{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T19:14:28Z","timestamp":1792782868540,"version":"4.5.0"},"reference-count":37,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Umea University","id":[{"id":"https:\/\/ror.org\/05kb8h459","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Bone Miner Metab"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Adolescence is a critical period for skeletal development, yet in adolescent athletes the relative contribution of lean and fat mass to areal bone mineral density (aBMD) across skeletal sites remains unclear. This cross-sectional study examined sex-specific differences in body composition and aBMD and evaluated the relative associations of lean and fat mass with aBMD in adolescent team sport athletes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>Two hundred two adolescent athletes (126 boys, 76 girls; 16.4 \u00b1 0.4\u00a0years) underwent whole-body dual-energy X-ray absorptiometry. Appendicular lean mass index and fat mass index were derived, and aBMD was assessed at the total body, lumbar spine (L1\u2013L4), and femoral neck. Multivariable linear regression models with sex interaction terms and linear contrasts were applied.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Appendicular lean mass index was positively associated with total body and lumbar spine aBMD in both sexes (\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.05), and with femoral neck aBMD in boys. Fat mass index was not significantly associated with aBMD at any site. No sex \u00d7 body composition interactions were observed. The relative magnitude of lean and fat mass associations could not be statistically distinguished at lumbar spine and femoral neck (\n                      <jats:italic>p<\/jats:italic>\n                      &gt; 0.05). In the combined model, explanatory power for total body, lumbar spine and femoral neck was\n                      <jats:italic>R<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      = 0.29, 0.18 and 0.05, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>These findings indicate that lean mass is a group-level correlate of aBMD, but the strength and separability of lean and fat mass associations vary across skeletal sites, with limited ability to distinguish their relative contributions at clinically relevant regions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00774-026-01760-w","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T15:42:41Z","timestamp":1790869361000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Lean and fat mass associations with areal bone mineral density in adolescent team sport athletes"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-5492-1990","authenticated-orcid":false,"given":"Pontus","family":"\u00d6hrner","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1107-9490","authenticated-orcid":false,"given":"Nicolas","family":"Pillon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus","family":"Bohlin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1597-5372","authenticated-orcid":false,"given":"Per","family":"Jonsson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8436-2476","authenticated-orcid":false,"given":"Christer","family":"Malm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4972-4416","authenticated-orcid":false,"given":"Michael","family":"Svensson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,1]]},"reference":[{"key":"1760_CR1","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1007\/s11914-017-0349-0","volume":"15","author":"JW Nieves","year":"2017","unstructured":"Nieves JW (2017) Sex-differences in skeletal growth and aging. Curr Osteoporos Rep 15:70\u201375. https:\/\/doi.org\/10.1007\/s11914-017-0349-0","journal-title":"Curr Osteoporos Rep"},{"key":"1760_CR2","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1056\/NEJMp038101","volume":"349","author":"E Seeman","year":"2003","unstructured":"Seeman E (2003) Periosteal bone formation \u2014 a neglected determinant of bone strength. N Engl J Med 349:320\u2013323. https:\/\/doi.org\/10.1056\/NEJMp038101","journal-title":"N Engl J Med"},{"key":"1760_CR3","doi-asserted-by":"publisher","first-page":"1729","DOI":"10.1002\/jbmr.412","volume":"26","author":"AD Baxter-Jones","year":"2011","unstructured":"Baxter-Jones AD, Faulkner RA, Forwood MR, Mirwald RL, Bailey DA (2011) Bone mineral accrual from 8 to 30 years of age: an estimation of peak bone mass. J Bone Miner Res 26:1729\u20131739. https:\/\/doi.org\/10.1002\/jbmr.412","journal-title":"J Bone Miner Res"},{"key":"1760_CR4","doi-asserted-by":"publisher","first-page":"1985","DOI":"10.1249\/01.MSS.0000142662.21767.58","volume":"36","author":"WM Kohrt","year":"2004","unstructured":"Kohrt WM, Bloomfield SA, Little KD, Nelson ME, Yingling VR (2004) American college of sports medicine position stand: physical activity and bone health. Med Sci Sports Exerc 36:1985\u20131996. https:\/\/doi.org\/10.1249\/01.MSS.0000142662.21767.58","journal-title":"Med Sci Sports Exerc"},{"key":"1760_CR5","doi-asserted-by":"publisher","first-page":"861","DOI":"10.1016\/j.pmrj.2011.05.019","volume":"3","author":"AS Tenforde","year":"2011","unstructured":"Tenforde AS, Fredericson M (2011) Influence of sports participation on bone health in the young athlete: a review of the literature. PM R 3:861\u2013867. https:\/\/doi.org\/10.1016\/j.pmrj.2011.05.019","journal-title":"PM R"},{"key":"1760_CR6","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-026-07905-x","author":"G Nicol","year":"2026","unstructured":"Nicol G, Sammut L (2026) Bone mineral density in paediatric to young adult tennis players: a narrative review. Osteoporos Int. https:\/\/doi.org\/10.1007\/s00198-026-07905-x","journal-title":"Osteoporos Int"},{"key":"1760_CR7","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1007\/s00774-007-0818-0","volume":"26","author":"G Vicente-Rodr\u00edguez","year":"2008","unstructured":"Vicente-Rodr\u00edguez G, Urzanqui A, Mesana MI, Ortega FB, Ruiz JR et al (2008) Physical fitness effect on bone mass is mediated by the independent association between lean mass and bone mass through adolescence: a cross-sectional study. J Bone Miner Metab 26:288\u2013294. https:\/\/doi.org\/10.1007\/s00774-007-0818-0","journal-title":"J Bone Miner Metab"},{"key":"1760_CR8","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1007\/s00223-016-0183-x","volume":"99","author":"I Sioen","year":"2016","unstructured":"Sioen I, Lust E, De Henauw S, Moreno LA, Jim\u00e9nez-Pav\u00f3n D (2016) Associations between body composition and bone health in children and adolescents: a systematic review. Calcif Tissue Int 99:557\u2013577. https:\/\/doi.org\/10.1007\/s00223-016-0183-x","journal-title":"Calcif Tissue Int"},{"key":"1760_CR9","doi-asserted-by":"publisher","DOI":"10.1016\/j.nut.2022.111857","volume":"105","author":"RR Bergamo","year":"2023","unstructured":"Bergamo RR, P\u00e1scoa MA, Hespanhol JE, De Moraes AM, Guerra-J\u00fanior G (2023) Positive association of lean mass and negative association of protein intake on bone mass and bone geometry of adolescent soccer players. Nutrition 105:111857. https:\/\/doi.org\/10.1016\/j.nut.2022.111857","journal-title":"Nutrition"},{"key":"1760_CR10","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1210\/jc.2013-3190","volume":"99","author":"LT Ho-Pham","year":"2014","unstructured":"Ho-Pham LT, Nguyen UDT, Nguyen TV (2014) Association between lean mass, fat mass, and bone mineral density: a meta-analysis. J Clin Endocrinol Metab 99:30\u201338. https:\/\/doi.org\/10.1210\/jc.2013-3190","journal-title":"J Clin Endocrinol Metab"},{"key":"1760_CR11","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph182212126","volume":"18","author":"K-L Deng","year":"2021","unstructured":"Deng K-L, Yang W-Y, Hou J-L, Li H, Feng H, Xiao S-M (2021) Association between body composition and bone mineral density in children and adolescents: a systematic review and meta-analysis. Int J Environ Res Public Health 18:12126. https:\/\/doi.org\/10.3390\/ijerph182212126","journal-title":"Int J Environ Res Public Health"},{"key":"1760_CR12","doi-asserted-by":"publisher","first-page":"759","DOI":"10.1007\/s00421-008-0959-4","volume":"105","author":"RPE Hage","year":"2009","unstructured":"Hage RPE, Courteix D, Benhamou C-L, Jacob C, Jaffr\u00e9 C (2009) Relative importance of lean and fat mass on bone mineral density in a group of adolescent girls and boys. Eur J Appl Physiol 105:759\u2013764. https:\/\/doi.org\/10.1007\/s00421-008-0959-4","journal-title":"Eur J Appl Physiol"},{"key":"1760_CR13","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-018-1933-x","volume":"19","author":"A Winther","year":"2018","unstructured":"Winther A, J\u00f8rgensen L, Ahmed LA, Christoffersen T, Furberg A-S et al (2018) Bone mineral density at the hip and its relation to fat mass and lean mass in adolescents: the Troms\u00f8 study, fit futures. BMC Musculoskelet Disord 19:21. https:\/\/doi.org\/10.1186\/s12891-018-1933-x","journal-title":"BMC Musculoskelet Disord"},{"key":"1760_CR14","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1016\/j.jocd.2014.11.002","volume":"18","author":"K Hind","year":"2015","unstructured":"Hind K, Gannon L, Brightmore A, Beck B (2015) Insights into relationships between body mass, composition and bone: findings in elite rugby players. J Clin Densitom 18:172\u2013178. https:\/\/doi.org\/10.1016\/j.jocd.2014.11.002","journal-title":"J Clin Densitom"},{"key":"1760_CR15","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1038\/oby.2002.8","volume":"10","author":"A Pietrobelli","year":"2002","unstructured":"Pietrobelli A, Faith MS, Wang J, Brambilla P, Chiumello G, Heymsfield SB (2002) Association of lean tissue and fat mass with bone mineral content in children and adolescents. Obes Res 10:56\u201360. https:\/\/doi.org\/10.1038\/oby.2002.8","journal-title":"Obes Res"},{"key":"1760_CR16","doi-asserted-by":"publisher","first-page":"1428","DOI":"10.1093\/ajcn\/80.5.1428","volume":"80","author":"A Arabi","year":"2004","unstructured":"Arabi A, Tamim H, Nabulsi M, Maalouf J, Khalif\u00e9 H et al (2004) Sex differences in the effect of body-composition variables on bone mass in healthy children and adolescents. Am J Clin Nutr 80:1428\u20131435. https:\/\/doi.org\/10.1093\/ajcn\/80.5.1428","journal-title":"Am J Clin Nutr"},{"key":"1760_CR17","doi-asserted-by":"publisher","DOI":"10.1530\/boneabs.6.P012","author":"L Gracia-Marco","year":"2017","unstructured":"Gracia-Marco L, Vlachopoulos D, Ubago-Guisado E, Barker AR, Fatouros IG et al (2017) Determinants of bone outcomes in adolescent athletes at baseline: the PRO-BONE study. BA. https:\/\/doi.org\/10.1530\/boneabs.6.P012","journal-title":"BA"},{"key":"1760_CR18","first-page":"62","volume":"20","author":"BS Baker","year":"2020","unstructured":"Baker BS, Chen Z, Larson RD, Bemben MG, Bemben DA (2020) Sex differences in bone density, geometry, and bone strength of competitive soccer players. J Musculoskelet Neuronal Interact 20:62\u201376","journal-title":"J Musculoskelet Neuronal Interact"},{"key":"1760_CR19","first-page":"403","volume":"42","author":"LM Mudd","year":"2007","unstructured":"Mudd LM, Fornetti W, Pivarnik JM (2007) Bone mineral density in collegiate female athletes: comparisons among sports. J Athl Train 42:403\u2013408","journal-title":"J Athl Train"},{"key":"1760_CR20","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1249\/JSR.0b013e3182779193","volume":"11","author":"KL Scofield","year":"2012","unstructured":"Scofield KL, Hecht S (2012) Bone health in endurance athletes: runners, cyclists, and swimmers. Curr Sports Med Rep 11:328\u2013334. https:\/\/doi.org\/10.1249\/JSR.0b013e3182779193","journal-title":"Curr Sports Med Rep"},{"key":"1760_CR21","doi-asserted-by":"publisher","first-page":"294","DOI":"10.1016\/j.bone.2009.10.005","volume":"46","author":"R Rizzoli","year":"2010","unstructured":"Rizzoli R, Bianchi ML, Garab\u00e9dian M, McKay HA, Moreno LA (2010) Maximizing bone mineral mass gain during growth for the prevention of fractures in the adolescents and the elderly. Bone 46:294\u2013305. https:\/\/doi.org\/10.1016\/j.bone.2009.10.005","journal-title":"Bone"},{"key":"1760_CR22","doi-asserted-by":"publisher","DOI":"10.3390\/sports9040052","volume":"9","author":"B Beck","year":"2021","unstructured":"Beck B, Drysdale L (2021) Risk factors, diagnosis and management of bone stress injuries in adolescent athletes: a narrative review. Sports (Basel) 9:52. https:\/\/doi.org\/10.3390\/sports9040052","journal-title":"Sports (Basel)"},{"key":"1760_CR23","doi-asserted-by":"publisher","first-page":"1539","DOI":"10.1080\/09523367.2021.1983543","volume":"38","author":"D Svensson","year":"1970","unstructured":"Svensson D (1970) Educating the elite in an egalitarian context: the emergence of sport schools for elite talents in Sweden in the 1970s. Int J Hist Sport 38:1539\u20131560. https:\/\/doi.org\/10.1080\/09523367.2021.1983543","journal-title":"Int J Hist Sport"},{"key":"1760_CR24","doi-asserted-by":"publisher","first-page":"279","DOI":"10.4300\/JGME-D-12-00156.1","volume":"4","author":"GM Sullivan","year":"2012","unstructured":"Sullivan GM, Feinn R (2012) Using effect size\u2014or why the P value is not enough. J Grad Med Educ 4:279\u2013282. https:\/\/doi.org\/10.4300\/JGME-D-12-00156.1","journal-title":"J Grad Med Educ"},{"key":"1760_CR25","doi-asserted-by":"publisher","first-page":"895","DOI":"10.1259\/0007-1285-65-778-895","volume":"65","author":"FF Horber","year":"1992","unstructured":"Horber FF, Thomi F, Casez JP, Fonteille J, Jaeger P (1992) Impact of hydration status on body composition as measured by dual energy X-ray absorptiometry in normal volunteers and patients on haemodialysis. Br J Radiol 65:895\u2013900. https:\/\/doi.org\/10.1259\/0007-1285-65-778-895","journal-title":"Br J Radiol"},{"key":"1760_CR26","doi-asserted-by":"publisher","DOI":"10.1016\/j.cdnut.2025.107475","volume":"9","author":"LE O\u2019Connor","year":"2025","unstructured":"O\u2019Connor LE, Lopez-Perez L, Martinez RX, Spill MK, Pe\u00f1a-Rosas JP, MacFarlane AJ (2025) Report of a meeting: an expert consultation on body composition and adiposity for children and adolescents in all their diversity. Curr Dev Nutr 9:107475. https:\/\/doi.org\/10.1016\/j.cdnut.2025.107475","journal-title":"Curr Dev Nutr"},{"key":"1760_CR27","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0097846","volume":"9","author":"DA Santos","year":"2014","unstructured":"Santos DA, Dawson JA, Matias CN, Rocha PM, Minderico CS et al (2014) Reference values for body composition and anthropometric measurements in athletes. PLoS ONE 9:e97846. https:\/\/doi.org\/10.1371\/journal.pone.0097846","journal-title":"PLoS ONE"},{"key":"1760_CR28","doi-asserted-by":"publisher","DOI":"10.7717\/peerj.14108","volume":"10","author":"MA Bim","year":"2022","unstructured":"Bim MA, Pinto ADA, Angelo HCCDD, Gonzaga I, Guimar\u00e3es ACDA et al (2022) Relationship between body composition and bone mass in normal-weight and overweight adolescents. PeerJ 10:e14108. https:\/\/doi.org\/10.7717\/peerj.14108","journal-title":"PeerJ"},{"key":"1760_CR29","doi-asserted-by":"publisher","first-page":"1081","DOI":"10.1002\/ar.a.10119","volume":"275A","author":"HM Frost","year":"2003","unstructured":"Frost HM (2003) Bone\u2019s mechanostat: a 2003 update. Anat Rec 275A:1081\u20131101. https:\/\/doi.org\/10.1002\/ar.a.10119","journal-title":"Anat Rec"},{"key":"1760_CR30","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1016\/j.bone.2007.05.003","volume":"41","author":"JF Nichols","year":"2007","unstructured":"Nichols JF, Rauh MJ, Barrack MT, Barkai H-S (2007) Bone mineral density in female high school athletes: interactions of menstrual function and type of mechanical loading. Bone 41:371\u2013377. https:\/\/doi.org\/10.1016\/j.bone.2007.05.003","journal-title":"Bone"},{"key":"1760_CR31","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1007\/s11914-023-00796-5","volume":"21","author":"A Armento","year":"2023","unstructured":"Armento A, Heronemus M, Truong D, Swanson C (2023) Bone health in young athletes: a narrative review of the recent literature. Curr Osteoporos Rep 21:447\u2013458. https:\/\/doi.org\/10.1007\/s11914-023-00796-5","journal-title":"Curr Osteoporos Rep"},{"key":"1760_CR32","doi-asserted-by":"publisher","first-page":"4779","DOI":"10.1113\/JP278209","volume":"597","author":"KM Hammond","year":"2019","unstructured":"Hammond KM, Sale C, Fraser W, Tang J, Shepherd SO et al (2019) Post\u2010exercise carbohydrate and energy availability induce independent effects on skeletal muscle cell signalling and bone turnover: implications for training adaptation. J Physiol 597:4779\u20134796. https:\/\/doi.org\/10.1113\/JP278209","journal-title":"J Physiol"},{"key":"1760_CR33","doi-asserted-by":"publisher","first-page":"1915","DOI":"10.1002\/jbmr.4658","volume":"37","author":"NC Fensham","year":"2020","unstructured":"Fensham NC, Heikura IA, McKay AKA, Tee N, Ackerman KE, Burke LM (2020) Short-term carbohydrate restriction impairs bone formation at rest and during prolonged exercise to a greater degree than low energy availability. J Bone Miner Res 37:1915\u20131925. https:\/\/doi.org\/10.1002\/jbmr.4658","journal-title":"J Bone Miner Res"},{"key":"1760_CR34","unstructured":"Riksidrottsf\u00f6rbundet. Statistik om barn- och ungdomsidrotten: Deltagare och deltagartillf\u00e4llen [Internet] (2025) https:\/\/www.rf.se\/download\/18.5adfcaf19a3a1017d775a4e\/1762242425259\/Underlag%201%20Deltagande.pdf. Accessed 7 Dec 2025"},{"key":"1760_CR35","doi-asserted-by":"publisher","first-page":"852","DOI":"10.1136\/bjsports-2015-094623","volume":"49","author":"RM Malina","year":"2015","unstructured":"Malina RM, Rogol AD, Cumming SP, Coelho E Silva MJ, Figueiredo AJ (2015) Biological maturation of youth athletes: assessment and implications. Br J Sports Med 49:852\u2013859. https:\/\/doi.org\/10.1136\/bjsports-2015-094623","journal-title":"Br J Sports Med"},{"key":"1760_CR36","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1002\/jbmr.5650080102","volume":"8","author":"EA Krall","year":"1993","unstructured":"Krall EA, Dawson-Hughes B (1993) Heritable and life-style determinants of bone mineral density. J Bone Miner Res 8:1\u20139. https:\/\/doi.org\/10.1002\/jbmr.5650080102","journal-title":"J Bone Miner Res"},{"key":"1760_CR37","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1093\/oxfordjournals.aje.a009362","volume":"147","author":"TV Nguyen","year":"1998","unstructured":"Nguyen TV, Howard GM, Kelly PJ, Eisman JA (1998) Bone mass, lean mass, and fat mass: same genes or same environments? Am J Epidemiol 147:3\u201316. https:\/\/doi.org\/10.1093\/oxfordjournals.aje.a009362","journal-title":"Am J Epidemiol"}],"container-title":["Journal of Bone and Mineral Metabolism"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00774-026-01760-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00774-026-01760-w","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00774-026-01760-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T15:42:43Z","timestamp":1790869363000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00774-026-01760-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,1]]},"references-count":37,"alternative-id":["1760"],"URL":"https:\/\/doi.org\/10.1007\/s00774-026-01760-w","relation":{},"ISSN":["0914-8779","1435-5604"],"issn-type":[{"value":"0914-8779","type":"print"},{"value":"1435-5604","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,1]]},"assertion":[{"value":"9 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 August 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 October 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors have no competing interests to declare that are relevant to the content of this article.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Written informed consent was obtained from all participants prior to enrolment.","order":2,"name":"Ethics","label":"Informed consent","group":{"name":"EthicsHeading","label":"Declarations"}}]}}