{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T09:49:07Z","timestamp":1785750547128,"version":"3.56.0"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T00:00:00Z","timestamp":1779667200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"vor","delay-in-days":70,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100004048","name":"Kashan University of Medical Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004048","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Metabolic dysfunction-associated steatotic liver disease (MASLD) is an increasingly recognized chronic liver disorder in children and adolescents, particularly among those with obesity and insulin resistance. Given the emerging role of the gut\u2013liver axis in disease pathogenesis, this study aimed to evaluate the effectiveness of synbiotic supplementation in improving biochemical and ultrasonographic outcomes in pediatric MASLD. This double-blind, randomized, placebo-controlled clinical trial was conducted over 8 weeks. A total of 60 participants aged 10\u201318 years with MASLD were randomly assigned to receive either synbiotics (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200930) or placebo (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200930). The synbiotic formulation contained a combination of nine probiotic strains with a prebiotic component, whereas the placebo consisted of prebiotic-only capsules (fructooligosaccharide with sucrose). The primary outcomes were predefined as changes in liver enzyme activities (alanine aminotransferase [ALT] and aspartate aminotransferase [AST]) and hepatic steatosis grade assessed by ultrasonography, while secondary outcomes included body mass index (BMI) and lipid profile parameters. Between-group differences were analyzed using appropriate statistical models adjusting for baseline values. After 8 weeks, the synbiotics group showed statistically significant reductions in BMI (\u2212\u20090.70\u2009\u00b1\u20090.16 kg\/m\n                    <jats:sup>2<\/jats:sup>\n                    ), triglycerides (\u2212\u200910.50\u2009\u00b1\u20093.10 mg\/dL), total cholesterol (\u2212\u200910.50\u2009\u00b1\u20092.90 mg\/dL), and LDL-cholesterol (\u2212\u20095.46\u2009\u00b1\u20091.85 mg\/dL) compared with the placebo group (all\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). Liver enzyme activities decreased significantly in the synbiotics group (ALT \u2212\u200920.36\u2009\u00b1\u20097.18 U\/L; AST \u2212\u200916.76\u2009\u00b1\u200910.67 U\/L), with greater reductions than in the placebo group (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001 for between-group comparisons). Furthermore, improvement in hepatic steatosis grade was observed in 73.3% of participants in the synbiotics group compared to 23.3% in the placebo group (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). Synbiotic supplementation over an 8-week period was associated with significant improvements in liver enzyme activities, lipid profile, BMI, and ultrasonographic steatosis grade in children with MASLD. While these findings suggest a beneficial role for synbiotics as an adjunctive strategy, the relatively short intervention period and lack of control for lifestyle factors warrant cautious interpretation. Further studies with longer follow-up, detailed lifestyle assessment, and mechanistic investigations are needed to confirm these results and clarify the underlying pathways.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Iranian Registry of Clinical Trials code<\/jats:italic>\n                    : IRCT20220314054279N1.\n                  <\/jats:p>","DOI":"10.1038\/s41598-026-54652-4","type":"journal-article","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T06:16:00Z","timestamp":1779689760000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Short term synbiotic supplementation improves hepatic and metabolic outcomes in children with metabolic dysfunction associated steatotic liver disease"],"prefix":"10.1038","volume":"16","clinical-trial-number":[{"clinical-trial-number":"irct20220314054279n1","registry":"10.18810\/irct"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5718-9284","authenticated-orcid":false,"given":"Maryam Naseri","family":"Taheri","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9079-382X","authenticated-orcid":false,"given":"Abbas","family":"Taghaviardakani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8831-4108","authenticated-orcid":false,"given":"Reza","family":"Hosseiniara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2570-8921","authenticated-orcid":false,"given":"Javid","family":"Azadbakht","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2049-3370","authenticated-orcid":false,"given":"Mohammad Reza","family":"Sharif","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5098-5157","authenticated-orcid":false,"given":"Davood","family":"Kheirkhah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,25]]},"reference":[{"key":"54652_CR1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drudis.2024.103910","author":"S Wei","year":"2024","unstructured":"Wei, S., Wang, L., Evans, P. C. & Xu, S. NAFLD and NASH: Etiology, targets and emerging therapies. Drug Discovery Today https:\/\/doi.org\/10.1016\/j.drudis.2024.103910 (2024).","journal-title":"Drug Discovery Today"},{"key":"54652_CR2","doi-asserted-by":"publisher","DOI":"10.20524\/aog.2021.0604","author":"E Cholongitas","year":"2021","unstructured":"Cholongitas, E. et al. Epidemiology of nonalcoholic fatty liver disease in Europe: A systematic review and meta-analysis. Ann Gastroenterol. https:\/\/doi.org\/10.20524\/aog.2021.0604 (2021).","journal-title":"Ann Gastroenterol."},{"issue":"6","key":"54652_CR3","doi-asserted-by":"publisher","DOI":"10.3390\/ijms17060947","volume":"17","author":"JL Temple","year":"2016","unstructured":"Temple, J. L., Cordero, P., Li, J., Nguyen, V. & Oben, J. A. A guide to non-alcoholic fatty liver disease in childhood and adolescence. Int. J. Mol. Sci. 17(6), 947. https:\/\/doi.org\/10.3390\/ijms17060947 (2016).","journal-title":"Int. J. Mol. Sci."},{"issue":"26","key":"54652_CR4","volume":"17","author":"L Pacifico","year":"2011","unstructured":"Pacifico, L., Nobili, V., Anania, C., Verdecchia, P. & Chiesa, C. Pediatric nonalcoholic fatty liver disease, metabolic syndrome and cardiovascular risk. World J. Gastroenterol. 17(26), 3082 (2011).","journal-title":"World J. Gastroenterol."},{"issue":"3","key":"54652_CR5","doi-asserted-by":"publisher","DOI":"10.3390\/biomedicines10030524","volume":"10","author":"Q Song","year":"2022","unstructured":"Song, Q. & Zhang, X. The role of gut-liver axis in gut microbiome dysbiosis associated NAFLD and NAFLD-HCC. Biomedicines 10(3), 524. https:\/\/doi.org\/10.3390\/biomedicines10030524 (2022).","journal-title":"Biomedicines"},{"key":"54652_CR6","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1111\/liv.14869","volume":"41","author":"AC Cardoso","year":"2021","unstructured":"Cardoso, A. C., de Figueiredo-Mendes, C. & Villela-Nogueira, C. A. Current management of NAFLD\/NASH. Liver Int. 41, 89\u201394. https:\/\/doi.org\/10.1111\/liv.14869 (2021).","journal-title":"Liver Int."},{"issue":"4","key":"54652_CR7","doi-asserted-by":"publisher","DOI":"10.3390\/biomedicines12040826","volume":"12","author":"D Kounatidis","year":"2024","unstructured":"Kounatidis, D. et al. NAFLD in the 21st century: Current knowledge regarding its pathogenesis, diagnosis and therapeutics. Biomedicines 12(4), 826. https:\/\/doi.org\/10.3390\/biomedicines12040826 (2024).","journal-title":"Biomedicines"},{"issue":"2","key":"54652_CR8","first-page":"97","volume":"3","author":"A Charles","year":"2024","unstructured":"Charles, A. et al. A case report on acquired ichthyosis and autoimmune hepatitis. J. Prevent. Complement. Med. 3(2), 97\u2013102 (2024).","journal-title":"J. Prevent. Complement. Med."},{"issue":"42","key":"54652_CR9","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v20.i42.15518","volume":"20","author":"G Paolella","year":"2014","unstructured":"Paolella, G. et al. Gut-liver axis and probiotics: Their role in non-alcoholic fatty liver disease. World J. Gastroenterol. 20(42), 15518. https:\/\/doi.org\/10.3748\/wjg.v20.i42.15518 (2014).","journal-title":"World J. Gastroenterol."},{"issue":"4","key":"54652_CR10","doi-asserted-by":"publisher","DOI":"10.5812\/aapm.14221","volume":"4","author":"G Taheri Moghadam","year":"2014","unstructured":"Taheri Moghadam, G., Hosseini-Zijoud, S. M., Heidary Shayesteh, T., Ghasemi, H. & Ranjbar, A. Attenuation of cisplathin-induced toxic oxidative stress by propofol. Anesth. Pain Med. 4(4), e14221. https:\/\/doi.org\/10.5812\/aapm.14221 (2014).","journal-title":"Anesth. Pain Med."},{"issue":"1","key":"54652_CR11","doi-asserted-by":"publisher","first-page":"110","DOI":"10.2174\/1389557523666230608163823","volume":"24","author":"S Zaib","year":"2024","unstructured":"Zaib, S., Hayat, A. & Khan, I. Probiotics and their beneficial health effects. Mini Rev. Med. Chem. 24(1), 110\u2013125. https:\/\/doi.org\/10.2174\/1389557523666230608163823 (2024).","journal-title":"Mini Rev. Med. Chem."},{"issue":"1","key":"54652_CR12","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1186\/s12876-024-03356-y","volume":"24","author":"Y Pan","year":"2024","unstructured":"Pan, Y., Yang, Y., Wu, J., Zhou, H. & Yang, C. Efficacy of probiotics, prebiotics, and synbiotics on liver enzymes, lipid profiles, and inflammation in patients with non-alcoholic fatty liver disease: A systematic review and meta-analysis of randomized controlled trials. BMC Gastroenterol. 24(1), 283. https:\/\/doi.org\/10.1186\/s12876-024-03356-y (2024).","journal-title":"BMC Gastroenterol."},{"issue":"3","key":"54652_CR13","doi-asserted-by":"publisher","first-page":"329","DOI":"10.3390\/antiox13030329","volume":"13","author":"Y Zhu","year":"2024","unstructured":"Zhu, Y., Tan, J. K., Liu, J. & Goon, J. A. Roles of traditional and next-generation probiotics on non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH): A systematic review and network meta-analysis. Antioxidants. 13(3), 329. https:\/\/doi.org\/10.3390\/antiox13030329 (2024).","journal-title":"Antioxidants."},{"key":"54652_CR14","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinre.2024.102397","author":"J Wu","year":"2024","unstructured":"Wu, J., Chen, X., Qian, J. & Li, G. Clinical improvement effect of regulating gut microbiota on metabolic dysfunction-associated steatotic liver disease: Systematic review and meta-analysis of randomized controlled trials. Clin. Res. Hepatol. Gastroenterol. https:\/\/doi.org\/10.1016\/j.clinre.2024.102397 (2024).","journal-title":"Clin. Res. Hepatol. Gastroenterol."},{"issue":"11","key":"54652_CR15","doi-asserted-by":"publisher","first-page":"1276","DOI":"10.1111\/apt.12758","volume":"39","author":"A Alisi","year":"2014","unstructured":"Alisi, A. et al. Randomised clinical trial: The beneficial effects of VSL#3 in obese children with non-alcoholic steatohepatitis. Aliment Pharmacol. Ther. 39(11), 1276\u20131285. https:\/\/doi.org\/10.1111\/apt.12758 (2014).","journal-title":"Aliment Pharmacol. Ther."},{"key":"54652_CR16","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-024-03783-7","author":"A Serbis","year":"2024","unstructured":"Serbis, A., Polyzos, S. A., Paschou, S. A., Siomou, E. & Kiortsis, D. N. Diet, exercise, and supplements: What is their role in the management of the metabolic dysfunction-associated steatotic liver disease in children?. Endocrine https:\/\/doi.org\/10.1007\/s12020-024-03783-7 (2024).","journal-title":"Endocrine"},{"issue":"6","key":"54652_CR17","doi-asserted-by":"publisher","first-page":"740","DOI":"10.1097\/MPG.0b013e31821f9b85","volume":"52","author":"P Vajro","year":"2011","unstructured":"Vajro, P. et al. Effects of Lactobacillus rhamnosus strain GG in pediatric obesity-related liver disease. J. Pediatr. Gastroenterol. Nutr. 52(6), 740\u2013743. https:\/\/doi.org\/10.1097\/MPG.0b013e31821f9b85 (2011).","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"issue":"36","key":"54652_CR18","doi-asserted-by":"publisher","first-page":"8078","DOI":"10.3748\/wjg.v22.i36.8078","volume":"22","author":"MG Clemente","year":"2016","unstructured":"Clemente, M. G., Mandato, C., Poeta, M. & Vajro, P. Pediatric non-alcoholic fatty liver disease: Recent solutions, unresolved issues, and future research directions. World J. Gastroenterol. 22(36), 8078. https:\/\/doi.org\/10.3748\/wjg.v22.i36.8078 (2016).","journal-title":"World J. Gastroenterol."},{"issue":"7","key":"54652_CR19","doi-asserted-by":"publisher","first-page":"1967","DOI":"10.1053\/j.gastro.2020.01.048","volume":"158","author":"D Goldner","year":"2020","unstructured":"Goldner, D. & Lavine, J. E. Nonalcoholic fatty liver disease in children: Unique considerations and challenges. Gastroenterology 158(7), 1967\u201383.e1. https:\/\/doi.org\/10.1053\/j.gastro.2020.01.048 (2020).","journal-title":"Gastroenterology"},{"issue":"3","key":"54652_CR20","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1097\/MPG.0000000000001422","volume":"64","author":"F Famouri","year":"2017","unstructured":"Famouri, F., Shariat, Z., Hashemipour, M., Keikha, M. & Kelishadi, R. Effects of probiotics on nonalcoholic fatty liver disease in obese children and adolescents. J. Pediatr. Gastroenterol. Nutr. 64(3), 413\u2013417. https:\/\/doi.org\/10.1097\/MPG.0000000000001422 (2017).","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"issue":"7","key":"54652_CR21","doi-asserted-by":"publisher","first-page":"1118","DOI":"10.1038\/ijo.2015.40","volume":"39","author":"A Miccheli","year":"2015","unstructured":"Miccheli, A. et al. Urinary 1H-NMR-based metabolic profiling of children with NAFLD undergoing VSL# 3 treatment. Int. J. Obes. 39(7), 1118\u20131125. https:\/\/doi.org\/10.1038\/ijo.2015.40 (2015).","journal-title":"Int. J. Obes."},{"key":"54652_CR22","doi-asserted-by":"publisher","DOI":"10.3389\/fnut.2022.880014","volume":"9","author":"S Kanchanasurakit","year":"2022","unstructured":"Kanchanasurakit, S. et al. Effects of synbiotics, probiotics, and prebiotics on liver enzymes of patients with non-alcoholic fatty liver disease: A systematic review and network meta-analysis. Front. Nutr. 9, 880014. https:\/\/doi.org\/10.3389\/fnut.2022.880014 (2022).","journal-title":"Front. Nutr."},{"key":"54652_CR23","doi-asserted-by":"publisher","DOI":"10.1093\/nutrit\/nuz001","volume":"77","author":"E Suzumura","year":"2019","unstructured":"Suzumura, E. et al. Effects of oral supplementation with probiotics or synbiotics in overweight and obese adults: A systematic review and meta-analyses of randomized trials. Nutr. Rev. 77, 430. https:\/\/doi.org\/10.1093\/nutrit\/nuz001 (2019).","journal-title":"Nutr. Rev."},{"key":"54652_CR24","doi-asserted-by":"publisher","first-page":"584","DOI":"10.1080\/10408398.2018.1545218","volume":"60","author":"A Hadi","year":"2018","unstructured":"Hadi, A., Alizadeh, K., Hajianfar, H., Mohammadi, H. & Miraghajani, M. Efficacy of synbiotic supplementation in obesity treatment: A systematic review and meta-analysis of clinical trials. Crit. Rev. Food Sci. Nutr. 60, 584\u2013596. https:\/\/doi.org\/10.1080\/10408398.2018.1545218 (2018).","journal-title":"Crit. Rev. Food Sci. Nutr."},{"key":"54652_CR25","doi-asserted-by":"publisher","DOI":"10.3390\/foods12234308","author":"C Deng","year":"2023","unstructured":"Deng, C., Pan, J., Zhu, H. & Chen, Z.-Y. Effect of gut microbiota on blood cholesterol: A review on mechanisms. Foods. https:\/\/doi.org\/10.3390\/foods12234308 (2023)."},{"key":"54652_CR26","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0178868","author":"Y Wu","year":"2017","unstructured":"Wu, Y., Zhang, Q., Ren, Y. & Ruan, Z. Effect of probiotic Lactobacillus on lipid profile: A systematic review and meta-analysis of randomized, controlled trials. PLoS ONE https:\/\/doi.org\/10.1371\/journal.pone.0178868 (2017).","journal-title":"PLoS ONE"},{"issue":"3","key":"54652_CR27","doi-asserted-by":"publisher","first-page":"e31","DOI":"10.1097\/MPG.0000000000003537","volume":"75","author":"\u039d Gkiourtzis","year":"2022","unstructured":"Gkiourtzis, \u039d et al. The benefit of probiotics in pediatric nonalcoholic fatty liver disease: A meta-analysis of randomized control trials. J. Pediatr. Gastroenterol. Nutr. 75(3), e31\u2013e37. https:\/\/doi.org\/10.1097\/MPG.0000000000003537 (2022).","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"issue":"1","key":"54652_CR28","doi-asserted-by":"publisher","DOI":"10.1155\/2019\/1484598","volume":"2019","author":"M-W Xiao","year":"2019","unstructured":"Xiao, M.-W., Lin, S.-X., Shen, Z.-H., Luo, W.-W. & Wang, X.-Y. Systematic review with meta\u2010analysis: The effects of probiotics in nonalcoholic fatty liver disease. Gastroenterol. Res. Pract. 2019(1), 1484598. https:\/\/doi.org\/10.1155\/2019\/1484598 (2019).","journal-title":"Gastroenterol. Res. Pract."},{"key":"54652_CR29","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhepr.2021.100321","author":"A Laschtowitz","year":"2021","unstructured":"Laschtowitz, A. et al. Histological activity despite normal ALT and IgG serum levels in patients with autoimmune hepatitis and cirrhosis. JHEP Rep. https:\/\/doi.org\/10.1016\/j.jhepr.2021.100321 (2021).","journal-title":"JHEP Rep."},{"key":"54652_CR30","doi-asserted-by":"publisher","first-page":"993","DOI":"10.1038\/ajg.2015.139","volume":"110","author":"H Dhaliwal","year":"2015","unstructured":"Dhaliwal, H. et al. Long-term prognostic significance of persisting histological activity despite biochemical remission in Autoimmune Hepatitis. Am. J. Gastroenterol. 110, 993\u2013999. https:\/\/doi.org\/10.1038\/ajg.2015.139 (2015).","journal-title":"Am. J. Gastroenterol."},{"key":"54652_CR31","doi-asserted-by":"publisher","DOI":"10.20517\/mtod.2021.05","author":"S Ballestri","year":"2021","unstructured":"Ballestri, S., Mantovani, A., Byrne, C., Lonardo, A. & Targher, G. Diagnostic accuracy of ultrasonography for the detection of hepatic steatosis: An updated meta-analysis of observational studies. Metab. Target Organ Damage. https:\/\/doi.org\/10.20517\/mtod.2021.05 (2021).","journal-title":"Metab. Target Organ Damage."},{"key":"54652_CR32","doi-asserted-by":"publisher","DOI":"10.3389\/fnut.2025.1637071","author":"W Bahitham","year":"2025","unstructured":"Bahitham, W. et al. \u201cTrust your gut\u201d: Exploring the connection between gut microbiome dysbiosis and the advancement of metabolic associated steatosis liver disease (MASLD)\/metabolic associated steatohepatitis (MASH): A systematic review of animal and human studies. Front. Nutr. https:\/\/doi.org\/10.3389\/fnut.2025.1637071 (2025).","journal-title":"Front. Nutr."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-54652-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-54652-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-54652-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T09:42:21Z","timestamp":1785750141000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-54652-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,25]]},"references-count":32,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["54652"],"URL":"https:\/\/doi.org\/10.1038\/s41598-026-54652-4","relation":{"references":[{"id-type":"doi","id":"10.3390\/foods12234308","asserted-by":"subject"}]},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,25]]},"assertion":[{"value":"18 October 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"23808"}}