Identification of sarcopenic obesity in adults undergoing orthopaedic surgery: Relationship between “a body shape index” (ABSI) and fat-free mass. A cross -sectional study
Background Sarcopenic obesity is a condition characterised by the coexistence of low muscle mass and function (sarcopenia) and excessive fat mass (obesity). The aim of this study was to determine the prevalence of this condition in patients undergoing orthopaedic surgery by gender and type of orthop...
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| description | Background Sarcopenic obesity is a condition characterised by the coexistence of low muscle mass and function (sarcopenia) and excessive fat mass (obesity). The aim of this study was to determine the prevalence of this condition in patients undergoing orthopaedic surgery by gender and type of orthopaedic surgery. In addition, this study investigated the suitability of a waist circumference-based anthropometric measure, body shape index (ABSI), for predicting sarcopenic obesity and the predictive power of ABSI for fat-free mass index (FFMI), a surrogate marker of lean body mass. Methods and findings A cross-sectional study of overweight and obese orthopaedic patients undergoing knee or hip and spine surgery was conducted between October 2019 and March 2020 in Orthopaedic Hospital Valdoltra, Slovenia. General anthropometric parameters body mass index (BMI) and ABSI = (WC/(BMI.sup.2/3 x height.sup.½) as well as body composition data (fat mass FM, fat-free mass FFM, FFMI, and the ratio FM/FFM as an index of sarcopenic obesity) were determined in 120 women (aged 66.5 ± 9.6 years) and 89 men (aged 65.5 ± 7.8 years) with overweight (25 kg/m.sup.2 [less than or equal to] BMI 0.80 was present in 15.3% of patients, mainly in female patients undergoing knee surgery. ABSI was significantly associated with age in all women and obese men and with waist circumference (WC) in all patients. ABSI did not correlate with BMI in women and men; however, multiple linear regression analysis showed that BMI independently predicted FFMI (R = 0.83 and 0.70, respectively, p < 0.001) in women and men ([beta]-coefficients: 0.801 and 0.686, respectively) and ABSI in women only ([beta]-coefficient: -0.104). Women with a lower ABSI had a significantly higher FFMI than the group with a higher ABSI. Conclusions Sarcopenic obesity was most prevalent in obese women scheduled for knee surgery. In addition, ABSI, independently predicted FFMI in women and represents a significant predictor of sarcopenic obesity. |
| doi_str_mv | 10.1371/journal.pone.0269956 |
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A cross -sectional study</title><source>DOAJ Directory of Open Access Journals</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>PubMed Central</source><source>Free Full-Text Journals in Chemistry</source><source>Public Library of Science (PLoS)</source><creator>Tomazic, Ana ; Zvanut, Bostjan ; Grbac, Lilijana Vouk ; Jurdana, Mihaela</creator><creatorcontrib>Tomazic, Ana ; Zvanut, Bostjan ; Grbac, Lilijana Vouk ; Jurdana, Mihaela</creatorcontrib><description>Background Sarcopenic obesity is a condition characterised by the coexistence of low muscle mass and function (sarcopenia) and excessive fat mass (obesity). The aim of this study was to determine the prevalence of this condition in patients undergoing orthopaedic surgery by gender and type of orthopaedic surgery. In addition, this study investigated the suitability of a waist circumference-based anthropometric measure, body shape index (ABSI), for predicting sarcopenic obesity and the predictive power of ABSI for fat-free mass index (FFMI), a surrogate marker of lean body mass. Methods and findings A cross-sectional study of overweight and obese orthopaedic patients undergoing knee or hip and spine surgery was conducted between October 2019 and March 2020 in Orthopaedic Hospital Valdoltra, Slovenia. General anthropometric parameters body mass index (BMI) and ABSI = (WC/(BMI.sup.2/3 x height.sup.½) as well as body composition data (fat mass FM, fat-free mass FFM, FFMI, and the ratio FM/FFM as an index of sarcopenic obesity) were determined in 120 women (aged 66.5 ± 9.6 years) and 89 men (aged 65.5 ± 7.8 years) with overweight (25 kg/m.sup.2 [less than or equal to] BMI 0.80 was present in 15.3% of patients, mainly in female patients undergoing knee surgery. ABSI was significantly associated with age in all women and obese men and with waist circumference (WC) in all patients. ABSI did not correlate with BMI in women and men; however, multiple linear regression analysis showed that BMI independently predicted FFMI (R = 0.83 and 0.70, respectively, p < 0.001) in women and men ([beta]-coefficients: 0.801 and 0.686, respectively) and ABSI in women only ([beta]-coefficient: -0.104). Women with a lower ABSI had a significantly higher FFMI than the group with a higher ABSI. Conclusions Sarcopenic obesity was most prevalent in obese women scheduled for knee surgery. In addition, ABSI, independently predicted FFMI in women and represents a significant predictor of sarcopenic obesity.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0269956</identifier><identifier>PMID: 35731798</identifier><language>eng</language><publisher>San Francisco: Public Library of Science</publisher><subject>Anthropometry ; Bioelectricity ; Biology and Life Sciences ; Body composition ; Body fat ; Body mass ; Body mass index ; Body size ; Body weight ; Bone surgery ; Care and treatment ; Coexistence ; Complications and side effects ; Cross-sectional studies ; Fat-free ; Fat-free body mass ; Health risk assessment ; Health risks ; Joint surgery ; Knee ; Lean body mass ; Medicine and Health Sciences ; Men ; Muscles ; Musculoskeletal system ; Obesity ; Orthopedic surgery ; Orthopedics ; Overweight ; Patient outcomes ; Patients ; Phenotypes ; Regression analysis ; Sarcopenia ; Spine ; Surgery ; Women</subject><ispartof>PloS one, 2022-06, Vol.17 (6), p.e0269956-e0269956</ispartof><rights>COPYRIGHT 2022 Public Library of Science</rights><rights>2022 Tomažič et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2022 Tomažič et al 2022 Tomažič et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c570t-cccdad6b664dbea41df047250d0d9cf6f693827bebbb273925df3e6e11ccb9723</citedby><cites>FETCH-LOGICAL-c570t-cccdad6b664dbea41df047250d0d9cf6f693827bebbb273925df3e6e11ccb9723</cites><orcidid>0000-0002-4514-7001</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9216617/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9216617/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79342,79343</link.rule.ids></links><search><creatorcontrib>Tomazic, Ana</creatorcontrib><creatorcontrib>Zvanut, Bostjan</creatorcontrib><creatorcontrib>Grbac, Lilijana Vouk</creatorcontrib><creatorcontrib>Jurdana, Mihaela</creatorcontrib><title>Identification of sarcopenic obesity in adults undergoing orthopaedic surgery: Relationship between “a body shape index” (ABSI) and fat-free mass. A cross -sectional study</title><title>PloS one</title><description>Background Sarcopenic obesity is a condition characterised by the coexistence of low muscle mass and function (sarcopenia) and excessive fat mass (obesity). The aim of this study was to determine the prevalence of this condition in patients undergoing orthopaedic surgery by gender and type of orthopaedic surgery. In addition, this study investigated the suitability of a waist circumference-based anthropometric measure, body shape index (ABSI), for predicting sarcopenic obesity and the predictive power of ABSI for fat-free mass index (FFMI), a surrogate marker of lean body mass. Methods and findings A cross-sectional study of overweight and obese orthopaedic patients undergoing knee or hip and spine surgery was conducted between October 2019 and March 2020 in Orthopaedic Hospital Valdoltra, Slovenia. General anthropometric parameters body mass index (BMI) and ABSI = (WC/(BMI.sup.2/3 x height.sup.½) as well as body composition data (fat mass FM, fat-free mass FFM, FFMI, and the ratio FM/FFM as an index of sarcopenic obesity) were determined in 120 women (aged 66.5 ± 9.6 years) and 89 men (aged 65.5 ± 7.8 years) with overweight (25 kg/m.sup.2 [less than or equal to] BMI 0.80 was present in 15.3% of patients, mainly in female patients undergoing knee surgery. ABSI was significantly associated with age in all women and obese men and with waist circumference (WC) in all patients. ABSI did not correlate with BMI in women and men; however, multiple linear regression analysis showed that BMI independently predicted FFMI (R = 0.83 and 0.70, respectively, p < 0.001) in women and men ([beta]-coefficients: 0.801 and 0.686, respectively) and ABSI in women only ([beta]-coefficient: -0.104). Women with a lower ABSI had a significantly higher FFMI than the group with a higher ABSI. Conclusions Sarcopenic obesity was most prevalent in obese women scheduled for knee surgery. In addition, ABSI, independently predicted FFMI in women and represents a significant predictor of sarcopenic obesity.</description><subject>Anthropometry</subject><subject>Bioelectricity</subject><subject>Biology and Life Sciences</subject><subject>Body composition</subject><subject>Body fat</subject><subject>Body mass</subject><subject>Body mass index</subject><subject>Body size</subject><subject>Body weight</subject><subject>Bone surgery</subject><subject>Care and treatment</subject><subject>Coexistence</subject><subject>Complications and side effects</subject><subject>Cross-sectional studies</subject><subject>Fat-free</subject><subject>Fat-free body mass</subject><subject>Health risk assessment</subject><subject>Health risks</subject><subject>Joint surgery</subject><subject>Knee</subject><subject>Lean body mass</subject><subject>Medicine and Health Sciences</subject><subject>Men</subject><subject>Muscles</subject><subject>Musculoskeletal system</subject><subject>Obesity</subject><subject>Orthopedic surgery</subject><subject>Orthopedics</subject><subject>Overweight</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>Phenotypes</subject><subject>Regression analysis</subject><subject>Sarcopenia</subject><subject>Spine</subject><subject>Surgery</subject><subject>Women</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNptkkmOEzEUhksIRDcNN0DCEptmkWDXYMcskEKLIVJLSAxry8Nz4qhiF3YVkF0fBM7AnfokuJIC0ajlhS37f5_f8BfFY4LnpGLk-TYM0ct23gUPc1xSzht6pzglvCpntMTV3X_OJ8WDlLYYN9WC0vvFSdWwijC-OC1-rQz43lmnZe-CR8GiJKMOHXinUVCQXL9HziNphrZPaPAG4jo4v0Yh9pvQSTBZmIa4hrh_gT5AewCljeuQgv4bgEfXVz8kUsHsUdrIDjLOwPfrq5_ofPnq4-oZkt4gK_uZjQBoJ1OaoyXSMaSEZgn0yJMtSv1g9g-Le1a2CR5N-1nx-c3rTxfvZpfv364ulpcz3TDcz7TWRhqqKK2NAlkTY3HNygYbbLi21FJeLUqmQClVsoqXjbEVUCBEa8VZWZ0VT47crg1JTL1OoqQLxnKzKcuK1VFhgtyKLrqdjHsRpBOHixDXQsbe6RaEJGbBatnwuqnrBoOqtaxBqspyS1gzsl5Ovw1qB0bnkUTZ3oDefPFuI9bhq-AloZSMgPMJEMOXAVIvdi5paFvpIQxj3oxTzrIfsvTpf9Lbq5tUa5kLcN6G_K8eoWLJ8AjjC5xV81tUeRnYOZ2NaV2-vxFQHwMO041g_9ZIsBht_ScZMdpaTLaufgPGKfDG</recordid><startdate>20220622</startdate><enddate>20220622</enddate><creator>Tomazic, Ana</creator><creator>Zvanut, Bostjan</creator><creator>Grbac, Lilijana Vouk</creator><creator>Jurdana, Mihaela</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-4514-7001</orcidid></search><sort><creationdate>20220622</creationdate><title>Identification of sarcopenic obesity in adults undergoing orthopaedic surgery: Relationship between “a body shape index” (ABSI) and fat-free mass. A cross -sectional study</title><author>Tomazic, Ana ; Zvanut, Bostjan ; Grbac, Lilijana Vouk ; Jurdana, Mihaela</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c570t-cccdad6b664dbea41df047250d0d9cf6f693827bebbb273925df3e6e11ccb9723</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Anthropometry</topic><topic>Bioelectricity</topic><topic>Biology and Life Sciences</topic><topic>Body composition</topic><topic>Body fat</topic><topic>Body mass</topic><topic>Body mass index</topic><topic>Body size</topic><topic>Body weight</topic><topic>Bone surgery</topic><topic>Care and treatment</topic><topic>Coexistence</topic><topic>Complications and side effects</topic><topic>Cross-sectional studies</topic><topic>Fat-free</topic><topic>Fat-free body mass</topic><topic>Health risk assessment</topic><topic>Health risks</topic><topic>Joint surgery</topic><topic>Knee</topic><topic>Lean body mass</topic><topic>Medicine and Health Sciences</topic><topic>Men</topic><topic>Muscles</topic><topic>Musculoskeletal system</topic><topic>Obesity</topic><topic>Orthopedic surgery</topic><topic>Orthopedics</topic><topic>Overweight</topic><topic>Patient outcomes</topic><topic>Patients</topic><topic>Phenotypes</topic><topic>Regression analysis</topic><topic>Sarcopenia</topic><topic>Spine</topic><topic>Surgery</topic><topic>Women</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tomazic, Ana</creatorcontrib><creatorcontrib>Zvanut, Bostjan</creatorcontrib><creatorcontrib>Grbac, Lilijana Vouk</creatorcontrib><creatorcontrib>Jurdana, Mihaela</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Animal Behavior Abstracts</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Ecology Abstracts</collection><collection>Entomology Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Meteorological & Geoastrophysical Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Agricultural Science Collection</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Materials Science & Engineering Collection</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>Agricultural & Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Materials Science Collection</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Materials Science Database</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Meteorological & Geoastrophysical Abstracts - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tomazic, Ana</au><au>Zvanut, Bostjan</au><au>Grbac, Lilijana Vouk</au><au>Jurdana, Mihaela</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Identification of sarcopenic obesity in adults undergoing orthopaedic surgery: Relationship between “a body shape index” (ABSI) and fat-free mass. A cross -sectional study</atitle><jtitle>PloS one</jtitle><date>2022-06-22</date><risdate>2022</risdate><volume>17</volume><issue>6</issue><spage>e0269956</spage><epage>e0269956</epage><pages>e0269956-e0269956</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Background Sarcopenic obesity is a condition characterised by the coexistence of low muscle mass and function (sarcopenia) and excessive fat mass (obesity). The aim of this study was to determine the prevalence of this condition in patients undergoing orthopaedic surgery by gender and type of orthopaedic surgery. In addition, this study investigated the suitability of a waist circumference-based anthropometric measure, body shape index (ABSI), for predicting sarcopenic obesity and the predictive power of ABSI for fat-free mass index (FFMI), a surrogate marker of lean body mass. Methods and findings A cross-sectional study of overweight and obese orthopaedic patients undergoing knee or hip and spine surgery was conducted between October 2019 and March 2020 in Orthopaedic Hospital Valdoltra, Slovenia. General anthropometric parameters body mass index (BMI) and ABSI = (WC/(BMI.sup.2/3 x height.sup.½) as well as body composition data (fat mass FM, fat-free mass FFM, FFMI, and the ratio FM/FFM as an index of sarcopenic obesity) were determined in 120 women (aged 66.5 ± 9.6 years) and 89 men (aged 65.5 ± 7.8 years) with overweight (25 kg/m.sup.2 [less than or equal to] BMI 0.80 was present in 15.3% of patients, mainly in female patients undergoing knee surgery. ABSI was significantly associated with age in all women and obese men and with waist circumference (WC) in all patients. ABSI did not correlate with BMI in women and men; however, multiple linear regression analysis showed that BMI independently predicted FFMI (R = 0.83 and 0.70, respectively, p < 0.001) in women and men ([beta]-coefficients: 0.801 and 0.686, respectively) and ABSI in women only ([beta]-coefficient: -0.104). Women with a lower ABSI had a significantly higher FFMI than the group with a higher ABSI. Conclusions Sarcopenic obesity was most prevalent in obese women scheduled for knee surgery. In addition, ABSI, independently predicted FFMI in women and represents a significant predictor of sarcopenic obesity.</abstract><cop>San Francisco</cop><pub>Public Library of Science</pub><pmid>35731798</pmid><doi>10.1371/journal.pone.0269956</doi><orcidid>https://orcid.org/0000-0002-4514-7001</orcidid><oa>free_for_read</oa></addata></record> |
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| source | DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Anthropometry Bioelectricity Biology and Life Sciences Body composition Body fat Body mass Body mass index Body size Body weight Bone surgery Care and treatment Coexistence Complications and side effects Cross-sectional studies Fat-free Fat-free body mass Health risk assessment Health risks Joint surgery Knee Lean body mass Medicine and Health Sciences Men Muscles Musculoskeletal system Obesity Orthopedic surgery Orthopedics Overweight Patient outcomes Patients Phenotypes Regression analysis Sarcopenia Spine Surgery Women |
| title | Identification of sarcopenic obesity in adults undergoing orthopaedic surgery: Relationship between “a body shape index” (ABSI) and fat-free mass. A cross -sectional study |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-09T07%3A52%3A31IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Identification%20of%20sarcopenic%20obesity%20in%20adults%20undergoing%20orthopaedic%20surgery:%20Relationship%20between%20%E2%80%9Ca%20body%20shape%20index%E2%80%9D%20(ABSI)%20and%20fat-free%20mass.%20A%20cross%20-sectional%20study&rft.jtitle=PloS%20one&rft.au=Tomazic,%20Ana&rft.date=2022-06-22&rft.volume=17&rft.issue=6&rft.spage=e0269956&rft.epage=e0269956&rft.pages=e0269956-e0269956&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0269956&rft_dat=%3Cgale_plos_%3EA707969980%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2687702667&rft_id=info:pmid/35731798&rft_galeid=A707969980&rft_doaj_id=oai_doaj_org_article_a1d874a59454450eb4ca4eab3f9f1757&rfr_iscdi=true |