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Article History

Received: 15 July 2025

Accepted: 2 February 2026

First Online: 15 February 2026

Declarations

:

: The National Health and Nutrition Examination Survey (NHANES) protocols were approved by the National Center for Health Statistics (NCHS) Research Ethics Review Board. All participants provided written informed consent during original data collection. This study utilized publicly available, de-identified NHANES data (2005–2018 cycles). Secondary analysis of anonymized data was exempt from additional ethics approval per institutional guidelines.

: Not applicable.

: The authors declare no competing interests.