{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T14:39:27Z","timestamp":1790087967932,"version":"4.0.1"},"reference-count":50,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2022,10,22]],"date-time":"2022-10-22T00:00:00Z","timestamp":1666396800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Champagne-Ardenne Region and Reims University Hospital"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>In the FIGHTDIGO study, digestive cancer patients with dynapenia experienced more chemotherapy-induced neurotoxicities. FIGHTDIGOTOX aimed to evaluate the relationship between pre-therapeutic handgrip strength (HGS) and chemotherapy-induced dose-limiting toxicity (DLT) or all-grade toxicity in digestive cancer patients. HGS measurement was performed with a Jamar dynamometer. Dynapenia was defined according to EWGSOP2 criteria (&lt;27 kg (men); &lt;16 kg (women)). DLT was defined as any toxicity leading to dose reduction, treatment delay, or permanent discontinuation. We also performed an exploratory analysis in patients below the included population\u2019s median HGS. A total of 244 patients were included. According to EWGSOP2 criteria, 23 patients had pre-therapeutic dynapenia (9.4%). With our exploratory median-based threshold (34 kg for men; 22 kg for women), 107 patients were dynapenic (43.8%). For each threshold, dynapenia was not an independent predictive factor of overall DLT and neurotoxicity. Dynapenic patients according to EWGSOP2 definition experienced more hand-foot syndrome (p = 0.007). Low HGS according to our exploratory threshold was associated with more all-grade asthenia (p = 0.014), anemia (p = 0.006), and asthenia with DLT (p = 0.029). Pre-therapeutic dynapenia was not a predictive factor for overall DLT and neurotoxicity in digestive cancer patients but could be a predictive factor of chemotherapy-induced anemia and asthenia. There is a need to better define the threshold of dynapenia in cancer patients.<\/jats:p>","DOI":"10.3390\/nu14214448","type":"journal-article","created":{"date-parts":[[2022,10,24]],"date-time":"2022-10-24T08:19:06Z","timestamp":1666599546000},"page":"4448","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Association of Low Handgrip Strength with Chemotherapy Toxicity in Digestive Cancer Patients: A Comprehensive Observational Cohort Study (FIGHTDIGOTOX)"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2447-4617","authenticated-orcid":false,"given":"Pierre","family":"Martin","sequence":"first","affiliation":[{"name":"Department of Medical Oncology, Godinot Cancer Institute, 51100 Reims, France"},{"name":"Department of Gastroenterology and Digestive Oncology, Universit\u00e9 de Reims Champagne-Ardenne, CHU Reims, 51100 Reims, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damien","family":"Botsen","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Godinot Cancer Institute, 51100 Reims, France"},{"name":"Department of Gastroenterology and Digestive Oncology, Universit\u00e9 de Reims Champagne-Ardenne, CHU Reims, 51100 Reims, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathias","family":"Brugel","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Digestive Oncology, Universit\u00e9 de Reims Champagne-Ardenne, CHU Reims, 51100 Reims, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8357-985X","authenticated-orcid":false,"given":"Eric","family":"Bertin","sequence":"additional","affiliation":[{"name":"Department of Nutrition, Endocrinology and Diabetology, CHU Reims, 51100 Reims, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Carlier","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Godinot Cancer Institute, 51100 Reims, France"},{"name":"Department of Gastroenterology and Digestive Oncology, Universit\u00e9 de Reims Champagne-Ardenne, CHU Reims, 51100 Reims, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4741-1934","authenticated-orcid":false,"given":"Rachid","family":"Mahmoudi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Geriatrics, Universit\u00e9 de Reims Champagne-Ardenne, VieFra, CHU Reims, 51100 Reims, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5139-7034","authenticated-orcid":false,"given":"Florian","family":"Slimano","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Universit\u00e9 de Reims Champagne-Ardenne, CHU Reims, 51100 Reims, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4528-5471","authenticated-orcid":false,"given":"Marine","family":"Perrier","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Digestive Oncology, Universit\u00e9 de Reims Champagne-Ardenne, CHU Reims, 51100 Reims, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8284-3743","authenticated-orcid":false,"given":"Olivier","family":"Bouch\u00e9","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Digestive Oncology, Universit\u00e9 de Reims Champagne-Ardenne, CHU Reims, 51100 Reims, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"209","DOI":"10.3322\/caac.21660","article-title":"Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA A Cancer J. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.pharmthera.2018.12.003","article-title":"Body Composition and Sarcopenia: The next-Generation of Personalized Oncology and Pharmacology?","volume":"196","author":"Hilmi","year":"2019","journal-title":"Pharmacol. Ther."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1002\/jcsm.12436","article-title":"Skeletal Muscle Mass Loss and Dose-Limiting Toxicities in Metastatic Colorectal Cancer Patients","volume":"10","author":"Kurk","year":"2019","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1007\/s10549-019-05352-3","article-title":"Muscle Composition and Outcomes in Patients with Breast Cancer: Meta-Analysis and Systematic Review","volume":"177","author":"Aleixo","year":"2019","journal-title":"Breast Cancer Res. Treat."},{"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":"412","DOI":"10.1093\/ageing\/afq034","article-title":"Sarcopenia: European Consensus on Definition and Diagnosis: Report of the European Working Group on Sarcopenia in Older People","volume":"39","author":"Baeyens","year":"2010","journal-title":"Age Ageing"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1136\/bmjspcare-2020-002751","article-title":"Nutrition and Physical Activity: French Intergroup Clinical Practice Guidelines for Diagnosis, Treatment and Follow-up (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, ACHBT, AFC, SFP-APA, SFNCM, AFSOS)","volume":"11","author":"Neuzillet","year":"2021","journal-title":"BMJ Support. Palliat. Care"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1093\/gerona\/63.8.829","article-title":"Sarcopenia =\/= Dynapenia","volume":"63","author":"Clark","year":"2008","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Dodds, R.M., Syddall, H.E., Cooper, R., Benzeval, M., Deary, I.J., Dennison, E.M., Der, G., Gale, C.R., Inskip, H.M., and Jagger, C. (2014). Grip Strength across the Life Course: Normative Data from Twelve British Studies. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0113637"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"M146","DOI":"10.1093\/gerona\/56.3.M146","article-title":"Frailty in Older Adults: Evidence for a Phenotype","volume":"56","author":"Fried","year":"2001","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1016\/j.clnu.2022.01.028","article-title":"Response to Comment: Evaluating Sarcopenia in Cancer Patients: The Role of Muscle Strength","volume":"41","author":"Findlay","year":"2022","journal-title":"Clin. Nutr."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.clnu.2010.09.010","article-title":"Hand Grip Strength: Outcome Predictor and Marker of Nutritional Status","volume":"30","author":"Norman","year":"2011","journal-title":"Clin. Nutr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.clnesp.2016.12.001","article-title":"Admission Handgrip Strength Predicts Functional Decline in Hospitalized Patients","volume":"17","author":"Bunout","year":"2017","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1007\/s13539-010-0016-0","article-title":"Cancer-Related Fatigue: The Impact of Skeletal Muscle Mass and Strength in Patients with Advanced Cancer","volume":"1","author":"Kilgour","year":"2010","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1016\/j.clnu.2010.02.007","article-title":"Determinants of Hand Grip Strength, Knee Extension Strength and Functional Status in Cancer Patients","volume":"29","author":"Norman","year":"2010","journal-title":"Clin. Nutr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1186\/1749-8090-6-98","article-title":"Hand-Grip Strength Is a Simple and Effective Outcome Predictor in Esophageal Cancer Following Esophagectomy with Reconstruction: A Prospective Study","volume":"6","author":"Chen","year":"2011","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Contreras-Bol\u00edvar, V., S\u00e1nchez-Torralvo, F.J., Ruiz-Vico, M., Gonz\u00e1lez-Almendros, I., Barrios, M., Pad\u00edn, S., Alba, E., and Olveira, G. (2019). GLIM Criteria Using Hand Grip Strength Adequately Predict Six-Month Mortality in Cancer Inpatients. Nutrients, 11.","DOI":"10.3390\/nu11092043"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1007\/s00520-021-06416-1","article-title":"Dynapenia in Digestive Cancer Outpatients: Association with Markers of Functional and Nutritional Status (the FIGHTDIGO Study)","volume":"30","author":"Perrier","year":"2022","journal-title":"Support. Care Cancer"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1501","DOI":"10.1002\/cncr.31207","article-title":"Feasibility of Systematic Handgrip Strength Testing in Digestive Cancer Patients Treated with Chemotherapy: The FIGHTDIGO Study","volume":"124","author":"Ordan","year":"2018","journal-title":"Cancer"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Botsen, D., Ordan, M.-A., Barbe, C., Mazza, C., Perrier, M., Moreau, J., Brasseur, M., Renard, Y., Tailli\u00e8re, B., and Slimano, F. (2018). Dynapenia Could Predict Chemotherapy-Induced Dose-Limiting Neurotoxicity in Digestive Cancer Patients. BMC Cancer, 18.","DOI":"10.1186\/s12885-018-4860-1"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1038\/sj.bjc.6606087","article-title":"An Inflammation-Based Prognostic Score (MGPS) Predicts Cancer Survival Independent of Tumour Site: A Glasgow Inflammation Outcome Study","volume":"104","author":"Proctor","year":"2011","journal-title":"Br. J. Cancer"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1093\/ageing\/afr051","article-title":"A Review of the Measurement of Grip Strength in Clinical and Epidemiological Studies: Towards a Standardised Approach","volume":"40","author":"Roberts","year":"2011","journal-title":"Age Ageing"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1007\/s41999-021-00592-3","article-title":"Sarcopenia Assessment by New EWGSOP2 Criteria for Predicting Chemotherapy Dose-Limiting Toxicity in Patients with Gastrointestinal Tract Tumors","volume":"13","author":"Celik","year":"2022","journal-title":"Eur. Geriatr. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1177\/0884533617700862","article-title":"Handgrip Strength Is Associated With Treatment Modifications During Neoadjuvant Chemoradiation in Patients With Esophageal Cancer","volume":"32","author":"Lakenman","year":"2017","journal-title":"Nutr. Clin. Pract."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"de Almeida Marques, R., de Souza, V.F., do Rosario, T.C., da Silva Garcia, M.R.P., Pereira, T.S.S., Marques-Rocha, J.L., and Guandalini, V.R. (2022). Agreement between Maximum and Mean Handgrip Strength Measurements in Cancer Patients. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0270631"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1016\/j.nut.2011.12.002","article-title":"What Is Dynapenia?","volume":"28","author":"Clark","year":"2012","journal-title":"Nutrition"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Cavusoglu, C., Tahtaci, G., Dogrul, R.T., Ileri, I., Yildirim, F., Candemir, B., Kizilarslanoglu, M.C., Uner, A., and Goker, B. (2021). Predictive Ability of the G8 Screening Test to Determine Probable Sarcopenia and Abnormal Comprehensive Geriatric Assessment in Older Patients with Solid Malignancies. BMC Geriatr., 21.","DOI":"10.1186\/s12877-021-02544-9"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1002\/jcsm.12528","article-title":"Cancer Cachexia and Its Pathophysiology: Links with Sarcopenia, Anorexia and Asthenia","volume":"11","author":"Santos","year":"2020","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1097\/MCO.0b013e32831cef61","article-title":"Inflammatory Burden and Amino Acid Metabolism in Cancer Cachexia","volume":"12","author":"Durham","year":"2009","journal-title":"Curr. Opin. Clin. Nutr. Metab. Care"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1007\/s12603-009-0009-x","article-title":"Cachexia and Aging: An Update Based on the Fourth International Cachexia Meeting","volume":"13","author":"Morley","year":"2009","journal-title":"J. Nutr. Health Aging"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1038\/s41416-022-01826-2","article-title":"Cancer Cachexia: A Nutritional or a Systemic Inflammatory Syndrome?","volume":"127","author":"McGovern","year":"2022","journal-title":"Br. J. Cancer"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/j.pan.2018.11.001","article-title":"Sarcopenia Is a Reliable Prognostic Factor in Patients with Advanced Pancreatic Cancer Receiving FOLFIRINOX Chemotherapy","volume":"19","author":"Kurita","year":"2019","journal-title":"Pancreatology"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1016\/j.clnu.2020.05.020","article-title":"Is Skeletal Muscle Loss Associated with Chemoradiotherapy Toxicity in Nasopharyngeal Carcinoma Patients? A Prospective Study","volume":"40","author":"Huang","year":"2021","journal-title":"Clin. Nutr."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.1182\/bloodadvances.2018030387","article-title":"Management of Cancer-Associated Anemia with Erythropoiesis-Stimulating Agents: ASCO\/ASH Clinical Practice Guideline Update","volume":"3","author":"Bohlius","year":"2019","journal-title":"Blood Adv."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1182\/blood.2019004017","article-title":"How I Treat Cancer-Associated Anemia","volume":"136","author":"Gilreath","year":"2020","journal-title":"Blood"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"vii167","DOI":"10.1093\/annonc\/mdq284","article-title":"Anemia in Cancer","volume":"21","author":"Dicato","year":"2010","journal-title":"Ann. Oncol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1002\/jcsm.12391","article-title":"Is Cachexia Associated with Chemotherapy Toxicities in Gastrointestinal Cancer Patients? A Prospective Study","volume":"10","author":"Marcadenti","year":"2019","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Gi, Y.-M., Jung, B., Kim, K.-W., Cho, J.-H., and Ha, I.-H. (2020). Low Handgrip Strength Is Closely Associated with Anemia among Adults: A Cross-Sectional Study Using Korea National Health and Nutrition Examination Survey (KNHANES). PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0218058"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1625","DOI":"10.1080\/14740338.2016.1238067","article-title":"Incidence and Implications of Chemotherapy Related Hand-Foot Syndrome","volume":"15","author":"Nikolaou","year":"2016","journal-title":"Expert Opin. Drug Saf."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1002\/cpt.2013","article-title":"Regulatory CDH4 Genetic Variants Associate With Risk to Develop Capecitabine-Induced Hand-Foot Syndrome","volume":"109","author":"Pita","year":"2021","journal-title":"Clin. Pharmacol. Ther."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1518","DOI":"10.1007\/s12094-019-02080-4","article-title":"Relation between Sarcopenia and Dose-Limiting Toxicity in Patients with Metastatic Colorectal Cancer Who Received Regorafenib","volume":"21","author":"Sunal","year":"2019","journal-title":"Clin. Transl. Oncol."},{"key":"ref_42","first-page":"S259","article-title":"Overview of Chemotherapy-Induced Nausea and Vomiting and Evidence-Based Therapies","volume":"23","author":"Adel","year":"2017","journal-title":"Am. J. Manag. Care"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1260","DOI":"10.1093\/annonc\/mdx100","article-title":"The Development of a Prediction Tool to Identify Cancer Patients at High Risk for Chemotherapy-Induced Nausea and Vomiting","volume":"28","author":"Dranitsaris","year":"2017","journal-title":"Ann. Oncol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.2174\/18715206113139990322","article-title":"Assessment of Nutritional Status in Cancer\u2013The Relationship Between Body Composition and Pharmacokinetics","volume":"13","author":"Prado","year":"2013","journal-title":"Anti-Cancer Agents Med. Chem."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1080\/01635581.2017.1299878","article-title":"Impact of Undernutrition on the Pharmacokinetics and Pharmacodynamics of Anticancer Drugs: A Literature Review","volume":"69","author":"Nacher","year":"2017","journal-title":"Nutr. Cancer"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1002\/cam4.4362","article-title":"Muscle Weakness as an Additional Criterion for Grading Sarcopenia-Related Prognosis in Patients with Cancer","volume":"11","author":"Cereda","year":"2022","journal-title":"Cancer Med."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"e85","DOI":"10.1634\/theoncologist.2019-0241","article-title":"Predicting Chemotherapy Toxicity and Death in Older Adults with Colon Cancer: Results of MOST Study","volume":"25","author":"Retornaz","year":"2020","journal-title":"Oncologist"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"afac164","DOI":"10.1093\/ageing\/afac164","article-title":"European Working Group on Sarcopenia in Older People 2010 (EWGSOP1) and 2019 (EWGSOP2) Criteria or Slowness: Which Is the Best Predictor of Mortality Risk in Older Adults?","volume":"51","author":"Spexoto","year":"2022","journal-title":"Age Ageing"},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Lemoine, A., Perrier, M., Mazza, C., Quinquenel, A., Brasseur, M., Delmer, A., Vallerand, H., Dewolf, M., Bertin, E., and Barbe, C. (2022). Feasibility and Impact of Adapted Physical Activity (APA) in Cancer Outpatients Beginning Medical Anti-Tumoral Treatment: The UMA-CHAPA Study. Cancers, 14.","DOI":"10.3390\/cancers14081993"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1016\/j.jpainsymman.2019.09.010","article-title":"Exercise Training for Improving Patient-Reported Outcomes in Patients With Advanced-Stage Cancer: A Systematic Review and Meta-Analysis","volume":"59","author":"Chen","year":"2020","journal-title":"J. Pain Symptom Manag."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/14\/21\/4448\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:01:02Z","timestamp":1760144462000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/14\/21\/4448"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,22]]},"references-count":50,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2022,11]]}},"alternative-id":["nu14214448"],"URL":"https:\/\/doi.org\/10.3390\/nu14214448","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,22]]}}}