Inflammaging in Obesity: Neutrophil-to-lymphocyte Ratio as a Key Mediator of Age-associated Peripheral Artery Disease

Aim: The aim of this study was to investigate the relationship between age, neutrophil-to-lymphocyte ratio (NLR), and peripheral arterial disease (PAD) in obese patients and sex differences. Methods: We analyzed the pairwise relationship among age, PAD, and NLR within a robust, ethnically diverse sample ( n = 2088) drawn from the National Health and Nutrition Examination Survey. Results: In the present study, patients with PAD demonstrated significantly higher NLR levels compared to those without PAD, and a significant positive association between NLR and PAD was observed, particularly pronounced in males ( P < 0.001). Further mediation analysis revealed that, in males, NLR served as a mediating variable that influenced the association between age and PAD, accounting for 7.10% of the total effect ( P = 0.006). These results remained robust after adjusting for other covariates ( P = 0.024); however, in females, the mediating effect of NLR was not significant. Conclusions: NLR as a mediator of the association between age and PAD in males was significant in obese patients.