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Article History

Received: 17 May 2025

Accepted: 13 August 2025

First Online: 26 September 2025

Declarations

:

: This study is a secondary analysis of publicly available data from the NHANES 2017–2018 cycle, conducted by the National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC), United States. The NHANES protocol was reviewed and approved by the NCHS Research Ethics Review Board, and written informed consent was obtained from all participants. All procedures involving human participants followed the ethical standards of the 1964 Declaration of Helsinki and its later amendments. As this study involved only de-identified secondary data, no additional ethical approval was required. The present study used publicly available, de-identified NHANES data for secondary analysis, with informed consent already obtained by NHANES investigators.

: Not applicable.

: The authors declare no competing interests.