{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T12:09:10Z","timestamp":1771243750662,"version":"3.50.1"},"reference-count":63,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T00:00:00Z","timestamp":1766966400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T00:00:00Z","timestamp":1766966400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Science Reports"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Bilirubin, an antioxidant and anti\u2010inflammatory agent, has been shown to negatively correlate with adiposity. However, the extent to which adiposity level influences total bilirubin (TBili) concentration remains unclear. We sought to evaluate the associations of body mass index (BMI; kg\/m\u00b2) and waist circumference (WC) with low TBili concentration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We included adults \u2265\u200920 years of age without elevated liver enzymes, excess alcohol use, iron overload, anemia, TBili \u2265\u20091.2\u2009mg\/dL, low albumin, or positive hepatitis serology from the 1999\u20132018 National Health and Nutrition Examination Survey. The primary outcome was low TBili, defined as &lt;\u20090.4\u2009mg\/dL. We used multivariable logistic regression to determine the odds ratios of low TBili by BMI and WC categories, stratified by gender. We additionally explored associations between past 1\u2010year, maximum lifetime, and non\u2010linear continuous BMI on low TBili.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 13,953 participants (mean age 47.3 years, 49% men, 69% non\u2010Hispanic White), 17% were \u2265\u200965 years, 32% had BMI\u2009\u2265\u200930, and 12% had low TBili. Women with a BMI\u2009\u2265\u200927.5 had at least a 42% increased odds of low TBili compared to women with a BMI\u2009\u2265\u200923 and &lt;\u200925. Women with a normal BMI but elevated WC of \u2265\u200988\u2009cm had increased odds of low TBili (OR: 2.74 [1.61\u20134.66]) than those with a normal WC. A BMI 1 year prior to survey \u2265\u200935 (OR: 1.59 [1.05\u20132.40]) and lifetime maximum BMI\u2009\u2265\u200925 (OR: 1.60 [1.13\u20132.28]) were independently associated with low TBili in women. Similar point estimates, but no significant associations were found in men.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Elevated BMI and an elevated WC but normal BMI were associated with higher likelihood of low TBili in women, potentially reflecting a consequence or indirect biomarker of clinical obesity. Further studies should determine the long\u2010term impact of low TBili on cardiometabolic disease risk and mortality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hsr2.71700","type":"journal-article","created":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T08:18:35Z","timestamp":1766996315000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association Between Adiposity and Low Total Serum Bilirubin Concentration: A Retrospective, Cross\u2010Sectional Study"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-9049-4027","authenticated-orcid":false,"given":"Trishna","family":"Parikh","sequence":"first","affiliation":[{"name":"Department of Internal Medicine Case Western Reserve University\/University Hospitals of Cleveland Cleveland Ohio 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