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E-selectin, but not CRP, partially mediates the association between metabolic indices and insulin resistance in older adults: a mediation analysis Cover

E-selectin, but not CRP, partially mediates the association between metabolic indices and insulin resistance in older adults: a mediation analysis

Asian Biomedicine
Volume 20 (2026): Issue 1 (February 2026)
By: ,  ,  ,  ,  ,  ,  ,  ,  ,  ,   and    
Open Access
|Feb 2026
Figures & tables

Figures & Tables

Figure 1.

Conceptual path diagram illustrating the mediation model examining predictors of IR, with CRP and E-selectin as mediating variables. BMI, body mass index; CRP, C-reactive protein; HbA1c, glycated hemoglobin A; HOMA-IR, homeostatic model assessment of IR; IR, insulin resistance; MIDUS HEI, MIDUS healthy eating index; WHR, waist-hip ratio.

Participant characteristics

CharacteristicsNTotal (%)
Sex
  Male30743
  Female40157
History of regular smoking
  Yes30944
  No39956
Anti-diabetic use
  Yes12618
  No58282
Anti-hyperlipidemic use
  Yes32846
  No38054
Anti-hypertensive use
  Yes36552
  No34348

Results of mediation analysis for the mediation of CRP and E-selectin for associations between metabolic factors and basic characteristics and HOMAR-IR in American older adults

TypeEffect95% CI‡
% change in HOMA IR†LowerUpperSig
IndirectSmoking (no) ⇒ E-selectin ⇒ HOMA-IR−1.55−4.09−0.13*
Smoking (no) ⇒ CRP ⇒ HOMA-IR−0.04−1.251.19
Sex (females) ⇒ E-selectin ⇒ HOMA-IR2.400.465.80*
Sex (females) ⇒ CRP ⇒ HOMA-IR0.09−2.292.89
AGE ⇒ E-selectin ⇒ HOMA-IR−1.11−2.58−0.27*
AGE ⇒ CRP ⇒ HOMA-IR0.01−0.420.64
HEI ⇒ E-selectin ⇒ HOMA-IR−7.87−17.48−2.43*
HEI ⇒ CRP ⇒ HOMA-IR−0.07−3.381.98
HbA1c ⇒ E-selectin ⇒ HOMA-IR9.263.4018.66*
HbA1c ⇒ CRP ⇒ HOMA-IR0.12−3.493.47
Total/HDL Chol.⇒ E-selectin ⇒ HOMA-IR1.920.344.49*
Total/HDL Chol.⇒ CRP ⇒ HOMA-IR0.03−0.891.13
BMI ⇒ E-selectin ⇒ HOMA-IR2.720.975.54*
BMI ⇒ CRP ⇒ HOMA-IR0.09−2.232.70
WHR ⇒ E-selectin ⇒ HOMA-IR5.59−3.8820.90
WHR ⇒ CRP ⇒ HOMA-IR0.14−4.187.67
Antidiabetic use (yes) ⇒ E-selectin ⇒ HOMA-IR−0.60−3.942.69
Antidiabetic use (yes) ⇒ CRP ⇒ HOMA-IR−0.03−1.730.99
Anti-hyperlipidemic use (yes)⇒ E-selectin ⇒ HOMA-IR0.13−1.952.25
Anti-hyperlipidemic use (yes)⇒ CRP ⇒ HOMA-IR−0.06−2.041.57
Anti-hypertensive use (no) ⇒ E-selectin ⇒ HOMA-IR−2.39−5.25−0.70*
Anti-hypertensive use (no) ⇒ CRP ⇒ HOMA-IR−0.01−0.690.46
Number of MET (min/week) ⇒ E-selectin ⇒ HOMA-IR0.62−0.021.93
Number of MET (min/week) ⇒ CRP ⇒ HOMA-IR0.00−0.230.19
ComponentSmoking (no) ⇒ E-selectin−2.88−5.81−0.03*
E-selectin ⇒ HOMA-IR5.572.349.02*
Smoking (no) ⇒ CRP−1.04−1.97−0.17*
CRP ⇒ HOMA-IR0.39−9.2712.18
Sex (females) ⇒ E-selectin4.380.458.34*
Sex (females) ⇒ CRP2.301.133.54*
AGE ⇒ E-selectin−0.21−0.36−0.06*
AGE ⇒ CRP0.04−0.010.09
HEI ⇒ E-selectin−1.51−2.80−0.44*
HEI ⇒ CRP−0.17−0.430.11
HbA1c ⇒ E-selectin5.453.198.00*
HbA1c ⇒ CRP1.010.301.71*
Total/HDL Chol.⇒ E-selectin1.750.123.40*
Total/HDL Chol. ⇒ CRP0.40−0.00040.84
BMI ⇒ E-selectin0.500.240.78*
BMI ⇒ CRP0.230.130.34*
WHR ⇒ E-selectin10.03−9.0728.60
WHR ⇒ CRP3.60−2.289.39
Anti-diabetic use (yes) ⇒ E-selectin−1.11−6.474.92
Anti-diabetic use (yes) ⇒ CRP−0.87−2.571.17
Anti-hyperlipidemic use (yes) ⇒ E-selectin0.24−3.323.81
Anti-hyperlipidemic use (yes) ⇒ CRP−1.57−2.60−0.54*
Anti-hypertensive use (no) ⇒ E-selectin−4.46−7.75−1.29*
Anti-hypertensive use (no) ⇒ CRP−0.23−1.210.73
Number of MET (min/week) ⇒ E-selectin0.0011−0.00010.0028
Number of MET (min/week) ⇒ CRP−0.00005−0.00030.0003
DirectSmoking (no) ⇒ HOMA-IR−0.43−9.579.72
Sex (females) ⇒ HOMA-IR8.97−3.0724.96
AGE ⇒ HOMA-IR−2.01−6.923.25
HEI ⇒ HOMA-IR7.23−25.9862.75
HbA1c ⇒ HOMA-IR86.1946.82144.03*
Total/HDL Chol. ⇒ HOMA-IR30.8117.6245.21*
BMI ⇒ HOMA-IR48.6834.6364.94*
WHR ⇒ HOMA-IR13.215.4421.85*
Anti-diabetic use (yes) ⇒ HOMA-IR34.1010.2166.90*
Anti-hyperlipidemic use (yes) ⇒ HOMA-IR18.976.9532.92*
Anti-hypertensive use (no) ⇒ HOMA-IR2.37−8.4514.41
Number of MET (min/week) ⇒ HOMA-IR−1.47−4.581.21
TotalSmoking (no) ⇒ HOMA-IR−2.01−11.038.22
Sex (females) ⇒ HOMA-IR11.69−1.0827.63
AGE ⇒ HOMA-IR−3.09−8.102.08
HEI ⇒ HOMA-IR−1.28−31.9447.04
HbA1c ⇒ HOMA-IR103.6861.31170.45*
Total/HDL Chol. ⇒ HOMA-IR33.3719.6947.93*
BMI ⇒ HOMA-IR52.8638.8468.63*
WHR ⇒ HOMA-IR13.845.7322.43*
Anti-diabetic use (yes) ⇒ HOMA-IR33.258.6265.71*
Anti-hyperlipidemic use (yes) ⇒ HOMA-IR19.057.4534.00*
Anti-hypertensive use (no) ⇒ HOMA-IR−0.08−10.6411.31
Number of MET (min/week) ⇒ HOMA-IR−0.86−4.022.15
DOI: https://doi.org/10.2478/abm-2026-0007 | Journal eISSN: 1875-855X | Journal ISSN: 1905-7415
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Language: English
Page range: 60 - 69
Published on: Feb 27, 2026
Published by: Chulalongkorn University
In partnership with: Paradigm Publishing Services
Publication frequency: 6 issues per year
Keywords:
C-reactive protein,
E-selectin,
insulin resistance,
metabolic indices,
older adults
Related subjects:
Medicine,
Assistive professions, nursing,
Basic medical science,
Basic medical science, other,
Clinical medicine,
Clinical medicine, other

© 2026 Laith Ashour, Tariq Albweitel, Juana Abu Rahmeh, Momen Alfawadleh, Afaf El Sharabi, Rahmah Ahmad Shareah, Zaid Alomari, Arar Alhawwari, Mohammad Alkalouti, Noura F. Al-Nawaiseh, Malak S. Ababneh, Abdelrahman Kaoukji, published by Chulalongkorn University
This work is licensed under the Creative Commons Attribution 4.0 License.

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