Serum cotinine, lipid accumulation product, and the mediating role of HOMA-IR among US adults: NHANES 2013-2018

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.