{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T09:08:31Z","timestamp":1788944911845,"version":"build-2803163510"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"9","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Hum Hypertens"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    To compare hypertension prevalence using \u2018initial\u2019 blood pressure (BP), \u2018subsequent\u2019 BP (averaged second and third readings) and \u2018total\u2019 BP (averaged three readings), we included 8\u201317-year-old youth with three BP readings from NHANES 2013\u20132020. From 2013\u20132016, BP was obtained using auscultation (manual protocol, MP) and subsequently, using oscillometry (automated protocol, AP). We excluded subjects with \u2018zero\u2019 diastolic blood pressure (DBP). In 5656 subjects, clinical hypertension (high systolic blood pressure [SBP] and\/or DBP) prevalence was highest with \u2018initial\u2019 BP (350\/5 642, 6.2% [95% CI 5.6\u20136.9%]), lower with \u2018subsequent\u2019 BP (289\/5 642, 5.1% [4.6\u20135.7%],\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001), and lowest with \u2018total\u2019 BP (251\/5 642, 4.4% [3.9\u20135.0%],\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). Both MP and AP groups maintained this trend with a significantly lower hypertension prevalence with \u2018total\u2019 vs. \u2018subsequent\u2019 BP. An exception to the trend occurred in the AP group for three conditions: diastolic hypertension, hypertension in high BMI and Hispanic subjects. Diastolic hypertension prevalence with \u2018subsequent\u2019 DBP (86\/2 285, 3.8% [3.1\u20134.6%]) exceeded that with \u2018initial\u2019 DBP (83\/2 285, 3.6% [2.9\u20134.5%]) and was lowest with \u2018total\u2019 DBP (59\/2 285, 2.6% [2.0\u20133.3%]). Diastolic hypertension prevalence was higher (126\/5 642, 2.2% [1.9\u2009\u2212\u20092.7%]) with the 2016 European guidelines (same as \u2018subsequent\u2019 DBP) than with \u2018total\u2019 DBP (94\/5 642, 1.7% [1.4\u2009\u2212\u20092.0%]). Our findings support the inclusion of the first BP reading in BP categorization, as \u2018total BP\u2019 leads to lower hypertension classification than \u2018subsequent\u2019 BP.\n                  <\/jats:p>","DOI":"10.1038\/s41371-026-01188-9","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T16:18:05Z","timestamp":1785341885000},"page":"739-746","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pediatric hypertension prevalence with 1 vs. 2 vs. 3 within-visit blood pressure readings (NHANES 2013-2020)"],"prefix":"10.1038","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1281-5277","authenticated-orcid":false,"given":"Sandeep K.","family":"RIAR","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6598-1888","authenticated-orcid":false,"given":"Donald L.","family":"BATISKY","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1295-3602","authenticated-orcid":false,"given":"Scott","family":"GILLESPIE","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3204-4142","authenticated-orcid":false,"given":"Andrew M.","family":"SOUTH","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"1188_CR1","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1161\/01.hyp.9.2.209","volume":"9","author":"G Mancia","year":"1987","unstructured":"Mancia G, Parati G, Pomidossi G, Grassi G, Casadei R, Zanchetti A. Alerting reaction and rise in blood pressure during measurement by physician and nurse. Hypertension. 1987;9:209\u201315. https:\/\/doi.org\/10.1161\/01.hyp.9.2.209","journal-title":"Hypertension"},{"key":"1188_CR2","doi-asserted-by":"publisher","first-page":"e2024311","DOI":"10.1001\/jamanetworkopen.2020.24311","volume":"3","author":"HJ Lin","year":"2020","unstructured":"Lin HJ, Pan HY, Chen WJ, Wang TD. Variation in blood pressure classification using 7 blood pressure estimation protocols among adults in taiwan. JAMA Netw Open. 2020;3:e2024311. https:\/\/doi.org\/10.1001\/jamanetworkopen.2020.24311","journal-title":"JAMA Netw Open"},{"key":"1188_CR3","doi-asserted-by":"publisher","first-page":"751","DOI":"10.1111\/jch.12009","volume":"14","author":"J Handler","year":"2012","unstructured":"Handler J, Zhao Y, Egan BM. Impact of the number of blood pressure measurements on blood pressure classification in US adults: NHANES 1999-2008. J Clin Hypertens. 2012;14:751\u20139. https:\/\/doi.org\/10.1111\/jch.12009","journal-title":"J Clin Hypertens"},{"key":"1188_CR4","doi-asserted-by":"publisher","first-page":"e13","DOI":"10.1161\/HYP.0000000000000065","volume":"71","author":"PK Whelton","year":"2018","unstructured":"Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC\/AHA\/AAPA\/ABC\/ACPM\/AGS\/APhA\/ASH\/ASPC\/NMA\/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the american college of cardiology\/american heart association task force on clinical practice guidelines. Hypertension. 2018;71:e13\u2013e115. https:\/\/doi.org\/10.1161\/HYP.0000000000000065","journal-title":"Hypertension"},{"key":"1188_CR5","doi-asserted-by":"publisher","first-page":"e20171904","DOI":"10.1542\/peds.2017-1904","volume":"140","author":"JT Flynn","year":"2017","unstructured":"Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics. 2017;140:e20171904. https:\/\/doi.org\/10.1542\/peds.2017-1904","journal-title":"Pediatrics"},{"key":"1188_CR6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.ejim.2024.05.033","volume":"126","author":"R Kreutz","year":"2024","unstructured":"Kreutz R, Brunstrom M, Burnier M, Grassi G, Januszewicz A, Muiesan ML, et al. 2024 European Society of Hypertension clinical practice guidelines for the management of arterial hypertension. Eur J Intern Med. 2024;126:1\u201315. https:\/\/doi.org\/10.1016\/j.ejim.2024.05.033","journal-title":"Eur J Intern Med"},{"key":"1188_CR7","doi-asserted-by":"publisher","first-page":"1887","DOI":"10.1097\/HJH.0000000000001039","volume":"34","author":"E Lurbe","year":"2016","unstructured":"Lurbe E, Agabiti-Rosei E, Cruickshank JK, Dominiczak A, Erdine S, Hirth A, et al. 2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents. J Hypertens. 2016;34:1887\u2013920. https:\/\/doi.org\/10.1097\/HJH.0000000000001039","journal-title":"J Hypertens"},{"key":"1188_CR8","doi-asserted-by":"publisher","first-page":"2090","DOI":"10.1093\/eurjpc\/zwac108","volume":"29","author":"Y Meng","year":"2022","unstructured":"Meng Y, Magnussen CG, Wu F, Juonala M, Buscot MJ, Pahkala K, et al. Impact of within-visit systolic blood pressure change patterns on blood pressure classification: the cardiovascular risk in young finns study. Eur J Prev Cardiol. 2022;29:2090\u20138. https:\/\/doi.org\/10.1093\/eurjpc\/zwac108","journal-title":"Eur J Prev Cardiol"},{"key":"1188_CR9","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1038\/jhh.2014.98","volume":"29","author":"MR Salazar","year":"2015","unstructured":"Salazar MR, Espeche WG, Aizpurua M, Sisnieguez CE, Sisnieguez BC, Dulbecco CA, et al. Should the first blood pressure reading be discarded? J Hum Hypertens. 2015;29:373\u20138. https:\/\/doi.org\/10.1038\/jhh.2014.98","journal-title":"J Hum Hypertens"},{"key":"1188_CR10","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1007\/s00431-017-3049-y","volume":"177","author":"P Veloudi","year":"2018","unstructured":"Veloudi P, Blizzard CL, Srikanth VK, Schultz MG, Sharman JE. Influence of blood pressure level and age on within-visit blood pressure variability in children and adolescents. Eur J Pediatr. 2018;177:205\u201310. https:\/\/doi.org\/10.1007\/s00431-017-3049-y","journal-title":"Eur J Pediatr"},{"key":"1188_CR11","doi-asserted-by":"publisher","first-page":"766","DOI":"10.1111\/jch.14127","volume":"23","author":"Y Duan","year":"2021","unstructured":"Duan Y, Sun J, Zhao M, Magnussen CG, Xi B. Utility of blood pressure measurements at an initial screening visit to identify Chinese children and adolescents with hypertension. J Clin Hypertens. 2021;23:766\u201372. https:\/\/doi.org\/10.1111\/jch.14127","journal-title":"J Clin Hypertens"},{"key":"1188_CR12","doi-asserted-by":"publisher","first-page":"1352","DOI":"10.1111\/jch.13645","volume":"21","author":"Z Outdili","year":"2019","unstructured":"Outdili Z, Marti-Soler H, Bovet P, Chiolero A. Performance of blood pressure measurements at an initial screening visit for the diagnosis of hypertension in children. J Clin Hypertens. 2019;21:1352\u20137. https:\/\/doi.org\/10.1111\/jch.13645","journal-title":"J Clin Hypertens"},{"key":"1188_CR13","doi-asserted-by":"publisher","first-page":"687","DOI":"10.1007\/s00467-019-04368-7","volume":"35","author":"G Ardissino","year":"2020","unstructured":"Ardissino G, Ghiglia S, Salice P, Perrone M, Piantanida S, De Luca FL, et al. Multiple office blood pressure measurement: a novel approach to overcome the weak cornerstone of blood pressure measurement in children. data from the SPA project. Pediatr Nephrol. 2020;35:687\u201393. https:\/\/doi.org\/10.1007\/s00467-019-04368-7","journal-title":"Pediatr Nephrol"},{"key":"1188_CR14","doi-asserted-by":"publisher","first-page":"717","DOI":"10.1111\/jch.12168","volume":"15","author":"LJ Becton","year":"2013","unstructured":"Becton LJ, Egan BM, Hailpern SM, Shatat IF. Blood pressure reclassification in adolescents based on repeat clinic blood pressure measurements. J Clin Hypertens. 2013;15:717\u201322. https:\/\/doi.org\/10.1111\/jch.12168","journal-title":"J Clin Hypertens"},{"key":"1188_CR15","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1038\/s41371-022-00693-x","volume":"37","author":"JE Sharman","year":"2023","unstructured":"Sharman JE, Tan I, Stergiou GS, Lombardi C, Saladini F, Butlin M, et al. Automated \u2018oscillometric\u2019 blood pressure measuring devices: how they work and what they measure. J Hum Hypertens. 2023;37:93\u2013100. https:\/\/doi.org\/10.1038\/s41371-022-00693-x","journal-title":"J Hum Hypertens"},{"key":"1188_CR16","doi-asserted-by":"publisher","first-page":"753","DOI":"10.1097\/HJH.0000000000001227","volume":"35","author":"P Veloudi","year":"2017","unstructured":"Veloudi P, Blizzard CL, Srikanth VK, Breslin M, Schultz MG, Sharman JE. Age-dependent changes in blood pressure over consecutive office measurements: impact on hypertension diagnosis and implications for international guidelines. J Hypertens. 2017;35:753\u201360. https:\/\/doi.org\/10.1097\/HJH.0000000000001227","journal-title":"J Hypertens"},{"key":"1188_CR17","doi-asserted-by":"publisher","first-page":"e20161433","DOI":"10.1542\/peds.2016-1433","volume":"139","author":"EL Cheung","year":"2017","unstructured":"Cheung EL, Bell CS, Samuel JP, Poffenbarger T, Redwine KM, Samuels JA. Race and obesity in adolescent hypertension. Pediatrics. 2017;139:e20161433. https:\/\/doi.org\/10.1542\/peds.2016-1433","journal-title":"Pediatrics"},{"key":"1188_CR18","unstructured":"Ostchega Y, Fryar CD, Nwankwo T, Nguyen DT Hypertension prevalence among adults aged 18 and over: United States, 2017-2018. NCHS Data Brief. 2020:1-8."},{"key":"1188_CR19","unstructured":"Centers for Disease Control and Prevention (CDC). National Center for Health Statistics (NCHS): National Health and Nutrition Examination Survey (NHANES) Blood Pressure Procedures Manual. 2019. https:\/\/wwwn.cdc.gov\/nchs\/data\/nhanes\/2019-2020\/manuals\/2019-Blood-Pressure-Procedures-Manual-508.pdf. Accessed December 31, 2021."},{"key":"1188_CR20","first-page":"1","volume":"1","author":"LJ Akinbami","year":"2022","unstructured":"Akinbami LJ, Chen TC, Davy O, Ogden CL, Fink S, Clark J, et al. National health and nutrition examination survey, 2017-march 2020 prepandemic file: sample design, estimation, and analytic guidelines. Vital Health Stat. 2022;1:1\u201336.","journal-title":"Vital Health Stat"},{"key":"1188_CR21","doi-asserted-by":"publisher","first-page":"1083","DOI":"10.1016\/0895-7061(95)00230-M","volume":"8","author":"IW Hammond","year":"1995","unstructured":"Hammond IW, Urbina EM, Wattigney WA, Bao W, Steinmann WC, Berenson GS. Comparison of fourth and fifth Korotkoff diastolic blood pressures in 5\u201330 year old individuals. Bogalusa Heart Study Am J Hypertens. 1995;8:1083\u20139. https:\/\/doi.org\/10.1016\/0895-7061(95)00230-M","journal-title":"Bogalusa Heart Study Am J Hypertens"},{"key":"1188_CR22","unstructured":"Centers for Disease Control and Prevention (CDC). National Center for Health Statistics (NCHS): National Health and Nutrition Examination Survery (NHANES) MEC Interviewers Procedures Manual.2016. https:\/\/wwwn.cdc.gov\/nchs\/data\/nhanes\/2015-2016\/manuals\/2016_MEC_Interviewers_Procedures.pdf. Accessed January 29, 2022 2022."},{"key":"1188_CR23","unstructured":"Centers for Disease Control and Prevention (CDC). National Center for Health Statistics (NCHS): National Health and Nutrition Examination Survery (NHANES) Physician Examination Procedures Manual. 2017. https:\/\/wwwn.cdc.gov\/nchs\/nhanes\/ContinuousNhanes\/Manuals.aspx?Cycle=2017-2020. Accessed March 30, 2025."},{"key":"1188_CR24","unstructured":"Centers for Disease Control and Prevention (CDC). National Center for Health Statistics (NCHS): National Health and Nutrition Examination Survey (NHANES) Anthropometry Procedures Manual. 2013. https:\/\/wwwn.cdc.gov\/nchs\/data\/nhanes\/public\/2013\/manuals\/2013_Anthropometry.pdf. Accessed."},{"key":"1188_CR25","unstructured":"Centers for Disease Control and Prevention: About Child & Teen BMI. 2021. https:\/\/www.cdc.gov\/healthyweight\/assessing\/bmi\/childrens_bmi\/about_childrens_bmi.html. Accessed December 19, 2021 2021."},{"key":"1188_CR26","unstructured":"Centers for Disease Control and Prevention (CDC). National Center for Health Statistics (NCHS): National Health and Nutrition Examination Survey (NHANES) Physician Examination. Procedures Manual. 2015. https:\/\/wwwn.cdc.gov\/nchs\/data\/nhanes\/2015-2016\/manuals\/2015_Physician_Examination_Procedures_Manual.pdf. Accessed Nov 12, 2023."},{"key":"1188_CR27","first-page":"1","volume":"1","author":"Y Ostchega","year":"2021","unstructured":"Ostchega Y, Nwankwo T, Chiappa M, Wolz M, Graber J, Nguyen DT. Comparing blood pressure values obtained by two different protocols: national health and nutrition examination survey, 2017-2018. Vital Health Stat. 2021;1:1\u201326.","journal-title":"Vital Health Stat"},{"key":"1188_CR28","first-page":"1","volume":"2","author":"TC Chen","year":"2020","unstructured":"Chen TC, Clark J, Riddles MK, Mohadjer LK, Fakhouri THI. National health and nutrition examination survey, 2015-2018: sample design and estimation procedures. Vital Health Stat. 2020;2:1\u201335.","journal-title":"Vital Health Stat"},{"key":"1188_CR29","doi-asserted-by":"publisher","first-page":"e101","DOI":"10.1161\/HYP.0000000000000228","volume":"80","author":"B Falkner","year":"2023","unstructured":"Falkner B, Gidding SS, Baker-Smith CM, Brady TM, Flynn JT, Malle LM, et al. Pediatric primary hypertension: an underrecognized condition: a scientific statement from the American Heart Association. Hypertension. 2023;80:e101\u2013e11. https:\/\/doi.org\/10.1161\/HYP.0000000000000228","journal-title":"Hypertension"},{"key":"1188_CR30","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1016\/j.jash.2015.12.001","volume":"10","author":"X Negroni-Balasquide","year":"2016","unstructured":"Negroni-Balasquide X, Bell CS, Samuel J, Samuels JA. Is one measurement enough to evaluate blood pressure among adolescents? A blood pressure screening experience in more than 9000 children with a subset comparison of auscultatory to mercury measurements. J Am Soc Hypertens. 2016;10:95\u2013100. https:\/\/doi.org\/10.1016\/j.jash.2015.12.001","journal-title":"J Am Soc Hypertens"},{"key":"1188_CR31","doi-asserted-by":"publisher","first-page":"1158","DOI":"10.1097\/HJH.0000000000004006","volume":"43","author":"SK Riar","year":"2025","unstructured":"Riar SK, Gillespie S, South AM. Within-visit blood pressure variability in children and adolescents in the national health and nutrition examination survey (2013-2020). J Hypertens. 2025;43:1158\u201368. https:\/\/doi.org\/10.1097\/HJH.0000000000004006","journal-title":"J Hypertens"},{"key":"1188_CR32","doi-asserted-by":"publisher","first-page":"521","DOI":"10.1097\/HJH.0000000000003629","volume":"42","author":"S Atasoy","year":"2024","unstructured":"Atasoy S, Henningsen P, Johar H, Middeke M, Sattel H, Linkohr B, et al. Hypertension in the first blood pressure reading and the risk of cardiovascular disease mortality in the general population: findings from the prospective KORA study. J Hypertens. 2024;42:521\u20139. https:\/\/doi.org\/10.1097\/HJH.0000000000003629","journal-title":"J Hypertens"},{"key":"1188_CR33","doi-asserted-by":"publisher","first-page":"1115","DOI":"10.1093\/oxfordjournals.aje.a114750","volume":"126","author":"B Rosner","year":"1987","unstructured":"Rosner B, Cook NR, Evans DA, Keough ME, Taylor JO, Polk BF, et al. Reproducibility and predictive values of routine blood pressure measurements in children. Comparison with adult values and implications for screening children for elevated blood pressure. Am J Epidemiol. 1987;126:1115\u201325. https:\/\/doi.org\/10.1093\/oxfordjournals.aje.a114750","journal-title":"Am J Epidemiol"},{"key":"1188_CR34","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1097\/MBP.0000000000000367","volume":"24","author":"JS Ringrose","year":"2019","unstructured":"Ringrose JS, Alabbas A, Jalali A, Khinda H, Morgan C, Yiu V, et al. Comparability of oscillometric to simultaneous auscultatory blood pressure measurement in children. Blood Press Monit. 2019;24:83\u20138. https:\/\/doi.org\/10.1097\/MBP.0000000000000367","journal-title":"Blood Press Monit"},{"key":"1188_CR35","doi-asserted-by":"publisher","first-page":"653","DOI":"10.1093\/aje\/kwm348","volume":"167","author":"B Rosner","year":"2008","unstructured":"Rosner B, Cook N, Portman R, Daniels S, Falkner B. Determination of blood pressure percentiles in normal-weight children: some methodological issues. Am J Epidemiol. 2008;167:653\u201366. https:\/\/doi.org\/10.1093\/aje\/kwm348","journal-title":"Am J Epidemiol"}],"container-title":["Journal of Human Hypertension"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41371-026-01188-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41371-026-01188-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41371-026-01188-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T08:39:02Z","timestamp":1788943142000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41371-026-01188-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,29]]},"references-count":35,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["1188"],"URL":"https:\/\/doi.org\/10.1038\/s41371-026-01188-9","relation":{},"ISSN":["1476-5527"],"issn-type":[{"value":"1476-5527","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,29]]},"assertion":[{"value":"12 December 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 July 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 July 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 July 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"SK Riar owns stock (CVS). Stocks owned in the past 3 years: ABT, ABBV, AMGN, BAX, BSX, CI, CVS, DGX, DVA, DXCM, HCA, INVITAE, ISRG, JNJ, LLY, NSRGY, NTRA, NVO, PPH, REGN, TEM, UNH, WGS, VRTX, WRBY). DL Batisky and S Gillespie have no disclosures. AM South has the following disclosures: Grants: NIH: R01HL146818, K23HL148394, R01HL164434 Advisory board (all past): Travere Therapeutics, Inc.; MJH Life Sciences; IDORSIA Pharmaceuticals US, Inc.; Kyowa Kirin Co., Ltd. Consultant (all past): Techspert.IO; Conjupro Biotherapeutics, Inc.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"NHANES data collection is approved by the National Center for Health Statistics Research Ethics Review Board (protocol #2011\u2009\u2212\u200917 for years 2011\u2009\u2212\u20092016, #2011\u2009\u2212\u200917 followed by #2018\u2009\u2212\u200901 for the year 2017 and #2018-01 for years 2018\u2009\u2212\u20092020). The Review Board ensures that research involving human participants confirms to United States federal regulations. Parental informed consent and participant assent were obtained for 7\u201317-year-old subjects.","order":2,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Ethics"}}]}}