IR among US adults: NHANES 2013-2018.
AU - Chi Zhuang
AU - Dingxiang Hu
AU - Lejin Hong
AU - Jing Chen
AU - Zhi Chen
PY - 2026
DA - 2026/10/21
JO - Tobacco induced diseases
DO - 10.18332/tid/226322
UR - https://europepmc.org/article/MED/42923142
AB - Introduction The 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 Data 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 Participants 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 Serum 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.
SN - 2070-7266
SN - 1617-9625
ER -