Hemade Ali, Hallit Souheil
Department of Internal Medicine, Division of Hematology and Oncology, American University of Beirut Medical Center, Naef K Bassile Cancer Institute, Beirut, Lebanon.
School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon.
Medicine (Baltimore). 2025 Sep 19;104(38):e44661. doi: 10.1097/MD.0000000000044661.
Racial and ethnic disparities in systemic inflammation contribute to differences in chronic disease risk. α-1-acid glycoprotein (AAG), an acute-phase inflammatory marker, has been associated with metabolic dysfunction and cardiovascular risk. Despite known racial differences in inflammatory biomarkers, the role of diet and physical activity as mediators of racial disparities in AAG levels remains unclear. This study investigates whether racial disparities in AAG are mediated by diet quality and physical activity in a nationally representative U.S. sample. We conducted a cross-sectional mediation analysis using National Health and Nutrition Examination Survey (NHANES) data (2011-2022), including 2451 participants. AAG levels were measured via serum assays. Diet quality was assessed using the healthy eating index (HEI-2015), while physical activity was quantified using metabolic equivalent of task (MET) minutes per week. Mediation analysis was performed using causal mediation models, adjusting for age, sex, body mass index (BMI), socioeconomic status (SES), and other covariates. Moderated mediation models assessed whether the mediation effect varied by gender, BMI, income, and age. Significant racial disparities in AAG were observed, with Non-Hispanic Black participants exhibiting higher AAG levels than Non-Hispanic Whites and Mexican Americans (P < .001). Diet quality significantly mediated the association between Race and AAG. However, physical activity was not a significant mediator in most racial comparisons, except for a minor effect in the Other/Multi-Racial group. Moderated mediation analysis revealed that the diet-AAG mediation effect was stronger among females, individuals with lower BMI, and those with lower income levels (P < .01). Racial disparities in AAG are partially explained by differences in diet quality, suggesting that nutritional interventions targeting racial/ethnic disparities may help reduce systemic inflammation. However, physical activity did not significantly mediate AAG disparities, indicating that other structural or behavioral factors may contribute. Future longitudinal studies are needed to confirm these relationships and explore additional mediators of inflammation-related health disparities.
全身炎症中的种族和族裔差异导致慢性病风险存在差异。α-1-酸性糖蛋白（AAG）是一种急性期炎症标志物，与代谢功能障碍和心血管风险相关。尽管已知炎症生物标志物存在种族差异，但饮食和身体活动作为AAG水平种族差异的调节因素的作用仍不清楚。本研究调查了在美国具有全国代表性的样本中，AAG的种族差异是否由饮食质量和身体活动介导。我们使用国家健康和营养检查调查（NHANES）数据（2011 - 2022年）进行了横断面中介分析，包括2451名参与者。通过血清检测测量AAG水平。使用健康饮食指数（HEI - 2015）评估饮食质量，同时使用每周代谢当量（MET）分钟数量化身体活动。使用因果中介模型进行中介分析，并对年龄、性别、体重指数（BMI）、社会经济地位（SES）和其他协变量进行调整。调节中介模型评估中介效应是否因性别、BMI、收入和年龄而异。观察到AAG存在显著的种族差异，非西班牙裔黑人参与者的AAG水平高于非西班牙裔白人和墨西哥裔美国人（P < 0.001）。饮食质量显著介导了种族与AAG之间的关联。然而，在大多数种族比较中身体活动不是显著的中介因素，除了在其他/多种族群体中有轻微影响。调节中介分析表明，饮食 - AAG中介效应在女性、BMI较低的个体和收入水平较低的个体中更强（P < 0.01）。AAG的种族差异部分由饮食质量差异解释，这表明针对种族/族裔差异的营养干预可能有助于减轻全身炎症。然而，身体活动并未显著介导AAG差异，这表明其他结构或行为因素可能起作用。需要未来的纵向研究来证实这些关系，并探索炎症相关健康差异的其他中介因素。
