ArticleMedicine2025
Sex differences in the association between fatty liver index and biological aging: A mediation analysis of insulin resistance in a cross-sectional study.
Article in Medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
1 citing paper in PubMed, 1 synthesis or guideline pooled it.
- Epigenetic Age Acceleration as a Modifiable Public Health Target: A Systematic Review and Meta-Analysis of Environmental, Behavioral, and Social Determinants with Development of the MEAB-Index.International journal of molecular sciences · 2026Pooled it
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Aging challenges global healthcare systems, with fatty livers potentially relevant to the process. This study sought to investigate the sex-specific associations of fatty liver index (FLI) with biological aging (BA), assessed via phenotypic age (PhenoAge) and PhenoAge acceleration (PhenoAgeAccel), and explored the mediating role of the metabolic score for insulin resistance (METS-IR). Utilizing nationally representative data from 16,479 American adults in the National Health and Nutrition Examination Survey (NHANES 1999-2020), this cross-sectional study employed weighted multivariable regression, receiver operating characteristic curves, restricted cubic splines, threshold effect analyses, sensitivity analyses, and mediation analyses. FLI was positively correlated with BA overall (P < .001), with significant sex interaction effects observed (Pinteraction < .05). For every 1 - standard deviation increase in FLI, females exhibited stronger associations with PhenoAge (βfemale = 3.33, 95% confidence interval [CI]: 3.07-3.58; βmale = 2.54, 95% CI: 2.20-2.89) and PhenoAgeAccel risk (ORfemale = 1.89, 95% CI: 1.76-2.03; ORmale = 1.57, 95% CI: 1.46-1.69; all P < .001). The area under the curve of FLI for PhenoAgeAccel was higher in females (0.73, 95% CI: 0.72-0.75) than in males (0.67, 95% CI: 0.66-0.68). Restricted cubic splines revealed a biphasic upward trend in the FLI-BA relationship across both sexes (Pnonlinear < .001), with sex-divergent threshold effects (Plikelihood ratio < .001). METS-IR partially mediated the FLI-BA association, with a greater percentage of mediation effect in males (PhenoAge: 20.23%; PhenoAgeAccel: 36.84%) than females (8.73%; 15.93%). A robust positive association exists between FLI and BA, partially mediated by METS-IR. Females exhibited stronger association strength, while males demonstrated a greater proportion of the METS-IR's mediation effect.
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Registered trials
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