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Nutr."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Moderate heavy metals can lead to the occurrence of liver injury, but the specific mechanism remains unclear.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study, based on data from the National Health and Nutrition Examination Survey (NHANES), analyzed associations between 10 heavy metals and hepatic injury in 5,613 adults, with a focus on the mediating role of the Systemic Immune-Inflammation Index (SII). Partial correlation analysis, weighted linear regression, weighted quantile sum (WQS) regression, and mediation effect models were used in the study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>SII showed significant negative correlations with hepatic fibrosis markers (FIB-4: <jats:italic>r<\/jats:italic> = \u22120.290; NFS: <jats:italic>r<\/jats:italic> = \u22120.382, both <jats:italic>P<\/jats:italic> &amp;lt; 0.001) but no association with hepatic steatosis indices. Arsenic (As), cobalt (Co), and cesium (Cs) were identified as critical metals linking fibrosis indicators and SII. As mediated its pro-fibrotic effects by completely suppressing SII (OR = 0.0220\u20130.0581), while Co promoted NFS risk through complete mediation by SII (Q2 vs. Q1 OR = 1.26). Conversely, Cs exhibited anti-fibrotic protectionvia complete positive mediation through SII.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The findings demonstrate that Heavy metals differentially regulate immune-inflammatory pathways to influence hepatic fibrosis progression, providing new evidence for the mechanisms of environmental exposure-induced hepatic injury.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fnut.2025.1566345","type":"journal-article","created":{"date-parts":[[2025,5,21]],"date-time":"2025-05-21T04:13:17Z","timestamp":1747800797000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Mediating role of systemic immune-inflammation index between heavy metal exposure and hepatic steatosis\/hepatic fibrosis: evidence from NHANES 2005\u20132020"],"prefix":"10.3389","volume":"12","author":[{"given":"Ningning","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuying","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiujuan","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingqi","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shijing","family":"Nian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kewei","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,5,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"104199","DOI":"10.1016\/j.jconhyd.2023.104199","article-title":"Assessment 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