{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T07:31:32Z","timestamp":1792222292567,"version":"4.4.0"},"reference-count":60,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T00:00:00Z","timestamp":1764201600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Ischemic heart disease (IHD) and type 2 diabetes mellitus (T2DM) are leading causes of disability-adjusted life years globally among adults aged 55 years and older. Although both diseases share common risk factors and pathophysiological pathways, previous research has predominantly addressed these conditions in isolation. The co-occurrence patterns and regional variations of IHD and T2DM burden remain poorly understood. We aimed to characterize the global co-occurrence patterns of IHD and T2DM from a spatial perspective and to identify the corresponding risk factors distinguishing different burden regions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 database, we extracted age-standardized disability-adjusted life year (DALY) rates for IHD and T2DM among individuals aged 55 years and older from 204 countries and territories. Based on quartile distributions of global DALY rates for both diseases, we classified countries into four distinct burden regions: Low-Burden Regions (56 countries), T2DM-Dominant Regions (46 countries), IHD-Dominant Regions (46 countries), and Dual-Burden Regions (56 countries). We examined temporal trends from 1990-2021, computed population attributable fractions for major risk factors, and used machine learning-based SHAP (Shapley Additive Explanations) analysis to screen and quantify the effects of corresponding risk factors distinguishing regional classifications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Dual-Burden Regions were distributed across multiple geographic areas including the Caribbean and Central America, Persian Gulf states, Balkan Peninsula, Southeast Asia, West Africa, Eastern Mediterranean, and Northern Europe. The spatial distribution revealed distinct geographic clustering, with higher IHD rates in Eastern Europe and Central Asia, and elevated T2DM rates in Pacific Island nations and parts of the Middle East. Countries and territories with the highest burden for both diseases included North African countries (eg, Morocco: IHD 25,193.1\/100,000 and T2DM 32,197.24\/100,000) and Pacific Island nations such as Fiji exhibiting IHD burden of 24,758.17 per 100,000 and T2DM burden of 32,197.24 per 100,000. Marshall Islands showed IHD burden of 25,107.72\/100,000 and T2DM burden of 22,122.46\/100,000, while Nauru demonstrated the highest IHD burden (39,483.92\/100,000). High systolic blood pressure contributed most to IHD burden globally (49.79%), while high body-mass index dominated T2DM burden (51.89%). Environmental factors demonstrated clear regional gradients, with household air pollution ranging from 4\u00b758% in Low-Burden to 14.43% in Dual-Burden Regions for IHD. High body-mass index contributed 51.89% to T2DM burden globally, with regional variation from 40.61% in IHD-Dominant to 51.36% in Low-Burden Regions. SHAP analysis identified sociodemographic index (SDI2021) as the primary factor distinguishing Low-Burden from Dual-Burden Regions for both IHD (mean |SHAP| = 1.245) and T2DM (mean |SHAP| = 1.317). Diet high in processed meat consistently showed strong discriminatory power across multiple regional comparisons for T2DM (SHAP values 0.923-1.721), while secondhand smoke emerged as a critical differentiator with SHAP values exceeding 1.0 across various regional distinctions. Diet low in vegetables served as a primary differentiator between Low-Burden and T2DM-Dominant Regions (mean |SHAP| = 1.188).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The co-occurrence of IHD and T2DM exhibits pronounced global heterogeneity, with Pacific Island nations and multiple geographic regions including Gulf states, North Africa, and other areas bearing disproportionate dual-burden. Socioeconomic development level fundamentally characterizes dual-burden status, while dietary and environmental factors serve as key regional differentiators. Intervening in modifiable risk factors, particularly processed meat consumption, vegetable intake, and environmental exposures, can fundamentally reduce the global burden of these co-occurring diseases.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2025.1693166","type":"journal-article","created":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T05:13:07Z","timestamp":1764220387000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Co-occurrence patterns and related risk factors of ischemic heart disease and type 2 diabetes in burden of disability-adjusted life years among people aged 55 years and older across 203 countries and territories"],"prefix":"10.3389","volume":"16","author":[{"given":"Yuting","family":"Luo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaohan","family":"Qiu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haozhong","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuwei","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ke","family":"Meng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Gu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Likun","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,11,27]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e072385","DOI":"10.1136\/bmj-2022-072385","article-title":"Global burden of type 2 diabetes in adolescents and young adults, 1990-2019: Systematic analysis of the global burden of disease study 2019","author":"Xie","year":"2022","journal-title":"BMJ"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1093\/eurjpc\/zwae384","article-title":"Temporal trend and attributable risk factors of cardiovascular disease burden for adults 55 years and older in 204 countries\/territories from 1990 to 2021: An analysis for the global burden of disease study 2021","volume":"32","author":"Wang","year":"2025","journal-title":"Eur J Prev Cardiol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1007\/s10840-018-0398-z","article-title":"Arrhythmia care in africa","volume":"56","author":"Adedinsewo","year":"2019","journal-title":"J Interv Card Electrophysiol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"e39079","DOI":"10.7759\/cureus.39079","article-title":"The transformation of the Indian healthcare system","volume":"15","author":"Kumar","year":"2023","journal-title":"Cureus"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(24)00685-8.8","article-title":"Burden of disease scenarios for 204 countries and territories, 2022-2050: A forecasting analysis for the global burden of disease study 2021","volume":"403","year":"2024","journal-title":"Lancet"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)01301-6","article-title":"Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: A systematic analysis for the global burden of disease study 2021","volume":"402","year":"2023","journal-title":"Lancet"},{"key":"B7","doi-asserted-by":"publisher","first-page":"101138","DOI":"10.1016\/j.lanwpc.2024.101138","article-title":"The burden of cardiovascular disease in asia from 2025 to 2050: A forecast analysis for east asia, south asia, south-east asia, central asia, and high-income asia pacific regions","volume":"49","author":"Goh","year":"2024","journal-title":"Lancet Reg Health West Pac"},{"key":"B8","doi-asserted-by":"publisher","first-page":"e120124225603","DOI":"10.2174\/0115733998274323231230131843","article-title":"Number of people with type 2 diabetes mellitus in 2035 and 2050: A modelling study in 188 countries","volume":"21","author":"Guzman-Vilca","year":"2024","journal-title":"Curr Diabetes Rev"},{"key":"B9","unstructured":"Adverse events following COVID-19 mRNA vaccines: A systematic review of cardiovascular complication, thrombosis, and thrombocytopenia"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1080\/14787210.2020.1822737","article-title":"COVID-19 and cardiac injury: Clinical manifestations, biomarkers, mechanisms, diagnosis, treatment, and follow up","volume":"19","author":"Tajbakhsh","year":"2021","journal-title":"Expert Rev Anti Infect Ther"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-med-042220-011857","article-title":"COVID-19 and diabetes","volume":"73","author":"Singh","year":"2022","journal-title":"Annu Rev Med"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab413","article-title":"Lifestyle, cardiometabolic disease, and multimorbidity in a prospective Chinese study","volume":"42","author":"Han","year":"2021","journal-title":"Eur Heart J"},{"key":"B13","doi-asserted-by":"publisher","first-page":"110595","DOI":"10.1016\/j.diabres.2023.110595","article-title":"Examining the causal effect of type 2 diabetes on ischemic heart disease - A longitudinal study with four measurements (1980-2017)","volume":"198","author":"Jans\u00e5ker","year":"2023","journal-title":"Diabetes Res Clin Pract"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000766","article-title":"Clinical management of stable coronary artery disease in patients with type 2 diabetes mellitus: A scientific statement from the american heart association","volume":"141","author":"Arnold","year":"2020","journal-title":"Circulation"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1536\/ihj.17-191","article-title":"Coronary artery disease and type 2 diabetes mellitus","volume":"58","author":"Naito","year":"2017","journal-title":"Int Heart J"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1111\/dom.16199","article-title":"Global burden, trends and inequalities for ischaemic heart disease attributable to high fasting plasma glucose, high low-density lipoprotein cholesterol and high systolic blood pressure, 1990-2021: An analysis of the Global Burden of Disease Study 2021","volume":"27","author":"An","year":"2025","journal-title":"Diabetes Obes Metab"},{"key":"B17","unstructured":"Causal effect of the triglyceride-glucose index and the joint exposure of higher glucose and triglyceride with extensive cardio-cerebrovascular metabolic outcomes in the UK biobank: A mendelian randomization study\n          \n          33553250"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)31992-5","article-title":"NCD Countdown 2030: worldwide trends in non-communicable disease mortality and progress towards Sustainable Development Goal target 3.4","volume":"392","year":"2018","journal-title":"Lancet"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-022-01990-1","article-title":"The Global Burden of Disease Study at 30 years","volume":"28","author":"Murray","year":"2022","journal-title":"Nat Med"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1016\/S2542-5196(22)00122-X","article-title":"Estimates, trends, and drivers of the global burden of type 2 diabetes attributable to PM2\u00b75 air pollution, 1990-2019: an analysis of data from the Global Burden of Disease Study 2019","volume":"6","year":"2022","journal-title":"Lancet Planet Health"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(25)00013-0","article-title":"Co-occurrence patterns and related risk factors of ischaemic heart disease and ischaemic stroke across 203 countries and territories: A spatial correspondence and systematic analysis","volume":"13","author":"An","year":"2025","journal-title":"Lancet Global Health"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-2667(21)00249-8","article-title":"Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019","volume":"7","year":"2022","journal-title":"Lancet Public Health"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30752-2","article-title":"Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019","volume":"396","year":"2020","journal-title":"Lancet"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(21)00395-3","article-title":"Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019","volume":"9","year":"2022","journal-title":"Lancet Psychiatry"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(23)00361-3","article-title":"Air pollution exposure and cardiometabolic risk","volume":"12","author":"Rajagopalan","year":"2024","journal-title":"Lancet Diabetes Endocrinol"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1002\/hec.4678","article-title":"Economic uncertainty and cardiovascular disease mortality","volume":"32","author":"Kawachi","year":"2023","journal-title":"Health Econ"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)32656-8","article-title":"6-month consequences of COVID-19 in patients discharged from hospital: a cohort study","volume":"397","author":"Huang","year":"2021","journal-title":"Lancet"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)31992-5","article-title":"NCD Countdown 2030: worldwide trends in non-communicable disease mortality and progress towards Sustainable Development Goal target 3.4","volume":"392","year":"2018","journal-title":"Lancet"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000766","article-title":"Clinical management of stable coronary artery disease in patients with type 2 diabetes mellitus: A scientific statement from the american heart association","volume":"141","author":"Arnold","year":"2020","journal-title":"Circulation"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2022.03.353","article-title":"Sodium glucose cotransporter-2 inhibition for acute myocardial infarction: JACC review topic of the week","volume":"79","author":"Udell","year":"2022","journal-title":"J Am Coll Cardiol"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1161\/ATVBAHA.116.306256","article-title":"Pathology of human coronary and carotid artery atherosclerosis and vascular calcification in diabetes mellitus","volume":"37","author":"Yahagi","year":"2017","journal-title":"Arterioscler Thromb Vasc Biol"},{"key":"B32","doi-asserted-by":"publisher","first-page":"85","DOI":"10.3390\/nu1101008","article-title":"The Role of Nutrients in Reducing the Risk for Noncommunicable Diseases during Aging","volume":"11","author":"Bruins","year":"2019","journal-title":"Nutrients"},{"key":"B33","doi-asserted-by":"publisher","first-page":"759","DOI":"10.1016\/j.cgh.2016.07.020","article-title":"Direct and indirect economic burden of chronic liver disease in the United States","volume":"15","author":"Stepanova","year":"2017","journal-title":"Clin Gastroenterol Hepatol"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.17269\/cjph.106.5214","article-title":"Reducing the economic burden of chronic disease requires major investment in public health","volume":"106","author":"Raine","year":"2015","journal-title":"Can J Public Health"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1007\/s10389-020-01371-3","article-title":"Post-COVID-19 precautions based on lessons learned from past pandemics: a review","volume":"30","author":"Munnoli","year":"2022","journal-title":"Z Gesundh Wiss"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)01787-6","article-title":"The 2021 report of the Lancet Countdown on health and climate change: code red for a healthy future","volume":"398","author":"Romanello","year":"2021","journal-title":"Lancet"},{"key":"B37","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1016\/j.zefq.2020.07.008","article-title":"Climate change: Causes, consequences, solutions and public health care implications","author":"Nikendei","year":"2020","journal-title":"Z Evid Fortbild Qual Gesundhwes"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1016\/j.cub.2019.08.042","article-title":"Climate change, human impacts, and coastal ecosystems in the anthropocene","volume":"29","author":"He","year":"2019","journal-title":"Curr Biol"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1111\/nyas.13950","article-title":"Impact of recent and future climate change on vector-borne diseases","volume":"1436","author":"Caminade","year":"2019","journal-title":"Ann N Y Acad Sci"},{"key":"B40","doi-asserted-by":"publisher","first-page":"114709","DOI":"10.1016\/j.envres.2022.114709","article-title":"Climate change and health care facilities: A risk analysis framework through a mapping review","volume":"216","author":"Guihenneuc","year":"2023","journal-title":"Environ Res"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1093\/abm\/kaaa044","article-title":"Loneliness, social isolation, and chronic disease outcomes","volume":"55","author":"Christiansen","year":"2021","journal-title":"Ann Behav Med"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2023.2309","article-title":"Association of early-, middle-, and late-life depression with incident dementia in a danish cohort","volume":"80","author":"Elser","year":"2023","journal-title":"JAMA Neurol"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.1016\/S2542-5196(22)00090-0","article-title":"Pollution and health: a progress update","volume":"6","author":"Fuller","year":"2022","journal-title":"Lancet Planet Health"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(24)01822-1","article-title":"The 2024 report of the Lancet Countdown on health and climate change: facing record-breaking threats from delayed action","volume":"404","author":"Romanello","year":"2024","journal-title":"Lancet"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)01859-7","article-title":"The 2023 report of the Lancet Countdown on health and climate change: the imperative for a health-centred response in a world facing irreversible harms","volume":"402","author":"Romanello","year":"2023","journal-title":"Lancet"},{"key":"B46","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(22)01540-9","article-title":"The 2022 report of the Lancet Countdown on health and climate change: health at the mercy of fossil fuels","volume":"400","author":"Romanello","year":"2022","journal-title":"Lancet"},{"key":"B47","unstructured":"COP29 reaffirms regional collaboration key to implementing the paris agreement effectively | UNFCCC"},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(22)01540-9","article-title":"The 2022 report of the Lancet Countdown on health and climate change: health at the mercy of fossil fuels","volume":"400","author":"Romanello","year":"2022","journal-title":"Lancet"},{"key":"B49","doi-asserted-by":"publisher","DOI":"10.1016\/j.eehl.2023.10.003","article-title":"Reconsidering gas as clean energy: Switching to electricity for household cooking to reduce NO2-attributed disease burden","volume":"3","author":"Hu","year":"2023","journal-title":"Eco Environ Health"},{"key":"B50","doi-asserted-by":"publisher","first-page":"1226538","DOI":"10.3389\/fnut.2023.1226538","article-title":"Sustainable transformation agenda for enhanced global food and nutrition security: a narrative review","volume":"10","author":"Oluwole","year":"2023","journal-title":"Front Nutr"},{"key":"B51","doi-asserted-by":"publisher","first-page":"2301","DOI":"10.3390\/foods11152301","article-title":"Impacts of the Russia-Ukraine war on global food security: towards more sustainable and resilient food systems","volume":"11","author":"Ben Hassen","year":"2022","journal-title":"Foods"},{"key":"B52","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(24)01822-1","article-title":"The 2024 report of the Lancet Countdown on health and climate change: facing record-breaking threats from delayed action","volume":"404","author":"Romanello","year":"2024","journal-title":"Lancet"},{"key":"B53","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1007\/s11892-019-1201-y","article-title":"Type 2 diabetes mellitus, insulin resistance, and vitamin D","volume":"19","author":"Sacerdote","year":"2019","journal-title":"Curr Diab Rep"},{"key":"B54","doi-asserted-by":"publisher","DOI":"10.1007\/s00592-022-01985-x","article-title":"Prognostic nutritional index as a risk factor for diabetic kidney disease and mortality in patients with type 2 diabetes mellitus","volume":"60","author":"Zhang","year":"2023","journal-title":"Acta Diabetol"},{"key":"B55","unstructured":"The planetary health diet"},{"key":"B56","doi-asserted-by":"publisher","DOI":"10.56781\/ijsrms.2024.4.1.0027","article-title":"Enhancing global food safety standards through international collaboration and policy harmonization","volume":"4","author":"Eruaga","year":"2024","journal-title":"Int J Scholarly Res Multidiscip Stud"},{"key":"B57","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2020.01117","article-title":"Valuing health impacts in climate policy: ethical issues and economic challenges","volume":"39","author":"Scovronick","year":"2020","journal-title":"Health Aff (Millwood)"},{"key":"B58","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-023-02438-w","article-title":"Climate change and health: three grand challenges","volume":"29","author":"Campbell-Lendrum","year":"2023","journal-title":"Nat Med"},{"key":"B59","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2021.11.1351","article-title":"Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) Statement: Updated Reporting Guidance for Health Economic Evaluations","volume":"25","author":"Husereau","year":"2022","journal-title":"Value Health"},{"key":"B60","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-022-01990-1","article-title":"The Global Burden of Disease Study at 30 years","volume":"28","author":"Murray","year":"2022","journal-title":"Nat Med"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2025.1693166\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T05:13:09Z","timestamp":1764220389000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2025.1693166\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,27]]},"references-count":60,"alternative-id":["10.3389\/fendo.2025.1693166"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2025.1693166","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,27]]},"article-number":"1693166"}}