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. 2025 Jun 17;37(1):188.
doi: 10.1007/s40520-025-03104-6.

The association between dietary live microbes intake and PhenoAge in US non-diabetes adults and the mediating effect of insulin resistance: NHANES 2007-2018

Yuhan Yang  1 , Ziyi Sun  1 , Jianguo Lin  2 , Qingqing Wang  3 , Xiaoning Sun  1 , Tong Tong  1 , Xiaoxiao Zhang  1 , Cheng Li  3 , Kuiwu Yao  4
Affiliations

The association between dietary live microbes intake and PhenoAge in US non-diabetes adults and the mediating effect of insulin resistance: NHANES 2007-2018

Yuhan Yang et al. Aging Clin Exp Res. .

Abstract

Background/objectives: Diets enriched with live microbes offer multiple health benefits. This study aimed to investigate the relationship between dietary intake of live microbes and accelerated biological age, as well as to examine the mediating role of insulin resistance.

Methods: The study included 4,909 participants from the National Health and Nutrition Examination Survey (NHANES) conducted between 2007 and 2018. Dietary live microbes intake was assessed using a self-report questionnaire. Insulin resistance was measured using the HOMA-IR and plasma insulin levels. Biological age and accelerated aging were assessed using PhenoAge and PhenoAgeAccel. We performed weighted multiple linear regression, logistic regression, restricted cubic spline (RCS) analysis, mediation analyses, and interaction analyses to explore the relationships between dietary live microbe intake, insulin resistance, and accelerated aging.

Results: Higher intake of live dietary microbes, compared to lower intake, was associated with a slower rate of accelerated aging after full adjustment for confounders (β = 0.15; 95% CI: - 0.26 to - 0.04; P = 0.008). RCS curves indicated an L-shaped dose-response relationship (P-nonlinear = 0.0003). Insulin resistance-related metrics (HOMA-IR and insulin) partially mediated these effects, with mediation proportions ranging from 24.65% to 30.03%. Interaction analyses revealed no significant interaction between dietary live microbe intake and other stratification factors regarding phenotypic age.

Conclusions: The intake of dietary live microbes is nonlinearly associated with accelerated biological age. IR partially mediated the relationship.

Keywords: Aging; Dietary live microbes; NHANES; Phenoage.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Ethics approval and consent to participant: The program was approved by the National Center for Health Statistics Ethics Review Board. All of the participants provided written informed consent. No additional ethical review board approval was required to analyze the anonymized NHANES data. Consent for publication: Not applicable.

Figures

Fig. 1
Fig. 1
Flowchart of the study design and participants
Fig. 2
Fig. 2
Nonlinear associations between dietary live microbes intake and the PhenoAgeAccel
Fig. 3
Fig. 3
The mediation effect of IR on the association between Dietary live microbes intake and PhenoAgeAccel. HOMA-IR and insulin were both log-transformed. Adjusted for age + gender + race + education level + PIR + smoking status + drinking status + Physical activity + BMI + hypertension + CVD
Fig. 4
Fig. 4
Forest plot of stratified analyses of the associations between Dietary live microbes intake and PhenoAgeAccel. Adjusted for age + gender + race + education level + PIR + smoking status + drinking status + physical activity + BMI + hypertension + CVD
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