{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T23:40:52Z","timestamp":1789342852117,"version":"build-2803163510"},"reference-count":60,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T00:00:00Z","timestamp":1757894400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Obstructive sleep apnea syndrome (OSAS) and heart failure (HF) frequently coexist, amplifying cardiovascular risk through mechanisms involving chronic inflammation and autonomic dysfunction. This study investigates the impact of systemic inflammation, measured by the systemic immune-inflammation index (SII), and OSAS severity, assessed by the apnea\u2013hypopnea index (AHI), on myocardial repolarization heterogeneity in patients with both conditions. Materials and Methods: In this retrospective study, 160 patients with HF and polysomnography-confirmed OSAS (AHI \u2265 5 events\/h) were evaluated between January 2018 and November 2024. Patients were stratified by QT dispersion (QTd &lt; 40 ms vs. \u226540 ms) to assess electrical heterogeneity. SII was calculated from neutrophil, platelet, and lymphocyte counts, and electrocardiographic markers (QTd, frontal QRS-T angle, T wave peak-to-end interval [TPEI]) were measured. Logistic regression and receiver operating characteristic (ROC) analyses were used to identify predictors of repolarization heterogeneity and ventricular arrhythmias. Results: Patients with QTd \u2265 40 ms (n = 78) exhibited higher SII (p &lt; 0.001) and AHI (p &lt; 0.001) compared to those with QTd &lt; 40 ms (n = 82). SII and AHI independently predicted increased QTd in multivariate analysis (p = 0.01 and p &lt; 0.001, respectively). ROC analysis identified SII \u2265 625.4 (sensitivity 73.1%, specificity 72%) and AHI \u2265 22.4 (sensitivity 79.5%, specificity 79.3%) as optimal cut-offs for predicting repolarization heterogeneity. SII, QTd, and TPEI were significantly associated with ventricular arrhythmias (p &lt; 0.05). Patients with moderate-to-severe OSAS (AHI \u2265 15) had higher rates of ventricular tachyarrhythmias (17.8% vs. 5.7%, p = 0.03) and sudden cardiac death (9.3% vs. 1.9%, p = 0.05). Conclusions: Elevated SII and AHI are independent predictors of myocardial repolarization heterogeneity in patients with HF and OSAS, contributing to increased arrhythmic risk. These findings highlight the potential use of SII and AHI as accessible biomarkers for risk stratification, particularly in patients with a preserved ejection fraction, and underscore the need for targeted interventions to mitigate inflammation and OSAS severity.<\/jats:p>","DOI":"10.3390\/medicina61091674","type":"journal-article","created":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T11:51:43Z","timestamp":1757937103000},"page":"1674","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Systemic Inflammation and Myocardial Repolarization Heterogeneity in Heart Failure and Obstructive Sleep Apnea: Impact on Arrhythmic Risk"],"prefix":"10.3390","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2231-1526","authenticated-orcid":false,"given":"Emirhan","family":"\u00c7ak\u0131r","sequence":"first","affiliation":[{"name":"Department of Cardiology, School of Medicine, Trakya University, 22030 Edirne, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7552-7654","authenticated-orcid":false,"given":"U\u011fur","family":"\u00d6zkan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, School of Medicine, Trakya University, 22030 Edirne, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4349-5771","authenticated-orcid":false,"given":"\u0130lker","family":"Y\u0131lmam","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, School of Medicine, Trakya University, 22030 Edirne, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Ciuca-Pan\u0103, M.-A., Boulmpou, A., Ileri, C., Manzi, G., Golino, M., Ostojic, M., Galimzhanov, A., Busnatu, S., Mega, S., and Perone, F. (2025). Chronic Heart Failure and Coronary Artery Disease: Pharmacological Treatment and Cardiac Rehabilitation. Medicina, 61.","DOI":"10.3390\/medicina61020211"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"252","DOI":"10.4274\/MMJ.galenos.2023.07455","article-title":"Novel Predictor of the AF Development in Patients with OSAS: Importance of Visceral Adipose Index","volume":"38","author":"Ozkan","year":"2023","journal-title":"Medeni. Med. J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"151","DOI":"10.14503\/THIJ-15-5678","article-title":"Obstructive Sleep Apnea in Heart Failure: Review of Prevalence, Treatment with Continuous Positive Airway Pressure, and Prognosis","volume":"45","author":"Khattak","year":"2018","journal-title":"Tex. Heart Inst. J."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Javaheri, S., and Javaheri, S. (2022). Obstructive Sleep Apnea in Heart Failure: Current Knowledge and Future Directions. J. Clin. Med., 11.","DOI":"10.3390\/jcm11123458"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2101640","DOI":"10.1183\/13993003.01640-2021","article-title":"Sleep apnoea and heart failure","volume":"59","author":"Naughton","year":"2022","journal-title":"Eur. Respir. J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"S4221","DOI":"10.21037\/jtd.2018.12.63","article-title":"Cardiac rhythm disorders in obstructive sleep apnea","volume":"10","author":"Geovanini","year":"2018","journal-title":"J. Thorac. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1007\/s12471-020-01464-4","article-title":"An antiarrhythmic approach to hydroxychloroquine-induced QT prolongation","volume":"28","author":"Yetkin","year":"2020","journal-title":"Neth. Heart J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1136\/heartjnl-2024-324424","article-title":"State-of-the-art analysis of electrocardiogram findings in sudden cardiac death","volume":"111","author":"Asada","year":"2025","journal-title":"Heart"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"106","DOI":"10.4330\/wjc.v15.i3.106","article-title":"Effect of reperfusion strategy on QT dispersion in patients with acute myocardial infarction: Impact on in-hospital arrhythmia","volume":"15","author":"Abdelmegid","year":"2023","journal-title":"World J. Cardiol."},{"key":"ref_10","first-page":"5846","article-title":"Empagliflozin and Dapagliflozin Therapies Favorably Alter QRS-T Angle and Cardiac Repolarization Parameters in Patients with Heart Failure","volume":"15","author":"Nriagu","year":"2024","journal-title":"J. Innov. Card. Rhythm Manag."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1016\/j.hrthm.2017.05.031","article-title":"The T(peak)\u2013T(end) interval as an electrocardiographic risk marker of arrhythmic and mortality outcomes: A systematic review and meta-analysis","volume":"14","author":"Tse","year":"2017","journal-title":"Heart Rhythm"},{"key":"ref_12","first-page":"523","article-title":"2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) with the special contribution of the Heart Failure Association (HFA) of the ESC","volume":"75","author":"McDonagh","year":"2022","journal-title":"Rev. Esp. Cardiol. (Engl. Ed.)"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"\u00d6zkan, U., G\u00fcrdo\u011fan, M., \u00d6zt\u00fcrk, C., Demir, M., Akku\u015f \u00d6., F., Y\u0131lmaz, E., and Altay, S. (2022). Systemic Immune-Inflammation Index: A Novel Predictor of Coronary Thrombus Burden in Patients with Non-ST Acute Coronary Syndrome. Medicina, 58.","DOI":"10.3390\/medicina58020143"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1093\/ejechocard\/jen174","article-title":"European Association of Echocardiography recommendations for standardization of performance, digital storage and reporting of echocardiographic studies","volume":"9","author":"Evangelista","year":"2008","journal-title":"Eur. J. Echocardiogr."},{"key":"ref_15","first-page":"e82846","article-title":"Prognostic Value of QTc Dispersion in Acute Myocardial Infarction","volume":"17","author":"Mohideen","year":"2025","journal-title":"Cureus"},{"key":"ref_16","first-page":"2","article-title":"The National Cholesterol Education Program Adult Treatment Panel III guidelines","volume":"9","author":"Lipsy","year":"2003","journal-title":"J. Manag. Care Pharm."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2643","DOI":"10.1016\/j.tjnut.2025.04.037","article-title":"Amino Acid Associations in Healthy and Unhealthy Obesity","volume":"155","author":"Lim","year":"2025","journal-title":"J. Nutr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"A4115652","DOI":"10.1161\/circ.150.suppl_1.4115652","article-title":"Abstract 4115652: Effect of the sodium-glucose co-transporter 2 inhibitor, Dapagliflozin, on ventricular repolarization electrocardiographic parameters: DAPA-ECG study","volume":"150","author":"Campos","year":"2024","journal-title":"Circulation"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e70148","DOI":"10.1002\/clc.70148","article-title":"KCNQ1 Polymorphism in the Context of Ischemic Cardiomyopathy: A Potential Key to Decision-Making for Device Implantation","volume":"48","author":"Budak","year":"2025","journal-title":"Clin. Cardiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1749","DOI":"10.1016\/S0735-1097(00)00962-1","article-title":"Measurement, interpretation and clinical potential of QT dispersion","volume":"36","author":"Malik","year":"2000","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3075","DOI":"10.1161\/01.CIR.103.25.3075","article-title":"Dispersion of Ventricular Depolarization-Repolarization","volume":"103","author":"Turrini","year":"2001","journal-title":"Circulation"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.ccep.2010.10.012","article-title":"Overview of Basic Mechanisms of Cardiac Arrhythmia","volume":"3","author":"Antzelevitch","year":"2011","journal-title":"Card. Electrophysiol. Clin."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1016\/j.jelectrocard.2013.06.016","article-title":"Electrocardiographic predictors of sudden cardiac death from a large Finnish general population cohort","volume":"46","author":"Aro","year":"2013","journal-title":"J. Electrocardiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"28","DOI":"10.4103\/IJCIIS.IJCIIS_59_17","article-title":"Prevalence and prognostic significance of prolonged QTc interval in emergency medical patients: A prospective observational study","volume":"8","author":"Birda","year":"2018","journal-title":"Int. J. Crit. Illn. Inj. Sci."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1136\/hrt.63.6.342","article-title":"QT dispersion: An indication of arrhythmia risk in patients with long QT intervals","volume":"63","author":"Day","year":"1990","journal-title":"Br. Heart J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2372","DOI":"10.1111\/j.1540-8159.1998.tb01184.x","article-title":"QT interval and QT dispersion measured with the threshold method depend on threshold level","volume":"21","author":"Batchvarov","year":"1998","journal-title":"Pacing Clin. Electrophysiol."},{"key":"ref_27","first-page":"33","article-title":"QT dispersion on ECG Holter monitoring and risk of ventricular arrhythmias in patients with dilated cardiomyopathy","volume":"2","author":"Curnis","year":"2006","journal-title":"Heart Int."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Yalta, K., Yetkin, E., and Yalta, T. (2021). Systemic inflammation in patients with Takotsubo syndrome: A review of mechanistic and clinical implications. Monaldi Arch. Chest Dis., 91.","DOI":"10.4081\/monaldi.2021.1718"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1111\/jce.15898","article-title":"Implantable defibrillator-detected heart failure status predicts ventricular tachyarrhythmias","volume":"34","author":"Compagnucci","year":"2023","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_30","first-page":"233","article-title":"Beyond the Broken Heart: Exploring Metabolic Anti-ischemic Solutions for Takotsubo Syndrome","volume":"39","author":"Yalta","year":"2024","journal-title":"Cardiovasc. Drugs Ther."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e018513","DOI":"10.1161\/JAHA.120.018513","article-title":"QT Interval Dynamics and Cardiovascular Outcomes: A Cohort Study in an Integrated Health Care Delivery System","volume":"10","author":"Mantri","year":"2021","journal-title":"J. Am. Heart Assoc."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1053\/euhj.1997.0865","article-title":"QT interval dispersion as a predictor of arrhythmic events in congestive heart failure. Importance of aetiology","volume":"19","author":"Galinier","year":"1998","journal-title":"Eur. Heart J."},{"key":"ref_33","first-page":"421","article-title":"Takotsubo Syndrome: An International Expert Consensus Report on Practical Challenges and Specific Conditions (Part-1: Diagnostic and Therapeutic Challenges)","volume":"41","author":"Yalta","year":"2024","journal-title":"Balkan Med. J."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1007\/s11325-025-03352-w","article-title":"Cardiovascular diseases and type D personality in patients with obstructive sleep apnea: A prospective cohort study","volume":"29","author":"Schotte","year":"2025","journal-title":"Sleep Breath."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Yatsu, S., Woo, A., Horvath, C.M., Tobushi, T., Logan, A.G., Floras, J.S., Tomlinson, G., and Bradley, T.D. (2025). LV Structure and Function in HFrEF With and Without Peak-Flow-Triggered Adaptive Servo-Ventilation-Treated Sleep-Disordered Breathing. JACC Heart Fail., 102434.","DOI":"10.1016\/j.jchf.2025.02.016"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2279","DOI":"10.2147\/NSS.S494018","article-title":"Association Between Nocturnal Hypoxemia Parameters and Coronary Microvascular Dysfunction: A Cross-Sectional Study","volume":"16","author":"Feng","year":"2024","journal-title":"Nat. Sci. Sleep"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Aromolaran, A.S., Srivastava, U., Al\u00ed, A., Chahine, M., Lazaro, D., El-Sherif, N., Capecchi, P.L., Laghi-Pasini, F., Lazzerini, P.E., and Boutjdir, M. (2018). Interleukin-6 inhibition of hERG underlies risk for acquired long QT in cardiac and systemic inflammation. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0208321"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1134\/S0362119719050207","article-title":"Heart Electrical Activity during Ventricular Repolarization in Subjects with Different Resistances to Hypoxia","volume":"45","author":"Zamenina","year":"2019","journal-title":"Hum. Physiol."},{"key":"ref_39","first-page":"e10424","article-title":"Obstructive Sleep Apnea and Cardiovascular Morbidities: A Review Article","volume":"12","author":"Rana","year":"2020","journal-title":"Cureus"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"106566","DOI":"10.1016\/j.sleep.2025.106566","article-title":"The cardiovascular consequences of chronic sleep fragmentation: Evidence from experimental models of obstructive sleep apnea","volume":"132","author":"Badran","year":"2025","journal-title":"Sleep Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e003666","DOI":"10.1161\/JAHA.116.003666","article-title":"Obstructive Sleep Apnea and Circulating Potassium Channel Levels","volume":"5","author":"Jiang","year":"2016","journal-title":"J. Am. Heart Assoc."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"110358","DOI":"10.1016\/j.exer.2025.110358","article-title":"Chronic intermittent hypoxia modulates corneal fibrotic markers and inflammatory cytokine expression in a sex-dependent manner","volume":"255","author":"Bradshaw","year":"2025","journal-title":"Exp. Eye Res."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Itaya, E.D., Ternes, C.M.P., Maher, T., Fernandes, A.A.D., Rocha, A.V., Wippel, C., Rivera, A., Locke, A.H., and d\u2019Avila, A. (2025). Efficacy of continuous positive airway pressure on atrial fibrillation recurrence after catheter ablation in patients with obstructive sleep apnea: A systematic review and meta-analysis. J. Interv. Card. Electrophysiol.","DOI":"10.1007\/s10840-025-02063-2"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"2206","DOI":"10.1093\/eurheartj\/ehs073","article-title":"The effects of continuous positive airway pressure therapy withdrawal on cardiac repolarization: Data from a randomized controlled trial","volume":"33","author":"Rossi","year":"2012","journal-title":"Eur. Heart J."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1159\/000324796","article-title":"Effect of obstructive sleep apnea on QT dispersion: A potential mechanism of sudden cardiac death","volume":"118","author":"Voigt","year":"2011","journal-title":"Cardiology"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1016\/j.cjco.2022.07.012","article-title":"Arrhythmic Sudden Cardiac Death in Heart Failure with Preserved Ejection Fraction: Mechanisms, Genetics, and Future Directions","volume":"4","author":"Safabakhsh","year":"2022","journal-title":"CJC Open"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"zsae296","DOI":"10.1093\/sleep\/zsae296","article-title":"Mineralocorticoid receptor antagonism prevents coronary microvascular dysfunction in intermittent hypoxia independent of blood pressure","volume":"48","author":"Badran","year":"2024","journal-title":"Sleep"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1080\/14779072.2022.2081547","article-title":"Cardiovascular remodeling in obstructive sleep apnea: Focus on arterial stiffness, left ventricular geometry and atrial fibrillation","volume":"20","author":"Saeed","year":"2022","journal-title":"Expert Rev. Cardiovasc. Ther."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"DiCaro, M.V., Lei, K., Yee, B., and Tak, T. (2024). The Effects of Obstructive Sleep Apnea on the Cardiovascular System: A Comprehensive Review. J. Clin. Med., 13.","DOI":"10.3390\/jcm13113223"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"ehad655.791","DOI":"10.1093\/eurheartj\/ehad655.791","article-title":"Sleep-disordered breathing is associated with fibrosis and impaired diastolic function","volume":"44","author":"Wester","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"319","DOI":"10.33549\/physiolres.930604","article-title":"Effect of systemic hypoxia and reoxygenation on electrical stability of the rat myocardium: Chronophysiological study","volume":"54","author":"Svorc","year":"2005","journal-title":"Physiol. Res."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1016\/j.cardiores.2006.04.014","article-title":"Role of ion channels in acute and chronic responses of the pulmonary vasculature to hypoxia","volume":"71","author":"Weir","year":"2006","journal-title":"Cardiovasc. Res."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1152\/japplphysiol.00510.2023","article-title":"Impaired cardiopulmonary baroreflex function and altered cardiovascular responses to hypovolemia in patients with heart failure with preserved ejection fraction","volume":"136","author":"Alpenglow","year":"2024","journal-title":"J. Appl. Physiol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.sleep.2022.05.846","article-title":"Baroreflex sensitivity during rest and pressor challenges in obstructive sleep apnea patients with and without CPAP","volume":"97","author":"Pal","year":"2022","journal-title":"Sleep Med."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"e24","DOI":"10.15420\/cfr.2022.12","article-title":"Microvascular Dysfunction in Heart Failure with Preserved Ejection Fraction: Pathophysiology, Assessment, Prevalence and Prognosis","volume":"8","author":"Bilak","year":"2022","journal-title":"Card. Fail. Rev."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Pojednic, R., D\u2019Arpino, E., Halliday, I., and Bantham, A. (2022). The Benefits of Physical Activity for People with Obesity, Independent of Weight Loss: A Systematic Review. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19094981"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"e0103","DOI":"10.15275\/rusomj.2022.0103","article-title":"Impact of Obesity on Cardiac Structural and Functional Changes","volume":"11","author":"Podzolkov","year":"2022","journal-title":"Russ. Open Med. J."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"920","DOI":"10.1096\/fj.02-0626fje","article-title":"Molecular and functional analyses of the contractile apparatus in lymphatic muscle","volume":"17","author":"Muthuchamy","year":"2003","journal-title":"FASEB J."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"5749","DOI":"10.1113\/JP272088","article-title":"Lymphatic pumping: Mechanics, mechanisms and malfunction","volume":"594","author":"Scallan","year":"2016","journal-title":"J. Physiol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1002\/oby.22377","article-title":"Metabolically Healthy Obesity and Risk for Atrial Fibrillation: The HUNT Study","volume":"27","author":"Feng","year":"2019","journal-title":"Obes. Soc."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/9\/1674\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:45:48Z","timestamp":1760035548000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/9\/1674"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,15]]},"references-count":60,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["medicina61091674"],"URL":"https:\/\/doi.org\/10.3390\/medicina61091674","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,15]]}}}