Document is current

Article History

Received: 21 November 2025

Accepted: 21 February 2026

First Online: 28 February 2026

Declarations

:

: The cross-sectional studies in Singapore were conducted in the National University of Singapore (NUS) campus annually (Reference Code: NUS-07-023, NUS-09-256, NUS-10-445, NUS-13-075, NUS-14-150, NUS-18-036, NUS-2020-495) with the approval of the Institutional Review Board and by the Helsinki declaration. The cross-sectional studies in Sunway University (Reference Code: SUREC 2019/029 and SUREC 2022/049) were held with ethical approval from the Sunway University Research Ethics Committee. The participant recruitment study in UTAR, Malaysia was approved by the UTAR Scientific and Ethical Review Committee (SERC). The study protocol was reviewed and approved by UTAR-SERC, Approval No. U/SERC/03/2016.All participants provided informed and written consent, with additional written informed consent obtained from the participant’s parent, legal guardian, or next of kin for those below 21 years old. All recruitment procedures were carried out in concordance with the principles of the Declaration of Helsinki and Good Clinical Practices, and in compliance with local regulatory requirements.

: All authors read, reviewed, and approved of the final manuscript.

: F.T.C reports grants from the National University of Singapore, Singapore Ministry of Education Academic Research Fund, Singapore Immunology Network, National Medical Research Council (NMRC) (Singapore), Biomedical Research Council (BMRC) (Singapore), National Research Foundation (NRF) (Singapore), Singapore Food Agency (SFA), Singapore’s Economic Development Board (EDB), and the Agency for Science Technology and Research (A*STAR) (Singapore), during the conduct of the study; and consulting fees from Sime Darby Technology Centre; First Resources Ltd; Genting Plantation, Olam International, Musim Mas, and Syngenta Crop Protection, outside the submitted work. The other authors declare no competing interests.