{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T23:01:05Z","timestamp":1768258865546,"version":"3.49.0"},"reference-count":57,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2024,2,24]],"date-time":"2024-02-24T00:00:00Z","timestamp":1708732800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>The prevalence of chronic kidney disease (CKD) is rising, especially in elderly individuals. The overlap between CKD and aging is associated with body composition modification, metabolic abnormalities, and malnutrition. Renal care guidelines suggest treating CKD patient with a low-protein diet according to the renal disease stage. On the other hand, geriatric care guidelines underline the need for a higher protein intake to prevent malnutrition. The challenge remains of how to reconcile a low dietary protein intake with insuring a favorable nutritional status in geriatric CKD populations. Therefore, this study aims to evaluate the effect of a low-protein adequate energy intake (LPAE) diet on nutritional risk and nutritional status among elderly CKD (stage 3\u20135) patients and then to assess its impact on CKD metabolic abnormalities. To this purpose, 42 subjects [age \u2265 65, CKD stage 3\u20135 in conservative therapy, and Geriatric Nutritional Risk Index (GNRI) \u2265 98] were recruited and the LPAE diet was prescribed. At baseline and after 6 months of the LPAE diet, the following data were collected: age, sex, biochemical parameters, anthropometric measurements, body composition, and the GNRI. According to their dietary compliance, the subjects were divided into groups: compliant and non-compliant. For the compliant group, the results obtained show no increased malnutrition risk incidence but, rather, an improvement in body composition and metabolic parameters, suggesting that the LPAE diet can provide a safe tool in geriatric CKD patients.<\/jats:p>","DOI":"10.3390\/nu16050632","type":"journal-article","created":{"date-parts":[[2024,2,26]],"date-time":"2024-02-26T08:59:01Z","timestamp":1708937941000},"page":"632","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Effects of Dietary Intervention on Nutritional Status in Elderly Individuals with Chronic Kidney Disease"],"prefix":"10.3390","volume":"16","author":[{"given":"Nunzia","family":"Cacciapuoti","sequence":"first","affiliation":[{"name":"Physiology Nutrition Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini 5, 80131 Napoli, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3768-4480","authenticated-orcid":false,"given":"Maria Serena","family":"Lonardo","sequence":"additional","affiliation":[{"name":"Physiology Nutrition Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini 5, 80131 Napoli, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariastella","family":"Di Lauro","sequence":"additional","affiliation":[{"name":"Physiology Nutrition Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini 5, 80131 Napoli, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariana","family":"Di Lorenzo","sequence":"additional","affiliation":[{"name":"Physiology Nutrition Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini 5, 80131 Napoli, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9060-2595","authenticated-orcid":false,"given":"Laura","family":"Aurino","sequence":"additional","affiliation":[{"name":"Physiology Nutrition Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini 5, 80131 Napoli, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2343-5069","authenticated-orcid":false,"given":"Daniela","family":"Pacella","sequence":"additional","affiliation":[{"name":"Department of Public Health, University of Naples Federico II, Via Sergio Pansini 5, 80131 Napoli, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruna","family":"Guida","sequence":"additional","affiliation":[{"name":"Physiology Nutrition Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Sergio Pansini 5, 80131 Napoli, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,2,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"iii32","DOI":"10.1093\/ndt\/gfs113","article-title":"The impact of CKD identification in large countries: The burden of illness","volume":"27","author":"Jha","year":"2012","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2554","DOI":"10.1016\/j.ekir.2021.05.039","article-title":"Sarcopenia and Frailty: Challenges in Mainstream Nephrology Practice","volume":"6","author":"Wong","year":"2021","journal-title":"Kidney Int. Rep."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Corsonello, A., Freiberger, E., and Lattanzio, F. (2020). The screening for chronic kidney disease among older people across Europe (SCOPE) project: Findings from cross-sectional analysis. BMC Geriatr., 20.","DOI":"10.1186\/s12877-020-01701-w"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"861","DOI":"10.3389\/fendo.2019.00861","article-title":"Aging and Imaging Assessment of Body Composition: From Fat to Facts","volume":"10","author":"Ponti","year":"2020","journal-title":"Front Endocrinol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"990S","DOI":"10.1093\/jn\/127.5.990S","article-title":"Sarcopenia: Origins and clinical relevance","volume":"127","author":"Rosenberg","year":"1997","journal-title":"J. Nutr."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1177\/0148607108324585","article-title":"Inflammation: Roles in aging and sarcopenia","volume":"32","author":"Jensen","year":"2008","journal-title":"JPEN J. Parenter. Enteral Nutr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1016\/j.numecd.2007.10.002","article-title":"Sarcopenic obesity: A new category of obesity in the elderly","volume":"18","author":"Zamboni","year":"2008","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1111\/jgs.12652","article-title":"Sarcopenic obesity and risk of cardiovascular disease and mortality: A population-based cohort study of older men","volume":"62","author":"Atkins","year":"2014","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1016\/j.clnu.2005.10.013","article-title":"A 3-year longitudinal study on body composition changes in the elderly: Role of physical exercise","volume":"25","author":"Raguso","year":"2006","journal-title":"Clin. Nutr."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1093\/gerona\/62.9.997","article-title":"Limb fat to trunk fat ratio in elderly persons is a strong determinant of insulin resistance and adiponectin levels","volume":"62","author":"Gavi","year":"2007","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e00023","DOI":"10.1097\/IN9.0000000000000023","article-title":"Adipose tissue metabolic changes in chronic kidney disease","volume":"5","author":"Serrano","year":"2023","journal-title":"Immunometabolism"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1208","DOI":"10.1016\/j.ekir.2017.07.007","article-title":"Altered Protein Composition of Subcutaneous Adipose Tissue in Chronic Kidney Disease","volume":"2","author":"Gertow","year":"2017","journal-title":"Kidney Int. Rep."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"F1087","DOI":"10.1152\/ajprenal.00340.2016","article-title":"Insulin resistance in chronic kidney disease: A systematic review","volume":"311","author":"Spoto","year":"2016","journal-title":"Am. J. Physiol. Renal Physiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1053\/j.jrn.2010.10.008","article-title":"Fighting protein-energy wasting in chronic kidney disease: A challenge of complexity","volume":"21","author":"Guarnieri","year":"2011","journal-title":"J. Ren. Nutr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1093\/ndt\/gfw411","article-title":"Clinical Practice Guideline on management of older patients with chronic kidney disease stage 3b or higher (eGFR<45\u2009mL\/min\/1.73 m2): A summary document from the European Renal Best Practice Group","volume":"32","author":"Farrington","year":"2017","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1016\/j.clnu.2023.01.018","article-title":"Nutritional status and the risk of malnutrition in older adults with chronic kidney disease\u2014Implications for low protein intake and nutritional care: A critical review endorsed by ERN-ERA and ESPEN","volume":"42","author":"Piccoli","year":"2023","journal-title":"Clin. Nutr."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Massini, G., Caldiroli, L., Molinari, P., Carminati, F.M.I., Castellano, G., and Vettoretti, S. (2023). Nutritional Strategies to Prevent Muscle Loss and Sarcopenia in Chronic Kidney Disease: What Do We Currently Know?. Nutrients, 15.","DOI":"10.3390\/nu15143107"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.clnu.2018.05.024","article-title":"ESPEN guideline on clinical nutrition and hydration in geriatrics","volume":"38","author":"Volkert","year":"2019","journal-title":"Clin. Nutr."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"825","DOI":"10.7326\/0003-4819-158-11-201306040-00007","article-title":"Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group Members. Evaluation and management of chronic kidney disease: Synopsis of the kidney disease: Improving global outcomes 2012 clinical practice guideline","volume":"158","author":"Stevens","year":"2013","journal-title":"Ann. Intern. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1016\/j.jamda.2013.05.021","article-title":"Evidence-Based Recommendations for Optimal Dietary Protein Intake in Older People: A Position Paper From the PROT-AGE Study Group","volume":"14","author":"Bauer","year":"2013","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1053\/j.ajkd.2020.05.006","article-title":"KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update","volume":"76","author":"Ikizler","year":"2020","journal-title":"Am. J. Kidney Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1007\/s40620-018-0497-z","article-title":"Nutritional treatment of advanced CKD: Twenty consensus statements","volume":"31","author":"Cupisti","year":"2018","journal-title":"J. Nephrol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"604","DOI":"10.7326\/0003-4819-150-9-200905050-00006","article-title":"A new equation to estimate glomerular filtration rate","volume":"150","author":"Levey","year":"2009","journal-title":"Ann. Intern Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"802","DOI":"10.7326\/0003-4819-139-10-200311180-00007","article-title":"Use of metabolic markers to identify overweight individuals who are insulin resistant","volume":"139","author":"McLaughlin","year":"2003","journal-title":"Ann. Intern. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/j.amjcard.2007.09.109","article-title":"Usefulness of the triglyceride-high-density lipoprotein versus the cholesterol-high-density lipoprotein ratio for predicting insulin resistance and cardiometabolic risk (from the Framingham Offspring Cohort)","volume":"101","author":"Kannel","year":"2008","journal-title":"Am. J. Cardiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"524S","DOI":"10.1093\/ajcn\/64.3.524S","article-title":"Bioelectrical impedance analysis in body composition measurement: National Institutes of Health Technology Assessment Conference Statement","volume":"64","author":"Yanovski","year":"1996","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1080\/07315724.1992.12098245","article-title":"Bioelectrical impedance analysis: A review of principles and applications","volume":"11","author":"Kushner","year":"1992","journal-title":"J. Am. Coll. Nutr."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1152\/jappl.2000.89.2.465","article-title":"Estimation of skeletal muscle mass by bioelectrical impedance analysis","volume":"89","author":"Janssen","year":"2000","journal-title":"J. Appl. Physiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1093\/ajcn\/82.4.777","article-title":"Geriatric Nutritional Risk Index: A new index for evaluating at-risk elderly medical patients","volume":"82","author":"Bouillanne","year":"2005","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1079\/PHN2001318","article-title":"Development, validation and utilisation of food-frequency questionnaires\u2014A review","volume":"5","author":"Cade","year":"2002","journal-title":"Public. Health Nutr."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e2014009","DOI":"10.4178\/epih\/e2014009","article-title":"Dietary assessment methods in epidemiologic studies","volume":"36","author":"Shim","year":"2014","journal-title":"Epidemiol. Health"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1093\/aje\/kwr317","article-title":"Taking Advantage of the Strengths of Two Different Dietary Assessment Instruments to Improve Intake Estimates for Nutritional Epidemiology","volume":"175","author":"Carroll","year":"2012","journal-title":"Am. J. Epidemiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1016\/j.kjms.2017.03.002","article-title":"Correlations of dietary energy and protein intakes with renal function impairment in chronic kidney disease patients with or without diabetes","volume":"33","author":"Chen","year":"2017","journal-title":"Kaohsiung J. Med. Sci."},{"key":"ref_34","first-page":"2018-vol5","article-title":"Nutritional diet therapy in the management of the patient with Chronic Kidney Disease in advanced phase to delay the beginning and reduce the frequency of dialysis. An option also in the pre-emptive transplant program","volume":"35","author":"Cupisti","year":"2018","journal-title":"G. Ital. Nefrol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"21","DOI":"10.2147\/IJNRD.S76831","article-title":"Strategies to promote adherence to nutritional advice in patients with chronic kidney disease: A narrative review and commentary","volume":"9","author":"Beto","year":"2016","journal-title":"Int. J. Nephrol. Renovasc Dis."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1136\/pgmj.2005.037564","article-title":"Malnutrition and ageing","volume":"82","author":"Hickson","year":"2006","journal-title":"Postgrad. Med. J."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"782499","DOI":"10.3389\/fnut.2021.782499","article-title":"Possible Benefits of a Low Protein Diet in Older Patients With CKD at Risk of Malnutrition: A Pilot Randomized Controlled Trial","volume":"8","author":"Caldiroli","year":"2022","journal-title":"Front. Nutr."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1053\/j.ajkd.2007.02.278","article-title":"Efficacy and safety of a very-low-protein diet when postponing dialysis in the elderly: A prospective randomized multicenter controlled study","volume":"49","author":"Brunori","year":"2007","journal-title":"Am. J. Kidney Dis."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1038\/ki.1997.395","article-title":"Effect of dietary protein restriction on nutritional status in the Modification of Diet in Renal Disease Study","volume":"52","author":"Kopple","year":"1997","journal-title":"Kidney Int."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1016\/j.clnesp.2021.08.037","article-title":"The association between low protein diet and body composition, muscle function, inflammation, and amino acid-based metabolic profile in chronic kidney disease stage 3-5 patients","volume":"46","author":"Hsu","year":"2021","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1016\/j.nefro.2018.06.007","article-title":"Influence of dietary protein intake on body composition in chronic kidney disease patients in stages 3-5: A cross-sectional study","volume":"38","author":"Barril","year":"2018","journal-title":"Nefrologia"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1002\/jcsm.12264","article-title":"Low-protein diet for conservative management of chronic kidney disease: A systematic review and meta-analysis of controlled trials","volume":"9","author":"Rhee","year":"2018","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1038\/ki.2011.118","article-title":"Nutrition and chronic kidney disease","volume":"80","author":"Fouque","year":"2011","journal-title":"Kidney Int."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1038\/ncpneph0524","article-title":"Eleven reasons to control the protein intake of patients with chronic kidney disease","volume":"3","author":"Fouque","year":"2007","journal-title":"Nat. Clin. Pract. Nephrol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1097\/00005792-197311000-00005","article-title":"Metabolic studies of low protein diets in uremia. II. Calcium, phosphorus and magnesium","volume":"52","author":"Kopple","year":"1973","journal-title":"Medicine"},{"key":"ref_46","first-page":"S278","article-title":"Restricted phosphorus and nitrogen intake to slow the progression of chronic renal failure: A controlled trial","volume":"16","author":"Barsotti","year":"1983","journal-title":"Kidney Int. Suppl."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1053\/j.ajkd.2013.01.007","article-title":"Effect of protein restriction on serum and urine phosphate in the modification of diet in renal disease (MDRD) study","volume":"61","author":"Newsome","year":"2013","journal-title":"Am. J. Kidney Dis."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1038\/ki.1972.84","article-title":"On the prevention of secondary hyperparathyroidism in experimental chronic renal disease using \u201cproportional reduction\u201d of dietary phosphorus intake","volume":"2","author":"Slatopolsky","year":"1972","journal-title":"Kidney Int."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1042\/CS20160203","article-title":"Urea, a true uremic toxin: The empire strikes back","volume":"131","author":"Lau","year":"2017","journal-title":"Clin. Sci."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"237","DOI":"10.3390\/toxins10060237","article-title":"Deleting Death and Dialysis: Conservative Care of Cardio-Vascular Risk and Kidney Function Loss in Chronic Kidney Disease (CKD)","volume":"10","author":"Vanholder","year":"2018","journal-title":"Toxins"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"3598","DOI":"10.1172\/JCI86181","article-title":"Urea impairs \u03b2 cell glycolysis and insulin secretion in chronic kidney disease","volume":"126","author":"Koppe","year":"2016","journal-title":"J. Clin. Invest"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.cca.2008.02.024","article-title":"The paradoxical relationship between serum uric acid and cardiovascular disease","volume":"392","author":"Lippi","year":"2008","journal-title":"Clin. Chim. Acta"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1975","DOI":"10.1016\/S0140-6736(14)61601-9","article-title":"Worldwide access to treatment for end-stage kidney disease: A systematic review","volume":"385","author":"Liyanage","year":"2015","journal-title":"Lancet"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1258","DOI":"10.2337\/db10-0916","article-title":"Hyperuricemia as a mediator of the proinflammatory endocrine imbalance in the adipose tissue in a murine model of the metabolic syndrome","volume":"60","author":"Baldwin","year":"2011","journal-title":"Diabetes"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"6676569","DOI":"10.1155\/2021\/6676569","article-title":"Triglycerides to High-Density Lipoprotein Cholesterol Ratio Is the Best Surrogate Marker for Insulin Resistance in Nonobese Middle-Aged and Elderly Population: A Cross-Sectional Study","volume":"2021","author":"Yang","year":"2021","journal-title":"Int. J. Endocrinol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1512","DOI":"10.1093\/ajcn\/65.5.1512","article-title":"A low-protein diet improves insulin sensitivity of endogenous glucose production in predialytic uremic patients","volume":"65","author":"Rigalleau","year":"1997","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1038\/sj.ki.5001955","article-title":"ERIKA Study-group. Very low protein diet supplemented with ketoanalogs improves blood pressure control in chronic kidney disease","volume":"71","author":"Bellizzi","year":"2007","journal-title":"Kidney Int."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/16\/5\/632\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:04:12Z","timestamp":1760105052000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/16\/5\/632"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,24]]},"references-count":57,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2024,3]]}},"alternative-id":["nu16050632"],"URL":"https:\/\/doi.org\/10.3390\/nu16050632","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,24]]}}}