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The SMILE study was approved by the institutional ethics committee of Renji Hospital, Shanghai Jiao Tong University School of Medicine (Approval No. LY2025-239-A), and written informed consent was obtained from all participants. NHANES is conducted by the Centers for Disease Control and Prevention (CDC) and the National Center for Health Statistics (NCHS); its protocol was approved by the NCHS Research Ethics Review Committee, and all participants provided written informed consent.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that they have no competing interests.","order":2,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":3,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"331"}}