{"id":"https://openalex.org/W7224840258","doi":"https://doi.org/10.3390/jcm15218480","title":"The Relationship Between Trace Element Levels and Arginines in Individuals with Metabolic Syndrome: An Exploratory Cross-Sectional Analysis of Endocrine and Nitric Oxide Metabolism","display_name":"The Relationship Between Trace Element Levels and Arginines in Individuals with Metabolic Syndrome: An Exploratory Cross-Sectional Analysis of Endocrine and Nitric Oxide Metabolism","publication_year":2026,"publication_date":"2026-10-30","ids":{"openalex":"https://openalex.org/W7224840258","doi":"https://doi.org/10.3390/jcm15218480"},"language":"en","primary_location":{"id":"doi:10.3390/jcm15218480","doi":"https://doi.org/10.3390/jcm15218480","is_oa":true,"landing_page_url":"https://doi.org/10.3390/jcm15218480","pdf_url":null,"source":{"id":"https://openalex.org/S2737969411","display_name":"Journal of Clinical Medicine","issn_l":"2077-0383","issn":["2077-0383"],"is_oa":true,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","ki-jl-1","norway-1","poland-140","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310310987","host_organization_name":"Multidisciplinary Digital Publishing Institute","host_organization_lineage":["https://openalex.org/P4310310987"],"host_organization_lineage_names":["Multidisciplinary Digital Publishing Institute"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Clinical Medicine","raw_type":"journal-article"},"volume":null,"type":"article","indexed_in":["crossref"],"open_access":{"is_oa":true,"oa_status":"gold","oa_url":"https://doi.org/10.3390/jcm15218480","any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5084039042","display_name":"Necip Nas","orcid":"https://orcid.org/0000-0002-0927-5217","observed_orcids":["https://orcid.org/0000-0002-0927-5217"]},"institutions":[{"id":"https://openalex.org/I149717392","display_name":"Siirt \u00dcniversitesi","ror":"https://ror.org/05ptwtz25","country_code":"TR","type":"education","lineage":["https://openalex.org/I149717392"]}],"countries":["TR"],"is_corresponding":false,"raw_author_name":"Necip Nas","raw_affiliation_strings":["Department of Internal Medicine, Siirt Training and Research Hospital, 56100 Siirt, T\u00fcrkiye"],"raw_orcid":"https://orcid.org/0000-0002-0927-5217","affiliations":[{"raw_affiliation_string":"Department of Internal Medicine, Siirt Training and Research Hospital, 56100 Siirt, T\u00fcrkiye","institution_ids":["https://openalex.org/I149717392"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5055263846","display_name":"Muzaffer Aslan","orcid":"https://orcid.org/0000-0003-0670-137X","observed_orcids":["https://orcid.org/0000-0003-0670-137X"]},"institutions":[{"id":"https://openalex.org/I149717392","display_name":"Siirt \u00dcniversitesi","ror":"https://ror.org/05ptwtz25","country_code":"TR","type":"education","lineage":["https://openalex.org/I149717392"]}],"countries":["TR"],"is_corresponding":false,"raw_author_name":"Muzaffer Aslan","raw_affiliation_strings":["Department of Cardiology, Siirt Training and Research Hospital, 56100 Siirt, T\u00fcrkiye"],"raw_orcid":"https://orcid.org/0000-0003-0670-137X","affiliations":[{"raw_affiliation_string":"Department of Cardiology, Siirt Training and Research Hospital, 56100 Siirt, T\u00fcrkiye","institution_ids":["https://openalex.org/I149717392"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5088459431","display_name":"Semih Sa\u011fl\u0131k","orcid":"https://orcid.org/0000-0002-4224-9272","observed_orcids":["https://orcid.org/0000-0002-4224-9272"]},"institutions":[{"id":"https://openalex.org/I149717392","display_name":"Siirt \u00dcniversitesi","ror":"https://ror.org/05ptwtz25","country_code":"TR","type":"education","lineage":["https://openalex.org/I149717392"]}],"countries":["TR"],"is_corresponding":false,"raw_author_name":"Semih Saglik","raw_affiliation_strings":["Department of Radiology, Siirt Training and Research Hospital, 56100 Siirt, T\u00fcrkiye"],"raw_orcid":"https://orcid.org/0000-0002-4224-9272","affiliations":[{"raw_affiliation_string":"Department of Radiology, Siirt Training and Research Hospital, 56100 Siirt, T\u00fcrkiye","institution_ids":["https://openalex.org/I149717392"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5048285805","display_name":"Vugar Ali T\u00fcrksoy","orcid":"https://orcid.org/0000-0002-3545-3945","observed_orcids":["https://orcid.org/0000-0002-3545-3945"]},"institutions":[{"id":"https://openalex.org/I2799303410","display_name":"Yozgat Bozok \u00dcniversitesi","ror":"https://ror.org/04qvdf239","country_code":"TR","type":"education","lineage":["https://openalex.org/I2799303410"]}],"countries":["TR"],"is_corresponding":true,"raw_author_name":"Vugar Ali Turksoy","raw_affiliation_strings":["Department of Public Health, Faculty of Medicine, Yozgat Bozok University, 66100 Yozgat, T\u00fcrkiye"],"raw_orcid":"https://orcid.org/0000-0002-3545-3945","affiliations":[{"raw_affiliation_string":"Department of Public Health, Faculty of Medicine, Yozgat Bozok University, 66100 Yozgat, T\u00fcrkiye","institution_ids":["https://openalex.org/I2799303410"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":2,"corresponding_author_ids":["https://openalex.org/A5048285805"],"corresponding_institution_ids":["https://openalex.org/I2799303410"],"apc_list":{"value":2600,"currency":"CHF","value_usd":3137},"apc_paid":{"value":2600,"currency":"CHF","value_usd":3137},"fwci":0.0,"has_fulltext":false,"cited_by_count":0,"citation_normalized_percentile":{"value":0.83953189,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"15","issue":"21","first_page":"8480","last_page":"8480"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10915","display_name":"Trace Elements in Health","score":0.9140999913215637,"subfield":{"id":"https://openalex.org/subfields/2916","display_name":"Nutrition and Dietetics"},"field":{"id":"https://openalex.org/fields/29","display_name":"Nursing"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10915","display_name":"Trace Elements in Health","score":0.9140999913215637,"subfield":{"id":"https://openalex.org/subfields/2916","display_name":"Nutrition and Dietetics"},"field":{"id":"https://openalex.org/fields/29","display_name":"Nursing"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10790","display_name":"Heavy Metal Exposure and Toxicity","score":0.05939999967813492,"subfield":{"id":"https://openalex.org/subfields/2307","display_name":"Health, Toxicology and Mutagenesis"},"field":{"id":"https://openalex.org/fields/23","display_name":"Environmental Science"},"domain":{"id":"https://openalex.org/domains/3","display_name":"Physical Sciences"}},{"id":"https://openalex.org/T10155","display_name":"Nitric Oxide and Endothelin Effects","score":0.023000000044703484,"subfield":{"id":"https://openalex.org/subfields/2737","display_name":"Physiology (medical)"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/metabolic-syndrome","display_name":"metabolic syndrome","score":0.9980000257492065},{"id":"https://openalex.org/keywords/trace-elements","display_name":"trace elements","score":0.9110000133514404},{"id":"https://openalex.org/keywords/arginine-metabolism","display_name":"arginine metabolism","score":0.9679999947547913},{"id":"https://openalex.org/keywords/nitric-oxide-metabolism","display_name":"nitric oxide metabolism","score":0.7910000085830688},{"id":"https://openalex.org/keywords/citrulline","display_name":"citrulline","score":0.843999981880188},{"id":"https://openalex.org/keywords/symmetric-dimethylarginine","display_name":"symmetric dimethylarginine","score":0.8700000047683716},{"id":"https://openalex.org/keywords/asymmetric-dimethylarginine","display_name":"asymmetric dimethylarginine","score":0.9959999918937683},{"id":"https://openalex.org/keywords/l-nmma","display_name":"L-NMMA","score":0.9539999961853027},{"id":"https://openalex.org/keywords/manganese","display_name":"manganese","score":0.7799999713897705},{"id":"https://openalex.org/keywords/selenium","display_name":"selenium","score":0.9570000171661377},{"id":"https://openalex.org/keywords/copper","display_name":"copper","score":0.8640000224113464},{"id":"https://openalex.org/keywords/zinc","display_name":"zinc","score":0.9990000128746033},{"id":"https://openalex.org/keywords/antimony","display_name":"antimony","score":0.6700000166893005},{"id":"https://openalex.org/keywords/molybdenum","display_name":"molybdenum","score":0.9890000224113464},{"id":"https://openalex.org/keywords/thallium","display_name":"thallium","score":0.9990000128746033},{"id":"https://openalex.org/keywords/endothelial-dysfunction","display_name":"endothelial dysfunction","score":0.8489999771118164},{"id":"https://openalex.org/keywords/oxidative-stress","display_name":"oxidative stress","score":0.9710000157356262},{"id":"https://openalex.org/keywords/chronic-low-grade-inflammation","display_name":"low-grade inflammation","score":0.7269999980926514},{"id":"https://openalex.org/keywords/serum-biomarkers","display_name":"serum biomarkers","score":0.5040000081062317},{"id":"https://openalex.org/keywords/trace-element-homeostasis","display_name":"trace element homeostasis","score":0.6990000009536743}],"concepts":[{"id":"https://openalex.org/C126322002","wikidata":"https://www.wikidata.org/wiki/Q11180","display_name":"Internal medicine","level":1,"score":0.6323999762535095},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.6146000027656555},{"id":"https://openalex.org/C134018914","wikidata":"https://www.wikidata.org/wiki/Q162606","display_name":"Endocrinology","level":1,"score":0.6126000285148621},{"id":"https://openalex.org/C2779877776","wikidata":"https://www.wikidata.org/wiki/Q752685","display_name":"Asymmetric dimethylarginine","level":4,"score":0.605400025844574},{"id":"https://openalex.org/C553756173","wikidata":"https://www.wikidata.org/wiki/Q876","display_name":"Selenium","level":2,"score":0.5985999703407288},{"id":"https://openalex.org/C2777468819","wikidata":"https://www.wikidata.org/wiki/Q173670","display_name":"Arginine","level":3,"score":0.5590999722480774},{"id":"https://openalex.org/C2779129087","wikidata":"https://www.wikidata.org/wiki/Q408641","display_name":"Citrulline","level":4,"score":0.5127999782562256},{"id":"https://openalex.org/C164007495","wikidata":"https://www.wikidata.org/wiki/Q24721374","display_name":"Arginase","level":4,"score":0.4943999946117401},{"id":"https://openalex.org/C555293320","wikidata":"https://www.wikidata.org/wiki/Q12206","display_name":"Diabetes mellitus","level":2,"score":0.48399999737739563},{"id":"https://openalex.org/C34682378","wikidata":"https://www.wikidata.org/wiki/Q351792","display_name":"Trace element","level":2,"score":0.48240000009536743},{"id":"https://openalex.org/C519581460","wikidata":"https://www.wikidata.org/wiki/Q207843","display_name":"Nitric oxide","level":2,"score":0.4544999897480011},{"id":"https://openalex.org/C2777090595","wikidata":"https://www.wikidata.org/wiki/Q192466","display_name":"Homocysteine","level":2,"score":0.45170000195503235},{"id":"https://openalex.org/C62231903","wikidata":"https://www.wikidata.org/wiki/Q1057","display_name":"Metabolism","level":2,"score":0.44600000977516174},{"id":"https://openalex.org/C63645605","wikidata":"https://www.wikidata.org/wiki/Q103191","display_name":"Homeostasis","level":2,"score":0.4203999936580658},{"id":"https://openalex.org/C21565614","wikidata":"https://www.wikidata.org/wiki/Q12149006","display_name":"Metabolomics","level":2,"score":0.40380001068115234},{"id":"https://openalex.org/C2780972559","wikidata":"https://www.wikidata.org/wiki/Q550061","display_name":"Endothelial dysfunction","level":2,"score":0.4032000005245209},{"id":"https://openalex.org/C2780578515","wikidata":"https://www.wikidata.org/wiki/Q657193","display_name":"Metabolic syndrome","level":3,"score":0.38100001215934753},{"id":"https://openalex.org/C2780942790","wikidata":"https://www.wikidata.org/wiki/Q372016","display_name":"Pathogenesis","level":2,"score":0.36410000920295715},{"id":"https://openalex.org/C502230775","wikidata":"https://www.wikidata.org/wiki/Q871","display_name":"Arsenic","level":2,"score":0.3314000070095062},{"id":"https://openalex.org/C535196362","wikidata":"https://www.wikidata.org/wiki/Q758","display_name":"Zinc","level":2,"score":0.3131999969482422},{"id":"https://openalex.org/C2776151105","wikidata":"https://www.wikidata.org/wiki/Q898814","display_name":"Oxidative stress","level":2,"score":0.30889999866485596},{"id":"https://openalex.org/C192989942","wikidata":"https://www.wikidata.org/wiki/Q68685","display_name":"Metabolic pathway","level":3,"score":0.30880001187324524},{"id":"https://openalex.org/C55493867","wikidata":"https://www.wikidata.org/wiki/Q7094","display_name":"Biochemistry","level":1,"score":0.30399999022483826},{"id":"https://openalex.org/C14522933","wikidata":"https://www.wikidata.org/wiki/Q531507","display_name":"Micronutrient","level":2,"score":0.296999990940094},{"id":"https://openalex.org/C46699223","wikidata":"https://www.wikidata.org/wiki/Q11078","display_name":"Endocrine system","level":3,"score":0.2969000041484833},{"id":"https://openalex.org/C2908676283","wikidata":"https://www.wikidata.org/wiki/Q2351083","display_name":"Metabolism disorder","level":2,"score":0.28619998693466187},{"id":"https://openalex.org/C2776796294","wikidata":"https://www.wikidata.org/wiki/Q410198","display_name":"Ornithine","level":4,"score":0.2757999897003174},{"id":"https://openalex.org/C165697059","wikidata":"https://www.wikidata.org/wiki/Q900680","display_name":"Inductively coupled plasma mass spectrometry","level":3,"score":0.2639000117778778},{"id":"https://openalex.org/C16525657","wikidata":"https://www.wikidata.org/wiki/Q5201183","display_name":"Cystathionine beta synthase","level":4,"score":0.25189998745918274}],"mesh":[],"locations_count":1,"locations":[{"id":"doi:10.3390/jcm15218480","doi":"https://doi.org/10.3390/jcm15218480","is_oa":true,"landing_page_url":"https://doi.org/10.3390/jcm15218480","pdf_url":null,"source":{"id":"https://openalex.org/S2737969411","display_name":"Journal of Clinical Medicine","issn_l":"2077-0383","issn":["2077-0383"],"is_oa":true,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","ki-jl-1","norway-1","poland-140","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310310987","host_organization_name":"Multidisciplinary Digital Publishing Institute","host_organization_lineage":["https://openalex.org/P4310310987"],"host_organization_lineage_names":["Multidisciplinary Digital Publishing Institute"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Clinical Medicine","raw_type":"journal-article"}],"best_oa_location":{"id":"doi:10.3390/jcm15218480","doi":"https://doi.org/10.3390/jcm15218480","is_oa":true,"landing_page_url":"https://doi.org/10.3390/jcm15218480","pdf_url":null,"source":{"id":"https://openalex.org/S2737969411","display_name":"Journal of Clinical Medicine","issn_l":"2077-0383","issn":["2077-0383"],"is_oa":true,"is_in_doaj":false,"is_core":true,"listed_in":["cwts-core","ki-jl-1","norway-1","poland-140","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310310987","host_organization_name":"Multidisciplinary Digital Publishing Institute","host_organization_lineage":["https://openalex.org/P4310310987"],"host_organization_lineage_names":["Multidisciplinary Digital Publishing Institute"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Clinical Medicine","raw_type":"journal-article"},"sustainable_development_goals":[{"id":"https://metadata.un.org/sdg/3","display_name":"Good health and well-being","score":0.9537000060081482}],"study_designs":[{"id":"https://openalex.org/study-designs/observational-study","display_name":"Observational Study"}],"awards":[],"funders":[],"has_content":{"pdf":false,"grobid_xml":false},"content_urls":null,"referenced_works_count":41,"referenced_works":["https://openalex.org/W74340591","https://openalex.org/W1966736088","https://openalex.org/W1967239550","https://openalex.org/W1986232249","https://openalex.org/W1987254109","https://openalex.org/W1992769985","https://openalex.org/W1997023449","https://openalex.org/W1999042542","https://openalex.org/W2013131201","https://openalex.org/W2074769261","https://openalex.org/W2103714496","https://openalex.org/W2104168812","https://openalex.org/W2117928472","https://openalex.org/W2118067027","https://openalex.org/W2143104968","https://openalex.org/W2146190354","https://openalex.org/W2149418619","https://openalex.org/W2151672477","https://openalex.org/W2302518331","https://openalex.org/W2341653166","https://openalex.org/W2410470526","https://openalex.org/W2535703399","https://openalex.org/W2574667695","https://openalex.org/W2593341591","https://openalex.org/W2790010624","https://openalex.org/W2793435470","https://openalex.org/W2883171854","https://openalex.org/W2888857894","https://openalex.org/W2965351710","https://openalex.org/W3012264214","https://openalex.org/W3176711736","https://openalex.org/W3196445809","https://openalex.org/W4281744295","https://openalex.org/W4380290993","https://openalex.org/W4385348389","https://openalex.org/W4387705895","https://openalex.org/W4394869511","https://openalex.org/W4395447727","https://openalex.org/W7129622559","https://openalex.org/W7133877022","https://openalex.org/W7161290577"],"related_works":["https://openalex.org/W2914863526","https://openalex.org/W4313169386","https://openalex.org/W2073841065","https://openalex.org/W2908334629","https://openalex.org/W2990137813","https://openalex.org/W3004376866","https://openalex.org/W1508905109","https://openalex.org/W7095934060","https://openalex.org/W2734862389","https://openalex.org/W4408260709"],"abstract_inverted_index":{"Background:":[0],"Metabolic":[1],"syndrome":[2],"(MetS)":[3],"is":[4],"characterized":[5],"by":[6,119,141],"a":[7,270],"cluster":[8],"of":[9,42,56,101,262,274],"cardiometabolic":[10],"abnormalities":[11],"associated":[12,301],"with":[13,80,90,175,200,211,302],"endothelial":[14],"dysfunction,":[15],"oxidative":[16],"stress,":[17],"and":[18,29,49,54,74,114,134,147,165,190,198,243,298,304,326],"chronic":[19],"low-grade":[20],"inflammation.":[21],"Disturbances":[22],"in":[23,31,39,78,138,266,329],"the":[24,40,45,67,166,233,307],"arginine\u2013nitric":[25],"oxide":[26],"(NO)":[27],"pathway":[28],"alterations":[30],"trace":[32,52,71],"element":[33,72],"homeostasis":[34],"have":[35],"independently":[36],"been":[37],"implicated":[38],"pathogenesis":[41],"MetS.":[43],"However,":[44],"associations":[46,68],"between":[47,69],"essential":[48],"potentially":[50],"toxic":[51],"elements":[53],"biomarkers":[55,77],"arginine":[57,75],"metabolism":[58,76],"remain":[59],"poorly":[60],"understood.":[61],"This":[62,84],"study":[63,86,158],"aimed":[64],"to":[65,94,255,269,280,321],"investigate":[66],"serum":[70],"concentrations":[73,100],"individuals":[79],"metabolic":[81],"syndrome.":[82],"Methods:":[83],"cross-sectional":[85,314],"included":[87,247],"72":[88],"adults":[89],"MetS":[91],"diagnosed":[92],"according":[93],"International":[95],"Diabetes":[96],"Federation":[97],"criteria.":[98],"Serum":[99],"manganese":[102],"(Mn),":[103],"selenium":[104],"(Se),":[105],"copper":[106],"(Cu),":[107],"zinc":[108],"(Zn),":[109],"antimony":[110],"(Sb),":[111],"molybdenum":[112],"(Mo),":[113],"thallium":[115],"(Tl)":[116],"were":[117,136,300,310],"determined":[118],"inductively":[120],"coupled":[121],"plasma":[122],"mass":[123,144],"spectrometry":[124,145],"(ICP-MS).":[125],"Asymmetric":[126],"dimethylarginine":[127,130],"(ADMA),":[128],"symmetric":[129],"(SDMA),":[131],"N-monomethyl-L-arginine":[132],"(L-NMMA),":[133],"citrulline":[135,283,303],"quantified":[137],"all":[139,148],"samples":[140],"liquid":[142],"chromatography-tandem":[143],"(LC-MS/MS),":[146],"reported":[149],"analyses":[150],"are":[151,168],"based":[152],"on":[153],"these":[154],"LC-MS/MS":[155],"values.":[156],"The":[157,219,282],"was":[159,223,285],"not":[160,238,317],"powered":[161],"for":[162],"multivariable":[163],"modeling,":[164],"findings":[167,315],"therefore":[169],"hypothesis-generating.":[170],"Results:":[171],"Citrulline":[172],"correlated":[173,209],"positively":[174],"Zn":[176],"(\u03c1":[177,184,192,202,213],"=":[178,185,188,193,196,203,214,217,227,230,250,258,289],"0.514,":[179],"q":[180,187,195,205,216],"<":[181,206,292],"0.001),":[182],"Se":[183],"0.428,":[186],"0.002),":[189],"Cu":[191],"0.370,":[194],"0.008)":[197],"inversely":[199,210],"Mn":[201,212,235,267,299],"\u22120.505,":[204],"0.001).":[207,293],"SDMA":[208,221,272],"\u22120.379,":[215],"0.007).":[218],"HC3-robust":[220],"model":[222,284],"significant":[224,286],"overall":[225,287],"(R2":[226,288],"0.219,":[228],"p":[229,257,291],"0.005),":[231],"whereas":[232],"adjusted":[234,308],"coefficient":[236],"did":[237],"reach":[239],"conventional":[240],"statistical":[241],"significance":[242],"its":[244],"95%":[245,252],"CI":[246],"zero":[248],"(B":[249],"\u22120.00475,":[251],"CI,":[253,278],"\u22120.00955":[254],"0.00004;":[256],"0.052).":[259],"An":[260],"increase":[261],"one":[263],"interquartile":[264],"range":[265],"corresponded":[268],"predicted":[271],"change":[273],"\u22120.0414":[275],"\u00b5mol/L":[276],"(95%":[277],"\u22120.0832":[279],"0.0003).":[281],"0.271,":[290],"Conclusions:":[294],"Zn,":[295],"Se,":[296],"Cu,":[297],"SDMA;":[305],"however,":[306],"estimates":[309],"imprecise.":[311],"These":[312],"exploratory":[313],"do":[316],"establish":[318],"causality,":[319],"specificity":[320],"MetS,":[322],"or":[323],"clinical":[324],"benefit":[325],"require":[327],"confirmation":[328],"controlled":[330],"prospective":[331],"studies.":[332]},"counts_by_year":[],"updated_date":"2026-11-04T10:54:05.112534","created_date":"2026-10-31T00:00:00"}