{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T22:06:31Z","timestamp":1793829991976,"version":"4.6.1"},"reference-count":42,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2023,11,15]],"date-time":"2023-11-15T00:00:00Z","timestamp":1700006400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,11,15]],"date-time":"2023-11-15T00:00:00Z","timestamp":1700006400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81770540"],"award-info":[{"award-number":["81770540"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Geriatr"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>This study was to explore the relationship between chronic constipation, chronic diarrhea, and frailty in older Americans.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>This cross-sectional study selected a total of 4241 community-dwelling individuals aged 60\u00a0years and older from the 2005\u20132010 National Health and Nutrition Examination Survey. Frailty was measured using a 49-item frailty index, and a frailty index\u2009&gt;\u20090.21 was defined as a frail status. Chronic constipation and chronic diarrhea were defined as the \u201cusual or most common type of stool\u201d by the Bristol Stool Form Scale (BSFS) Types 1 and 2 and BSFS Types 6 and 7, respectively. Weighted logistic regression analysis was used to examine the relationship between gut health and frailty status. Restricted cubic spline (RCS) curves were built to assess the association between frailty index and stool frequency.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Frailty status was associated with higher odds of constipation in an unadjusted model; however, after further adjusting for confounding variables, the relationship between frailty status and constipation was not statistically significant. We discovered a positive correlation between the frailty status and diarrhea after adjustment for all variables. The frailty index showed a U-shaped relationship with stool frequency, and the frailty index was the smallest at a frequency of 10 stools\/week.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Negative associations were observed between frailty status and chronic constipation and diarrhea among older adults. Older adults who have a bowel movement frequency of about 10 times per week are the least frail. Future studies are warranted to confirm the causal relationship in this association.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12877-023-04438-4","type":"journal-article","created":{"date-parts":[[2023,11,15]],"date-time":"2023-11-15T12:02:50Z","timestamp":1700049770000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":33,"title":["Association between frailty and chronic constipation and chronic diarrhea among American older adults: National Health and Nutrition Examination Survey"],"prefix":"10.1186","volume":"23","author":[{"given":"Xuna","family":"Liu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiwen","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Shen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yating","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beibei","family":"Zeng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boxu","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei","family":"Dai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,11,15]]},"reference":[{"key":"4438_CR1","doi-asserted-by":"publisher","first-page":"1365","DOI":"10.1016\/S0140-6736(19)31786-6","volume":"394","author":"EO Hoogendijk","year":"2019","unstructured":"Hoogendijk EO, Afilalo J, Ensrud KE, Kowal P, Onder G, Fried LP. Frailty: implications for clinical practice and public health. The Lancet. 2019;394:1365\u201375.","journal-title":"The Lancet"},{"key":"4438_CR2","doi-asserted-by":"publisher","first-page":"1376","DOI":"10.1016\/S0140-6736(19)31785-4","volume":"394","author":"E Dent","year":"2019","unstructured":"Dent E, Martin FC, Bergman H, Woo J, Romero-Ortuno R, Walston JD. Management of frailty: opportunities, challenges, and future directions. The Lancet. 2019;394:1376\u201386.","journal-title":"The Lancet"},{"key":"4438_CR3","first-page":"383","volume":"46","author":"MTE Puts","year":"2017","unstructured":"Puts MTE, Toubasi S, Andrew MK, Ashe MC, Ploeg J, Atkinson E, et al. Interventions to prevent or reduce the level of frailty in community-dwelling older adults: a scoping review of the literature and international policies. Age Ageing. 2017;46:383\u201392.","journal-title":"Age Ageing"},{"key":"4438_CR4","doi-asserted-by":"publisher","first-page":"M146","DOI":"10.1093\/gerona\/56.3.M146","volume":"56","author":"LP Fried","year":"2001","unstructured":"Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146-156.","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"4438_CR5","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1503\/cmaj.050051","volume":"173","author":"K Rockwood","year":"2005","unstructured":"Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173:489\u201395.","journal-title":"CMAJ"},{"key":"4438_CR6","doi-asserted-by":"publisher","first-page":"e43749","DOI":"10.1371\/journal.pone.0043749","volume":"7","author":"Y-F Zhao","year":"2012","unstructured":"Zhao Y-F, Guo X-J, Zhang Z-S, Ma X-Q, Wang R, Yan X-Y, et al. Epidemiology of functional diarrhea and comparison with diarrhea-predominant irritable bowel syndrome: a population-based survey in China. PLoS One. 2012;7:e43749.","journal-title":"PLoS One"},{"key":"4438_CR7","doi-asserted-by":"publisher","first-page":"1521","DOI":"10.1111\/j.1365-2036.2007.03540.x","volume":"26","author":"RS Choung","year":"2007","unstructured":"Choung RS, Locke GR, Schleck CD, Zinsmeister AR, Talley NJ. Cumulative incidence of chronic constipation: a population-based study 1988\u20132003. Aliment Pharmacol Ther. 2007;26:1521\u20138.","journal-title":"Aliment Pharmacol Ther"},{"key":"4438_CR8","doi-asserted-by":"publisher","first-page":"e183","DOI":"10.1111\/jgs.14521","volume":"64","author":"UU Andy","year":"2016","unstructured":"Andy UU, Vaughan CP, Burgio KL, Alli FM, Goode PS, Markland AD. Shared risk factors for constipation, fecal incontinence, and combined symptoms in older U. S. Adults. J Am Geriatr Soc. 2016;64:e183-8.","journal-title":"J Am Geriatr Soc"},{"key":"4438_CR9","doi-asserted-by":"publisher","first-page":"593","DOI":"10.1038\/ajg.2018.24","volume":"113","author":"P Singh","year":"2018","unstructured":"Singh P, Mitsuhashi S, Ballou S, Rangan V, Sommers T, Cheng V, et al. Demographic and dietary associations of chronic diarrhea in a representative sample of adults in the United States. Am J Gastroenterol. 2018;113:593\u2013600.","journal-title":"Am J Gastroenterol"},{"key":"4438_CR10","doi-asserted-by":"publisher","first-page":"873","DOI":"10.1016\/S2468-1253(19)30199-2","volume":"4","author":"LR Schiller","year":"2019","unstructured":"Schiller LR. Chronic constipation: new insights, better outcomes? Lancet Gastroenterol Hepatol. 2019;4:873\u201382.","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"4438_CR11","doi-asserted-by":"publisher","first-page":"1675","DOI":"10.1016\/S0140-6736(20)31548-8","volume":"396","author":"AC Ford","year":"2020","unstructured":"Ford AC, Sperber AD, Corsetti M, Camilleri M. Irritable bowel syndrome. The Lancet. 2020;396:1675\u201388.","journal-title":"The Lancet"},{"issue":"13","key":"4438_CR12","doi-asserted-by":"publisher","first-page":"2696","DOI":"10.1016\/j.cgh.2019.03.046","volume":"17","author":"S Ballou","year":"2019","unstructured":"Ballou S, Katon J, Singh P, Rangan V, Lee HN, McMahon C, et al. Chronic diarrhea and constipation are more common in depressed individuals. Clin Gastroenterol Hepatol. 2019;17(13):2696\u2013703.","journal-title":"Clin Gastroenterol Hepatol"},{"key":"4438_CR13","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1016\/j.cgh.2016.07.028","volume":"15","author":"LR Schiller","year":"2017","unstructured":"Schiller LR, Pardi DS, Sellin JH. Chronic diarrhea: diagnosis and management. Clin Gastroenterol Hepatol. 2017;15:182-193.e3.","journal-title":"Clin Gastroenterol Hepatol"},{"key":"4438_CR14","doi-asserted-by":"publisher","first-page":"101744","DOI":"10.1016\/j.arr.2022.101744","volume":"82","author":"NH Rashidah","year":"2022","unstructured":"Rashidah NH, Lim SM, Neoh CF, Majeed ABA, Tan MP, Khor HM, et al. Differential gut microbiota and intestinal permeability between frail and healthy older adults: A systematic review. Ageing Res Rev. 2022;82:101744.","journal-title":"Ageing Res Rev"},{"key":"4438_CR15","doi-asserted-by":"publisher","first-page":"481","DOI":"10.1016\/j.gtc.2009.06.008","volume":"38","author":"LR Schiller","year":"2009","unstructured":"Schiller LR. Diarrhea and malabsorption in the elderly. Gastroenterol Clin North Am. 2009;38:481\u2013502.","journal-title":"Gastroenterol Clin North Am"},{"key":"4438_CR16","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1159\/000517212","volume":"68","author":"S Arco","year":"2022","unstructured":"Arco S, Salda\u00f1a E, Serra-Prat M, Palomera E, Ribas Y, Font S, et al. Functional constipation in older adults: prevalence, clinical symptoms and subtypes, association with frailty, and impact on quality of life. Gerontology. 2022;68:397\u2013406.","journal-title":"Gerontology"},{"key":"4438_CR17","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1186\/s12876-021-01684-x","volume":"21","author":"J Lim","year":"2021","unstructured":"Lim J, Park H, Lee H, Lee E, Lee D, Jung H-W, et al. Higher frailty burden in older adults with chronic constipation. BMC Gastroenterol. 2021;21:137.","journal-title":"BMC Gastroenterol"},{"key":"4438_CR18","doi-asserted-by":"publisher","first-page":"1677","DOI":"10.2169\/internalmedicine.4399-19","volume":"59","author":"D Asaoka","year":"2020","unstructured":"Asaoka D, Takeda T, Inami Y, Abe D, Shimada Y, Matsumoto K, et al. The association between frailty and abdominal symptoms: a hospital-based cross-sectional study. Intern Med. 2020;59:1677\u201385.","journal-title":"Intern Med"},{"key":"4438_CR19","doi-asserted-by":"publisher","first-page":"3205","DOI":"10.1007\/s12011-020-02451-x","volume":"199","author":"C Wang","year":"2021","unstructured":"Wang C, Zhang L, Li L. Association between selenium intake with chronic constipation and chronic diarrhea in adults: findings from the national health and nutrition examination survey. Biol Trace Elem Res. 2021;199:3205\u201312.","journal-title":"Biol Trace Elem Res"},{"key":"4438_CR20","doi-asserted-by":"publisher","first-page":"559","DOI":"10.1016\/j.jamda.2020.07.023","volume":"22","author":"FF Hakeem","year":"2021","unstructured":"Hakeem FF, Bernab\u00e9 E, Sabbah W. Association between oral health and frailty among american older adults. J Am Med Dir Assoc. 2021;22:559-563.e2.","journal-title":"J Am Med Dir Assoc"},{"key":"4438_CR21","doi-asserted-by":"publisher","first-page":"464","DOI":"10.1016\/j.archger.2015.01.016","volume":"60","author":"J Blodgett","year":"2015","unstructured":"Blodgett J, Theou O, Kirkland S, Andreou P, Rockwood K. Frailty in NHANES: Comparing the frailty index and phenotype. Arch Gerontol Geriatr. 2015;60:464\u201370.","journal-title":"Arch Gerontol Geriatr"},{"key":"4438_CR22","doi-asserted-by":"publisher","first-page":"1971","DOI":"10.1186\/s12889-022-14360-w","volume":"22","author":"Q Liu","year":"2022","unstructured":"Liu Q, Kang Y, Yan J. Association between overall dietary quality and constipation in American adults: a cross-sectional study. BMC Public Health. 2022;22:1971.","journal-title":"BMC Public Health"},{"key":"4438_CR23","doi-asserted-by":"publisher","first-page":"823987","DOI":"10.3389\/fpubh.2022.823987","volume":"10","author":"X Du","year":"2022","unstructured":"Du X, Liu S, Jia P, Wang X, Gan J, Hu W, et al. Epidemiology of constipation in elderly people in parts of China: a multicenter study. Front Public Health. 2022;10:823987.","journal-title":"Front Public Health"},{"key":"4438_CR24","doi-asserted-by":"publisher","first-page":"938","DOI":"10.1111\/j.1365-2036.2010.04273.x","volume":"31","author":"J Belsey","year":"2010","unstructured":"Belsey J, Greenfield S, Candy D, Geraint M. Systematic review: impact of constipation on quality of life in adults and children. Aliment Pharmacol Ther. 2010;31:938\u201349.","journal-title":"Aliment Pharmacol Ther"},{"key":"4438_CR25","doi-asserted-by":"publisher","first-page":"797","DOI":"10.1080\/00365521.2018.1473485","volume":"53","author":"MP Dore","year":"2018","unstructured":"Dore MP, Pes GM, Bibb\u00f2 S, Tedde P, Bassotti G. Constipation in the elderly from Northern Sardinia is positively associated with depression, malnutrition and female gender. Scand J Gastroenterol. 2018;53:797\u2013802.","journal-title":"Scand J Gastroenterol"},{"key":"4438_CR26","doi-asserted-by":"publisher","first-page":"507","DOI":"10.3945\/an.115.011254","volume":"7","author":"NC F\u00e1varo-Moreira","year":"2016","unstructured":"F\u00e1varo-Moreira NC, Krausch-Hofmann S, Matthys C, Vereecken C, Vanhauwaert E, Declercq A, et al. Risk factors for malnutrition in older adults: a systematic review of the literature based on longitudinal data. Adv Nutr. 2016;7:507\u201322.","journal-title":"Adv Nutr"},{"key":"4438_CR27","doi-asserted-by":"publisher","first-page":"eaap8914","DOI":"10.1126\/scitranslmed.aap8914","volume":"10","author":"A Vich Vila","year":"2018","unstructured":"Vich Vila A, Imhann F, Collij V, Jankipersadsing SA, Gurry T, Mujagic Z, et al. Gut microbiota composition and functional changes in inflammatory bowel disease and irritable bowel syndrome. Sci Transl Med. 2018;10:eaap8914.","journal-title":"Sci Transl Med"},{"key":"4438_CR28","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1038\/s41572-021-00273-2","volume":"7","author":"KE Burke","year":"2021","unstructured":"Burke KE, D\u2019Amato M, Ng SC, Pardi DS, Ludvigsson JF, Khalili H. Microscopic colitis. Nat Rev Dis Primers. 2021;7:39.","journal-title":"Nat Rev Dis Primers"},{"key":"4438_CR29","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1007\/s00535-011-0379-9","volume":"46","author":"AC Ford","year":"2011","unstructured":"Ford AC, Talley NJ. Mucosal inflammation as a potential etiological factor in irritable bowel syndrome: a systematic review. J Gastroenterol. 2011;46:421\u201331.","journal-title":"J Gastroenterol"},{"key":"4438_CR30","doi-asserted-by":"publisher","first-page":"752","DOI":"10.1016\/S0140-6736(12)62167-9","volume":"381","author":"A Clegg","year":"2013","unstructured":"Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. The Lancet. 2013;381:752\u201362.","journal-title":"The Lancet"},{"key":"4438_CR31","doi-asserted-by":"publisher","unstructured":"Greenberg AL, Tolstykh IV, Van Loon K, Laffan A, Stanfield D, Steiding P, et al. Association between adherence to the American Cancer Society Nutrition and Physical Activity Guidelines and stool frequency among colon cancer survivors: a cohort study. J Cancer Surviv. 2022. https:\/\/doi.org\/10.1007\/s11764-022-01288-8.","DOI":"10.1007\/s11764-022-01288-8"},{"key":"4438_CR32","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdiacomp.2020.107751","volume":"35","author":"T Ohkuma","year":"2021","unstructured":"Ohkuma T, Iwase M, Fujii H, Ide H, Komorita Y, Yoshinari M, et al. Defecation frequency and glycemic control in patients with diabetes: The Fukuoka Diabetes Registry. J Diabetes Complications. 2021;35: 107751.","journal-title":"J Diabetes Complications"},{"key":"4438_CR33","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1016\/j.atherosclerosis.2016.01.007","volume":"246","author":"K Honkura","year":"2016","unstructured":"Honkura K, Tomata Y, Sugiyama K, Kaiho Y, Watanabe T, Zhang S, et al. Defecation frequency and cardiovascular disease mortality in Japan: The Ohsaki cohort study. Atherosclerosis. 2016;246:251\u20136.","journal-title":"Atherosclerosis"},{"key":"4438_CR34","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1186\/s12916-021-01918-5","volume":"19","author":"K Jayanama","year":"2021","unstructured":"Jayanama K, Theou O, Godin J, Cahill L, Shivappa N, H\u00e9bert JR, et al. Relationship between diet quality scores and the risk of frailty and mortality in adults across a wide age spectrum. BMC Med. 2021;19:64.","journal-title":"BMC Med"},{"key":"4438_CR35","doi-asserted-by":"publisher","first-page":"877","DOI":"10.1093\/ajcn\/nqaa028","volume":"111","author":"EA Struijk","year":"2020","unstructured":"Struijk EA, Hagan KA, Fung TT, Hu FB, Rodr\u00edguez-Artalejo F, Lopez-Garcia E. Diet quality and risk of frailty among older women in the Nurses\u2019 Health Study. Am J Clin Nutr. 2020;111:877\u201383.","journal-title":"Am J Clin Nutr"},{"key":"4438_CR36","doi-asserted-by":"publisher","first-page":"523","DOI":"10.1002\/jcsm.12192","volume":"8","author":"JE Morley","year":"2017","unstructured":"Morley JE. Anorexia of ageing: a key component in the pathogenesis of both sarcopenia and cachexia. J Cachexia Sarcopenia Muscle. 2017;8:523\u20136.","journal-title":"J Cachexia Sarcopenia Muscle"},{"key":"4438_CR37","doi-asserted-by":"publisher","first-page":"2581","DOI":"10.3390\/nu14132581","volume":"14","author":"M Kostecka","year":"2022","unstructured":"Kostecka M, Kostecka-Jarecka J, I\u0142owiecka K, Kostecka J. An Evaluation of nutritional status and problems with dietary compliance in Polish patients with celiac disease. Nutrients. 2022;14:2581.","journal-title":"Nutrients"},{"key":"4438_CR38","doi-asserted-by":"publisher","first-page":"17","DOI":"10.3945\/an.116.013474","volume":"8","author":"J Shlisky","year":"2017","unstructured":"Shlisky J, Bloom DE, Beaudreault AR, Tucker KL, Keller HH, Freund-Levi Y, et al. Nutritional considerations for healthy aging and reduction in age-related chronic disease. Adv Nutr. 2017;8:17\u201326.","journal-title":"Adv Nutr"},{"key":"4438_CR39","doi-asserted-by":"publisher","first-page":"483","DOI":"10.3390\/nu14030483","volume":"14","author":"M Romani","year":"2022","unstructured":"Romani M, Berger MM, D\u2019Amelio P. From the bench to the bedside: Branched amino acid and micronutrient strategies to improve mitochondrial dysfunction leading to sarcopenia. Nutrients. 2022;14:483.","journal-title":"Nutrients"},{"key":"4438_CR40","doi-asserted-by":"crossref","unstructured":"Wu AH, Setiawan VW, Stram DO, Crimmins EM, Tseng C-C, Lim U, et al. Racial, ethnic, and socioeconomic differences in a deficit accumulation frailty index in the Multiethnic Cohort Study. J Gerontol A. 2022:glac216.","DOI":"10.1093\/gerona\/glac216"},{"key":"4438_CR41","doi-asserted-by":"publisher","first-page":"902599","DOI":"10.3389\/fpubh.2022.902599","volume":"10","author":"Q Xu","year":"2022","unstructured":"Xu Q, Ou X, Li J. The risk of falls among the aging population: A systematic review and meta-analysis. Front Public Health. 2022;10:902599.","journal-title":"Front Public Health"},{"issue":"11","key":"4438_CR42","doi-asserted-by":"publisher","first-page":"2041","DOI":"10.1111\/acer.14941","volume":"46","author":"DE Levitt","year":"2022","unstructured":"Levitt DE, Simon L, Lin H-Y, Siggins RW, Ferguson TF, Molina PE, et al. Alcohol use, physical activity, and muscle strength moderate the relationship between body composition and frailty risk among people living with HIV. Alcohol Clin Exp Res. 2022;46(11):2041\u201353. https:\/\/doi.org\/10.1111\/acer.14941.","journal-title":"Alcohol Clin Exp Res"}],"container-title":["BMC Geriatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12877-023-04438-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12877-023-04438-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12877-023-04438-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,15]],"date-time":"2023-11-15T12:03:20Z","timestamp":1700049800000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcgeriatr.biomedcentral.com\/articles\/10.1186\/s12877-023-04438-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,15]]},"references-count":42,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["4438"],"URL":"https:\/\/doi.org\/10.1186\/s12877-023-04438-4","relation":{},"ISSN":["1471-2318"],"issn-type":[{"value":"1471-2318","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,15]]},"assertion":[{"value":"8 February 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 October 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 November 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Approval of this study was obtained from the ethics review board of the National Center for Health Statistics. All participants gave written informed consent. The experimental protocol was established according to the ethical guidelines of the Declaration of Helsinki.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"745"}}