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Article History

Received: 12 February 2025

Accepted: 16 July 2025

First Online: 22 July 2025

Declarations

:

: The authors declare no competing interests.

: This study analyzed data from the National Health and Nutrition Examination Survey (NHANES) collected between 2001 and 2018. All NHANES protocols and procedures were approved by the National Center for Health Statistics (NCHS) Research Ethics Review Board, and the survey was conducted in accordance with the Declaration of Helsinki principles. The NHANES program employs a complex, multistage probability sampling design to collect comprehensive health data from the non-institutionalized civilian U.S. population through detailed in-home interviews, standardized physical examinations, and laboratory tests conducted at mobile examination centers (MECs). All NHANES participants provided written informed consent before data collection. As this analysis utilized publicly available de-identified data from the NHANES database (), additional Institutional Review Board (IRB) approval was not required for the current study.

: Written informed consent was obtained from all participants during the original NHANES data collection process. No additional consent was required for this secondary analysis of de-identified, publicly available data.

: Not applicable, as this study used anonymous, publicly available data with no individually identifiable information.