Examining the associations among adults’ physical activity, serum cotinine, and the risk of metabolic syndrome

This study indicates a positive relationship between SC concentration and MetS risk, whereas higher PA energy expenditure was inversely associated with MetS risk. Moreover, the findings indicate a potential compensatory association between PA and SC levels in relation to MetS risk. These estimates are based on statistical modeling and should be viewed as illustrative approximations rather than definitive causal or prescriptive thresholds. Future longitudinal and interventional studies are warranted to confirm these relationships.