ORIGINAL RESEARCH article

Front. Public Health

Sec. Public Health Education and Promotion

Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1602629

This article is part of the Research TopicSports, Nutrition and Public Health: Analyzing their Interconnected ImpactsView all 14 articles

Cumulative behavioral and metabolic determinants of health are associated with higher inflammation-related indices: insights from a cross-sectional study (NHANES 2005-2018)

Provisionally accepted
Anzhi  WangAnzhi Wang1Youping  ZengYouping Zeng1Xiaoyan  GaoXiaoyan Gao1Shenshen  DuShenshen Du1Ping  WangPing Wang2Yun  PanYun Pan1*
  • 1First Affiliated Hospital of Jinan University, Guangzhou, China
  • 2Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China

The final, formatted version of the article will be published soon.

Objective: This study innovatively investigates the cumulative associations between behavioral determinants of health (BDoH), metabolic determinants of health (MDoH), and systemic inflammation biomarkers in U.S. adults, using a novel cross-sectional framework to quantify their synergistic effects.: Utilizing cross-sectional data from 18,500 participants in the National Health and Nutrition Examination Survey (NHANES 2005-2018 cycle), we developed a composite exposure model integrating BDoH (smoking status, physical activity, dietary quality) and MDoH (obesity metrics, hypertension, diabetes) through standardized questionnaires and clinical measurements. Systemic immune-inflammation index (SII) and systemic inflammatory response index (SIRI) were calculated from peripheral blood cell counts. Multivariable-adjusted logistic regression models examined doseresponse relationships, with trend analysis explicitly testing cumulative BDoH-MDoH interactions. Results: The cohort (mean age 44.3±0.3 years; 52.4% male) demonstrated significant positive associations between adverse health determinants and inflammatory indices. Current tobacco use (OR=1.32, 95%CI=1.18-1.47), suboptimal diet (HEI<52: OR=1.24, 95%CI=1.11-1.38), obesity (BMI≥30 kg/m²: OR=1.41, 95%CI=1.27-1.56), and central adipometry (OR=1.39, 95%CI=1.25-1.54) showed strongest correlations with elevated SII/SIRI. Metabolic disorders exhibited distinct patterns: hypertension and diabetes associated specifically with SIRI elevation (OR=1.19, 95%CI=1.06-1.33 and OR=1.17, 95%CI=1.03-1.32, respectively), while physical inactivity (<600 MET-min/week) uniquely correlated with SII increase (OR=1.26, 95%CI=1.13-1.40). Notably, our cumulative model revealed synergistic effects: exposure to ≥3 adverse behavioral determinants amplified inflammation risks (SII: OR=1.57, 95%CI=1.42-1.73; SIRI: OR=1.49, 95%CI=1.35-1.64), with significant dosedependent trends (P-trend<0.001). Co-occurring metabolic abnormalities demonstrated additive inflammatory effects (P-trend<0.001), exceeding individual risk factor impacts. Conclusion: This cross-sectional study provides the first evidence that integrated BDoH-MDoH cumulative exposure models uncover distinct and synergistic inflammatory pathways. Both individual and combined behavioralmetabolic risk factors significantly associate with systemic inflammation biomarker elevation, highlighting the necessity of dual-target intervention strategies.

Keywords: Behavioral determinants of health, Metabolic determinants of health, systemic immune-inflammation index, systemic inflammatory response index, NHANES

Received: 30 Mar 2025; Accepted: 02 Jun 2025.

Copyright: © 2025 Wang, Zeng, Gao, Du, Wang and Pan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Yun Pan, First Affiliated Hospital of Jinan University, Guangzhou, China

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