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. 2025 Jul 4;13:1588041. doi: 10.3389/fpubh.2025.1588041

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Copyright © 2025 Zhang, Li and Wang.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

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Flowchart depicting the study process using NHANES data from 2011-2018. Initial participants numbered 39,156, with exclusions leading to a final group of 1,743. Exclusions included age under 18 (15,331), missing skeletal muscle mass and height (12,029), and missing heavy metal exposure indicators (10,053). The population was split into a training set (70%, 1,220) and a validation set (30%, 523). Variable screening involved Boruta and Lasso methods. Model validation included GBDT, Decision Tree, AdaBoost, NB, CatBoost, and SVM, leading to an optimal model. SHAP analysis was used for model explanation. — Flowchart of the study design.