{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T19:44:54Z","timestamp":1791229494904,"version":"4.1.0"},"reference-count":47,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:00:00Z","timestamp":1778803200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>Background\/Obejctives: Sarcopenic obesity (SO) has gained growing attention in metabolic dysfunction-associated steatotic liver disease (MASLD), yet data in Caucasian populations remain limited. The aim of this study was to assess the prevalence of SO using different definitions and to explore its relationship with steroid androgens, physical performance and frailty in MASLD individuals. Methods: Two hundred Caucasian patients with MASLD and available dual-energy X-ray absorptiometry (DEXA) data were evaluated. Clinical, biochemical, hormonal and elastography data were recorded, while physical performance was assessed using the Short Physical Performance Battery (SPPB) and Liver Frailty Index (LFI). Results: SO prevalence ranged from 34.5% to 76.5% depending on the definition applied (AIMSO score, body mass index, and body fat percentage-based criteria). Across definitions, SO individuals showed greater hepatic steatosis, more metabolic comorbidities and demonstrated poorer physical performance. Lower dehydroepiandrosterone sulfate (DHEAS) levels were independently associated with SO when the definition is based on total body fat percentage, and waist circumference (WC) was consistently linked to SO across all definitions. Separate analysis based on gender, confirmed that DHEAS was independently associated with SO in men, while WC represented an independent factor associated with SO in both genders. Conclusions: In conclusion, SO is common among Caucasian MASLD patients and is accompanied by metabolic, hepatic, hormonal, and functional alterations. These findings may help recognize patients at risk of SO and support more focused assessment and monitoring in clinical practice.<\/jats:p>","DOI":"10.3390\/medsci14020257","type":"journal-article","created":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T14:19:29Z","timestamp":1778854769000},"page":"257","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Evaluation of Sarcopenic Obesity in Patients with MASLD"],"prefix":"10.3390","volume":"14","author":[{"given":"Niki G.","family":"Mourelatou","sequence":"first","affiliation":[{"name":"First Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, General Hospital of Athens \u201cLaiko\u201d, 11527 Athens, Greece"},{"name":"Second Department of Internal Medicine and Diabetes Centre, NIMTS Hospital, 11521 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Triada","family":"Bali","sequence":"additional","affiliation":[{"name":"First Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, General Hospital of Athens \u201cLaiko\u201d, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3306-050X","authenticated-orcid":false,"given":"Magdalini","family":"Adamantou","sequence":"additional","affiliation":[{"name":"First Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, General Hospital of Athens \u201cLaiko\u201d, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2632-0742","authenticated-orcid":false,"given":"Lampros","family":"Chrysavgis","sequence":"additional","affiliation":[{"name":"First Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, General Hospital of Athens \u201cLaiko\u201d, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christos","family":"Chologkitas","sequence":"additional","affiliation":[{"name":"First Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, General Hospital of Athens \u201cLaiko\u201d, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margarita","family":"Sarri","sequence":"additional","affiliation":[{"name":"First Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, General Hospital of Athens \u201cLaiko\u201d, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitra","family":"Pavlopoulou","sequence":"additional","affiliation":[{"name":"First Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, General Hospital of Athens \u201cLaiko\u201d, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7963-1865","authenticated-orcid":false,"given":"Georgios","family":"Schinas","sequence":"additional","affiliation":[{"name":"First Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, General Hospital of Athens \u201cLaiko\u201d, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2556-6230","authenticated-orcid":false,"given":"Theodoros","family":"Androutsakos","sequence":"additional","affiliation":[{"name":"Department of Pathophysiology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Str., 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgia","family":"Sypsa","sequence":"additional","affiliation":[{"name":"Department of Radiology, General Hospital of Athens \u201cLaiko\u201d, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0082-634X","authenticated-orcid":false,"given":"Dimitrios S.","family":"Karagiannakis","sequence":"additional","affiliation":[{"name":"Fourth Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Attiko Academic Hospital, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3518-4060","authenticated-orcid":false,"given":"George","family":"Papatheodoridis","sequence":"additional","affiliation":[{"name":"First Department of Gastroenterology, Medical School, National and Kapodistrian University of Athens, General Hospital of Athens \u201cLaiko\u201d, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0615-2534","authenticated-orcid":false,"given":"Nikolaos","family":"Tentolouris","sequence":"additional","affiliation":[{"name":"First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, General Hospital of Athens \u201cLaiko\u201d, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anastasia N.","family":"Mavrogiannaki","sequence":"additional","affiliation":[{"name":"Second Department of Internal Medicine and Diabetes Centre, NIMTS Hospital, 11521 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3645-582X","authenticated-orcid":false,"given":"Evangelos","family":"Cholongitas","sequence":"additional","affiliation":[{"name":"First Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, General Hospital of Athens \u201cLaiko\u201d, 11527 Athens, Greece"},{"name":"First Department of Gastroenterology, Medical School, National and Kapodistrian University of Athens, General Hospital of Athens \u201cLaiko\u201d, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1966","DOI":"10.1097\/HEP.0000000000000520","article-title":"A multisociety Delphi consensus statement on new fatty liver disease nomenclature","volume":"78","author":"Rinella","year":"2023","journal-title":"Hepatology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1016\/j.jhep.2024.04.031","article-title":"EASL\u2013EASD\u2013EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD)","volume":"81","author":"Tacke","year":"2024","journal-title":"J. Hepatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"841","DOI":"10.3350\/cmh.2022.0239","article-title":"Forecasted 2040 global prevalence of nonalcoholic fatty liver disease using hierarchical bayesian approach","volume":"28","author":"Le","year":"2022","journal-title":"Clin. Mol. Hepatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/S2468-1253(22)00317-X","article-title":"Global prevalence of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in the overweight and obese population: A systematic review and meta-analysis","volume":"8","author":"Quek","year":"2023","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1093\/ageing\/afy169","article-title":"Sarcopenia: Revised European consensus on definition and diagnosis","volume":"48","author":"Bahat","year":"2019","journal-title":"Age Ageing"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"155533","DOI":"10.1016\/j.metabol.2023.155533","article-title":"Epidemiology of sarcopenia: Prevalence, risk factors, and consequences","volume":"144","author":"Yuan","year":"2023","journal-title":"Metabolism"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2005","DOI":"10.1016\/j.clnu.2024.07.006","article-title":"The prevalence and effects of sarcopenia in patients with metabolic dysfunction-associated steatotic liver disease (MASLD): A systematic review and meta-analysis","volume":"43","author":"Li","year":"2024","journal-title":"Clin. Nutr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"871","DOI":"10.4254\/wjh.v16.i6.871","article-title":"Sarcopenia and metabolic dysfunction associated steatotic liver disease: Time to address both","volume":"16","author":"Wong","year":"2024","journal-title":"World J. Hepatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"4633","DOI":"10.1016\/j.clnu.2021.06.009","article-title":"Global prevalence of sarcopenic obesity in older adults: A systematic review and meta-analysis","volume":"40","author":"Gao","year":"2021","journal-title":"Clin. Nutr."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1190","DOI":"10.1007\/s10620-025-08844-z","article-title":"Clinical Relevancies of Sarcopenic Obesity in Patients with Metabolic Dysfunction-Associated Fatty Liver Disease (MASLD)","volume":"70","author":"Chien","year":"2025","journal-title":"Dig. Dis. Sci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1159\/000521241","article-title":"Definition and Diagnostic Criteria for Sarcopenic Obesity: ESPEN and EASO Consensus Statement","volume":"15","author":"Donini","year":"2022","journal-title":"Obes. Facts"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1111\/ggi.12579","article-title":"Association of sarcopenic obesity with the risk of all-cause mortality: A meta-analysis of prospective cohort studies","volume":"16","author":"Tian","year":"2016","journal-title":"Geriatr. Gerontol. Int."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Luo, Y., Xin, C., Liu, Y., Xu, Y., Liu, G., and Han, B. (2025). Association between sarcopenic obesity and cardiovascular diseases: The role of systemic inflammation indices. Front. Med., 12.","DOI":"10.3389\/fmed.2025.1581146"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1007\/s42000-018-0049-x","article-title":"Sarcopenic obesity","volume":"17","author":"Polyzos","year":"2018","journal-title":"Hormones"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1007\/s13679-019-00359-9","article-title":"Sarcopenic Obesity: Epidemiologic Evidence, Pathophysiology, and Therapeutic Perspectives","volume":"8","author":"Koliaki","year":"2019","journal-title":"Curr. Obes. Rep."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1038\/s41574-018-0062-9","article-title":"Sarcopenic obesity in older adults: Aetiology, epidemiology and treatment strategies","volume":"14","author":"Batsis","year":"2018","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1186\/s12986-025-01000-4","article-title":"Prevalence and risk of metabolic dysfunction-associated steatotic liver disease in patients with sarcopenic obesity: A systematic review and meta-analysis","volume":"22","author":"Wang","year":"2025","journal-title":"Nutr. Metab."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"130","DOI":"10.5009\/gnl220041","article-title":"Association between Sarcopenic Obesity Status and Nonalcoholic Fatty Liver Disease and Fibrosis","volume":"17","author":"Song","year":"2023","journal-title":"Gut Liver"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"227","DOI":"10.15403\/jgld-3323","article-title":"Association between Sarcopenic Obesity and Nonalcoholic Fatty Liver Disease and Fibrosis detected by Fibroscan","volume":"30","author":"Wijarnpreecha","year":"2021","journal-title":"J. Gastrointestin Liver Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2298","DOI":"10.1016\/j.cgh.2022.11.031","article-title":"Risk Stratification for Sarcopenic Obesity in Subjects With Nonalcoholic Fatty Liver Disease","volume":"21","author":"Chun","year":"2023","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1264","DOI":"10.1002\/jcsm.13502","article-title":"Sarcopenic obesity and health outcomes: An umbrella review of systematic reviews with meta-analysis","volume":"15","author":"Veronese","year":"2024","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1007\/BF00280883","article-title":"Homeostasis model assessment: Insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man","volume":"28","author":"Matthews","year":"1985","journal-title":"Diabetologia"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"3666","DOI":"10.1210\/jcem.84.10.6079","article-title":"A critical evaluation of simple methods for the estimation of free testosterone in serum","volume":"84","author":"Vermeulen","year":"1999","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Cuomo, G., Iandoli, C., Galiero, R., Caturano, A., Di Vico, C., Perretta, D., Adamo, P.V., Ferrara, R., Rinaldi, L., and Romano, C. (2023). Liver Involvement in Patients with Systemic Sclerosis: Role of Transient Elastography in the Assessment of Hepatic Fibrosis and Steatosis. Diagnostics, 13.","DOI":"10.20944\/preprints202304.0896.v1"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"197","DOI":"10.7863\/ultra.33.2.197","article-title":"Shear wave elastography for evaluation of liver fibrosis","volume":"33","author":"Ferraioli","year":"2014","journal-title":"J. Ultrasound Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1002\/hep.21178","article-title":"Development of a simple noninvasive index to predict significant fibrosis in patients with HIV\/HCV coinfection","volume":"43","author":"Sterling","year":"2006","journal-title":"Hepatology"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"M221","DOI":"10.1093\/gerona\/55.4.M221","article-title":"Lower extremity function and subsequent disability: Consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery","volume":"55","author":"Guralnik","year":"2000","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1002\/lt.25449","article-title":"The Range and Reproducibility of the Liver Frailty Index","volume":"25","author":"Wang","year":"2019","journal-title":"Liver Transpl."},{"key":"ref_29","unstructured":"(2000). Obesity: Preventing and Managing the Global Epidemic, World Health Organization. Report of a WHO Consultation."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1016\/j.clnu.2024.10.037","article-title":"Metabolic and hepatic phenotypes in sarcopenic obesity and impact of bariatric surgery","volume":"43","author":"Genser","year":"2024","journal-title":"Clin. Nutr."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1148\/radiology.143.1.7063747","article-title":"The meaning and use of the area under a receiver operating characteristic (ROC) curve","volume":"143","author":"Hanley","year":"1982","journal-title":"Radiology"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Ishimoto, R., Mutsuzaki, H., Shimizu, Y., Kishimoto, H., Takeuchi, R., and Hada, Y. (2023). Prevalence of Sarcopenic Obesity and Factors Influencing Body Composition in Persons with Spinal Cord Injury in Japan. Nutrients, 15.","DOI":"10.3390\/nu15020473"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Diago-Galm\u00e9s, A., Guillamon-Escudero, C., Ten\u00edas-Burillo, J.M., Soriano, J.M., and Fern\u00e1ndez-Garrido, J. (2023). Sarcopenic Obesity in Community-Dwelling Spanish Adults Older than 65 Years. Nutrients, 15.","DOI":"10.3390\/nu15234932"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"37","DOI":"10.14283\/jfa.2019.28","article-title":"Obesity Definitions in Sarcopenic Obesity: Differences in Prevalence, Agreement and Association with Muscle Function","volume":"9","author":"Khor","year":"2020","journal-title":"J. Frailty Aging"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1007\/s11657-022-01146-1","article-title":"Sarcopenic osteoporosis, sarcopenic obesity, and sarcopenic osteoporotic obesity in the Camargo cohort (Cantabria, Spain)","volume":"17","author":"Olmos","year":"2022","journal-title":"Arch. Osteoporos."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1007\/s10238-025-01865-y","article-title":"Sarcopenic visceral obesity in patients with metabolic dysfunction-associated steatotic liver disease (MASLD)","volume":"25","author":"Elsabaawy","year":"2025","journal-title":"Clin. Exp. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1370\/afm.240330","article-title":"Body Mass Index vs Body Fat Percentage as a Predictor of Mortality in Adults Aged 20\u201349 Years","volume":"23","author":"Mainous","year":"2025","journal-title":"Ann. Fam. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"155676","DOI":"10.1016\/j.metabol.2023.155676","article-title":"Sarcopenia, sarcopenic obesity and nonalcoholic fatty liver disease","volume":"147","author":"Polyzos","year":"2023","journal-title":"Metabolism"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Saito, H., Matsue, Y., Kamiya, K., Kagiyama, N., Maeda, D., Endo, Y., Ueno, H., Yoshioka, K., Mizukami, A., and Saito, K. (2022). Sarcopenic obesity is associated with impaired physical function and mortality in older patients with heart failure: Insight from FRAGILE-HF. BMC Geriatr., 22.","DOI":"10.1186\/s12877-022-03168-3"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"104065","DOI":"10.1016\/j.archger.2020.104065","article-title":"Effect of sarcopenic obesity on deterioration of physical function in the elderly","volume":"89","author":"Kong","year":"2020","journal-title":"Arch. Gerontol. Geriatr."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Ghiotto, L., Muollo, V., Tatangelo, T., Schena, F., and Rossi, A.P. (2022). Exercise and physical performance in older adults with sarcopenic obesity: A systematic review. Front. Endocrinol., 13.","DOI":"10.3389\/fendo.2022.913953"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.cccn.2003.10.031","article-title":"DHEAS as a new diagnostic tool","volume":"341","author":"Leowattana","year":"2004","journal-title":"Clin. Chim. Acta"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e70384","DOI":"10.1111\/liv.70384","article-title":"Association of Hormonal Status With Sarcopenia, Frailty and Outcome in Patients with Decompensated Cirrhosis","volume":"45","author":"Adamantou","year":"2025","journal-title":"Liver Int."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1515\/hmbci-2013-0009","article-title":"Effects of DHEA on metabolic and endocrine functions of adipose tissue","volume":"14","author":"Karbowska","year":"2013","journal-title":"Horm. Mol. Biol. Clin. Investig."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Lin, H.Y., Chen, J.H., and Chen, K.H. (2025). The sex hormone precursors dehydroepiandrosterone (DHEA) and its sulfate ester form (DHEAS): Molecular mechanisms and actions on human body. Int. J. Mol. Sci., 26.","DOI":"10.3390\/ijms26178568"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1002\/jcsm.12901","article-title":"Pathogenesis of sarcopenia and the relationship with fat mass: Descriptive review","volume":"13","author":"Li","year":"2022","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Lindqvist, C., Brismar, T.B., Majeed, A., and Wahlin, S. (2019). Assessment of muscle mass depletion in chronic liver disease: Dual-energy X-ray absorptiometry compared with computed tomography. Nutrients, 11.","DOI":"10.1016\/j.nut.2018.10.031"}],"container-title":["Medical Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3271\/14\/2\/257\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T12:53:27Z","timestamp":1779281607000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3271\/14\/2\/257"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,15]]},"references-count":47,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["medsci14020257"],"URL":"https:\/\/doi.org\/10.3390\/medsci14020257","relation":{},"ISSN":["2076-3271"],"issn-type":[{"value":"2076-3271","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,15]]}}}