2 Tropical Animal Medicine Center of Hainan Tropical Agricultural Resources Research Institute, Sanya, 572025, China
Author Correspondence author
Genomics and Applied Biology, 2024, Vol. 15, No. 3 doi: 10.5376/gab.2024.15.0015
Received: 28 Mar., 2024 Accepted: 06 May, 2024 Published: 17 May, 2024
Wang Z.L., and Lin X.F., 2024, Nutritional genomics in pet animals: interactions between diet and genetics, Genomics and Applied Biology, 15(3): 132-141 (doi: 10.5376/gab.2024.15.015)
Nutrigenomics, a rapidly evolving field, studies the complex interactions between diet and genetics, aiming to provide personalized nutritional strategies for optimal health. In pets, this emerging area of research focuses on understanding how genetic variation influences nutritional needs and dietary responses. This study highlights key aspects of pet nutrigenomics, including the role of genetic markers in nutrient metabolism, breed-specific genetic influences on diet, and the effects of macronutrient composition on gene expression. It also discusses the application of high-throughput genomic technologies, the development of personalized pet diets, and the integration of genomics into veterinary practice. While nutrigenomics holds great promise, challenges such as ethical considerations, technical barriers, and economic limitations must be addressed. Future research opportunities lie in advancing breed-specific nutritional strategies and further exploring the interaction between diet and gene expression. The application of nutrigenomics in veterinary medicine has the potential to revolutionize pet health, providing more precise interventions to improve longevity and quality of life.
1 Introduction
The field of nutritional genomics, also known as nutrigenomics, explores the intricate interactions between diet and genetic factors to understand how nutrients influence gene expression and how an individual’s genetic makeup can affect their response to specific dietary components. Initially focused on human health, this field has now expanded to companion animals. Pet owners are increasingly seeking personalized nutrition for their pets, recognizing that animals, like humans, have unique genetic profiles influencing their health and dietary needs. The rise in demand for personalized pet nutrition demonstrates the need for deeper insights into how genetics and nutrition interact to improve overall pet health.
Nutritional genomics studies how nutrients interact with the genome, regulating gene expression and metabolic pathways, and influencing health outcomes. By understanding these interactions, personalized nutrition can be tailored to the genetic makeup of individual pets to optimize their health. This means diets can be specifically designed to cater to each pet’s unique genetic profile, much like approaches used in human nutrigenomics (Rozga and Handu, 2019). Nutritional genomics has already demonstrated potential in human health for preventing chronic diseases like diabetes and cardiovascular conditions, with similar applications now being explored for animals (Franzago et al., 2020; Rahman et al., 2020).
The application of nutritional genomics in pet health offers significant benefits, including the ability to prevent or manage diseases like obesity, diabetes, and digestive disorders through personalized diets tailored to a pet’s genetic predispositions (Bordoni and Gabbianelli, 2019). Nutrigenomics allows for breed-specific diets or individualized plans, enhancing health and performance while potentially extending a pet's lifespan (Mullins et al., 2020). Furthermore, it provides veterinarians with more precise tools for disease prevention and management, improving the overall quality of life for pets.
This study will provide a comprehensive overview of the current state of nutrigenomics in pets, focusing on how diet and genetic factors interact to influence health outcomes. The research emphasizes the importance of personalized nutrition in promoting optimal health in companion animals and explores the potential challenges and opportunities of integrating genomics into pet nutrition practices. By synthesizing the latest research, this study aims to inform veterinarians, pet owners, and researchers about the critical role nutrigenomics plays in advancing pet health.
2 The Role of Genetics in Pet Nutrition
The role of genetics in pet nutrition is a growing area of interest, as it helps us understand how genetic variability influences the nutritional requirements and dietary responses of companion animals. By identifying genetic markers and breed-specific traits, veterinarians and pet nutritionists can create tailored dietary plans that optimize health and well-being.
2.1 Genetic variability and nutritional requirements
Genetic variability plays a crucial role in determining the nutritional needs of individual animals. Genetic differences can influence metabolism, nutrient absorption, and the utilization of specific dietary components, leading to variability in how pets respond to different diets. For instance, energy and protein requirements can vary significantly based on genetic factors that influence metabolic rate, growth, and body composition (Gaillard et al., 2019). Understanding these genetic differences is essential for optimizing nutrition to support growth, maintain healthy body weight, and prevent conditions like obesity or malnutrition.
2.2 Genetic markers associated with dietary response
Genetic markers, particularly single nucleotide polymorphisms (SNPs), have been increasingly studied for their role in influencing how pets respond to different dietary components. These markers are variations in DNA sequences that can affect an individual’s metabolism, nutrient absorption, and disease susceptibility. For example, in dogs, SNPs in genes related to lipid metabolism, such as the FADS1 and FADS2 genes, are known to influence how efficiently omega-3 and omega-6 fatty acids are processed. These fatty acids are critical for maintaining skin health, cognitive function, and reducing inflammation. Animals with specific genetic variants in these genes may require tailored diets to ensure they receive the correct balance of these essential nutrients (Fabretti et al., 2020). Similarly, markers linked to the insulin-like growth factor 1 (IGF1) gene have been associated with body size and growth patterns in dogs, influencing the protein and caloric needs of different breeds (Wilding, 2018).
Moreover, research in companion animals has highlighted the importance of these genetic markers in managing conditions like obesity and diabetes. Variants in genes such as the PPAR-γ gene, which is involved in fat storage and glucose metabolism, can affect how an animal metabolizes carbohydrates and fats, making them more or less prone to weight gain. Identifying these genetic markers allows veterinarians and pet nutritionists to recommend diets that are more suited to an individual pet’s metabolic profile, helping to prevent or manage weight-related health issues (Rapkin et al., 2018). For instance, animals with a genetic predisposition to obesity may benefit from low-carbohydrate, high-protein diets that minimize fat accumulation. This precision nutrition approach, guided by genetic information, is increasingly being seen as a way to improve pet health and longevity by addressing specific dietary needs based on an individual’s genetic makeup.
2.3 Influence of breed-specific genetics on diet
Breed-specific genetics have a profound influence on the nutritional requirements of pets, as different breeds often have distinct metabolic rates, body compositions, and predispositions to certain health conditions. Large breeds such as Great Danes and Saint Bernards, for instance, typically require diets that are higher in protein and fat to support their muscle mass and higher energy expenditure. These breeds are also more prone to joint and skeletal issues, which can be managed through the inclusion of specific nutrients like glucosamine, chondroitin, and omega-3 fatty acids that promote joint health (Dougherty et al., 2022). On the other hand, small breeds such as Chihuahuas or Pomeranians have faster metabolisms relative to their size but require fewer overall calories. Their diets need to be carefully balanced to prevent obesity, a common issue among smaller breeds. Furthermore, some small breeds are prone to dental problems, making nutrient-dense kibble or softer foods a preferable option to support oral health (Wilding, 2018).
In addition to basic metabolic differences, breed-specific genetics often play a role in predisposition to certain diseases, which can be mitigated through tailored nutrition. For instance, breeds like Golden Retrievers and Labradors are genetically predisposed to obesity and may benefit from diets lower in fat and higher in fiber to aid in weight management (Fabretti et al., 2020). Additionally, certain breeds are more likely to develop food sensitivities or allergies. For example, some Terrier breeds are more susceptible to gastrointestinal issues, which require diets formulated with easily digestible proteins and limited ingredient formulas to prevent adverse reactions. Understanding these genetic predispositions allows veterinarians and pet nutritionists to recommend diets that not only meet the general nutritional needs of the breed but also address specific health concerns, potentially increasing longevity and improving the quality of life for these animals (Rapkin et al., 2018).
3 Diet and its Interaction with the Pet Genome
The interaction between diet and the genome plays a significant role in shaping the health outcomes of companion animals (Tan et al., 2022). Nutritional genomics helps us understand how different dietary components can influence gene expression, epigenetic modifications, and the overall health of pets.
3.1 Nutrient-gene interactions
Nutrient-gene interactions refer to the way specific nutrients influence gene expression and how genetic variations impact an animal’s response to dietary components. These interactions are a cornerstone of nutritional genomics and help explain why individual pets may have different reactions to the same diet (Mondal and Panda, 2020). For example, certain genetic variations in the enzymes responsible for metabolizing fats and carbohydrates can lead to differences in how efficiently these nutrients are processed. Pets with specific variants in the FADS1 and FADS2 genes, which regulate fatty acid desaturation, may have varying levels of polyunsaturated fatty acids in their tissues, affecting their risk for inflammation-related diseases or cardiovascular issues (Figure 1) (Simopoulos, 2019). Similarly, variations in genes responsible for carbohydrate metabolism can influence insulin sensitivity, predisposing some pets to diabetes if fed a high-carbohydrate diet. These findings emphasize the need for personalized nutrition strategies that take into account an individual animal's genetic predispositions to optimize health outcomes.
Figure 1 Synthesis pathway of long-chain polyunsaturated fatty acids (LC-PUFA) from essential fatty acids n-6 and n-3 (Adapted from Glaser et al., 2010) Image caption: FADS2 catalyzes the Δ-6 desaturation of linoleic acid (LA) into gamma-linolenic acid (GLA) and alpha-linolenic acid (ALA) into eicosatetraenoic acid (ETA). These products are further converted by FADS1-mediated Δ-5 desaturation into arachidonic acid (AA) and eicosapentaenoic acid (EPA). Polymorphisms in the FADS1 and FADS2 genes can affect the activity of these enzymes, thereby influencing the metabolism of PUFAs and ultimately affecting the concentrations of long-chain PUFAs like AA and EPA in the bloodstream (Adapted from Glaser et al., 2010) |
Recent advances in technologies like RNA sequencing have provided deeper insights into how nutrients regulate gene expression at a cellular level. For instance, studies using RNA-Seq technology have revealed that dietary interventions can trigger widespread changes in gene expression that influence metabolic pathways, immune responses, and even behavior in animals (Hasan et al., 2019). By examining the entire transcriptome, researchers have identified how specific nutrients, such as omega-3 fatty acids or certain amino acids, can upregulate or downregulate genes involved in fat metabolism, inflammation, and antioxidant defenses. This ability to monitor changes in gene expression helps to fine-tune dietary interventions, making it possible to design precise diets that can prevent or mitigate genetic risks in pets. For example, a dog with a predisposition to arthritis could benefit from a diet rich in omega-3 fatty acids, which downregulates pro-inflammatory genes, potentially delaying the onset of the disease or alleviating symptoms. Understanding nutrient-gene interactions allows for these tailored approaches, ensuring that each pet receives a diet that supports its unique genetic makeup.
3.2 Epigenetic modifications induced by diet
Epigenetic modifications refer to changes in gene expression that occur without altering the underlying DNA sequence, primarily through mechanisms such as DNA methylation, histone modification, and non-coding RNA interactions. These modifications can be significantly influenced by diet, with certain nutrients acting as modulators of gene expression. For example, folate and other B vitamins are key components in the methylation cycle, contributing to DNA methylation processes that regulate gene activity. Diets rich in methyl donors (such as folate, choline, and methionine) can lead to increased DNA methylation, potentially silencing genes associated with disease pathways, such as inflammation or cancer (Andreescu et al., 2018). These modifications are crucial for maintaining homeostasis and regulating various physiological functions in pets, influencing everything from metabolic pathways to immune responses.
Furthermore, dietary components such as polyunsaturated fatty acids (PUFAs), particularly omega-3 and omega-6 fatty acids, have been shown to influence histone modifications, thereby regulating genes involved in inflammation and metabolism. Omega-3 fatty acids, for instance, can decrease the expression of pro-inflammatory genes by altering histone acetylation patterns. This is particularly relevant for pets with a predisposition to inflammatory conditions such as arthritis or inflammatory bowel disease, where dietary interventions could modulate gene expression to reduce inflammation (Simopoulos, 2019). Epigenetic changes induced by diet are not only critical for short-term health outcomes but can also have long-lasting effects across generations. Emerging evidence suggests that these epigenetic modifications can be inherited, meaning that a pet’s nutritional environment can impact not only its own gene expression but also that of its offspring, influencing health outcomes in future generations. This highlights the importance of diet in the broader context of pet health and longevity, as well as the potential for personalized nutrition to optimize epigenetic health across generations.
3.3 Impact of macronutrient composition on gene expression
The composition of macronutrients in a pet’s diet—proteins, carbohydrates, and fats—has a direct influence on gene expression, regulating key metabolic pathways that affect health and performance. Protein intake, for instance, is closely associated with the expression of genes involved in muscle growth and tissue repair. High-protein diets can upregulate anabolic pathways, enhancing muscle synthesis and promoting lean body mass in both dogs and cats. This is particularly important in active and working pets, where the demand for muscle maintenance is high. Studies in animal models have demonstrated that protein-rich diets can activate genes involved in the insulin-like growth factor (IGF) signaling pathway, which is crucial for muscle development and overall growth (Rapkin et al., 2018). On the other hand, carbohydrate-rich diets influence genes related to glucose metabolism, promoting the expression of genes that regulate insulin sensitivity and glucose uptake. This can have significant implications for pets with metabolic disorders, such as obesity and diabetes, as excessive carbohydrate consumption may dysregulate these pathways and exacerbate insulin resistance.
Similarly, the type and amount of fat in the diet can alter the expression of genes involved in lipid metabolism and inflammation. Diets high in omega-3 fatty acids, for example, have been shown to downregulate the expression of pro-inflammatory genes, such as those involved in the nuclear factor-kappa B (NF-κB) pathway, while upregulating genes responsible for anti-inflammatory responses (Andreescu et al., 2018). This can be beneficial for managing inflammatory conditions in pets, including arthritis and skin disorders. Conversely, diets high in saturated fats may activate genes associated with fat storage and lipid accumulation, increasing the risk of obesity and cardiovascular issues. Genetic predispositions can further amplify these effects, making it essential to tailor macronutrient ratios according to the individual pet's genetic profile to optimize their health and longevity. Understanding the intricate relationship between macronutrient composition and gene expression allows for more precise dietary interventions, supporting the prevention and management of various health conditions in pets.
4 Case Studies in Nutritional Genomics of Pet Animals
4.1 Canine nutritional genomics: obesity and metabolism
Canine obesity is a growing concern, as it significantly impacts a dog's overall health, lifespan, and quality of life. Nutritional genomics has become an essential tool in understanding the genetic and molecular underpinnings of obesity and metabolic dysfunction in dogs. Research shows that high-fat diets (HFDs) can induce profound changes in canine metabolism, with shifts in lipid and fatty acid metabolism being key contributors to obesity-related disorders. In one study, dogs fed a high-fat diet exhibited notable increases in body weight, hyperlipidemia, and impaired insulin sensitivity (Figure 2). Metabolomic analyses revealed altered levels of metabolites such as stearidonic acid and long-chain ceramides, which are involved in fat metabolism and energy regulation. These metabolic disruptions underline the complexity of obesity as a multi-faceted condition involving both genetic predisposition and dietary influences (Qu et al., 2022).
Figure 2 Experimental design of the effects of high-fat diet (HFD) on obesity and metabolic disorders in dogs, and comparison of body weight and body fat data (Adapted from Qu et al., 2022) Image caption: In the experiment, 18 healthy male Beagles were randomly divided into a normal diet control group (NC) and a high-fat diet group (HFD) for a duration of 24 weeks. The study revealed that dogs in the HFD group experienced significant weight gain, with an approximate 60% increase in body weight after 24 weeks. Body Mass Index (BMI), Body Condition Score (BCS), and subcutaneous fat thickness were also significantly higher in the HFD group compared to the NC group (Adapted from Qu et al., 2022) |
Additionally, canine obesity has been linked to significant changes in glucose metabolism and inflammation, further complicating the management of the condition. Proteomic analyses have identified numerous proteins associated with lipid metabolism, immune system function, and inflammatory pathways that are elevated in obese dogs with metabolic dysfunction. For example, obese dogs with insulin resistance and dysregulated adipokine levels show increased markers of inflammation and liver dysfunction, paralleling many features of human metabolic syndrome (Tvarijonaviciute et al., 2019). Fortunately, weight loss interventions that involve dietary modifications, such as high-protein, high-fiber diets, have been shown to reverse many of these metabolic changes. Dogs that undergo controlled weight loss programs demonstrate improved insulin sensitivity, reduced inflammatory markers, and healthier gut microbiota profiles. These findings underscore the importance of integrating genomics with dietary strategies to manage canine obesity effectively (Phungviwatnikul et al., 2021).
4.2 Feline nutritional genomics: dietary impact on kidney health
Chronic kidney disease (CKD) is highly prevalent among aging cats and is often associated with progressive damage to the kidneys, leading to loss of function. Genetic predispositions in certain cat breeds, such as Persians and Siamese, increase the likelihood of developing CKD. Nutritional interventions are crucial in managing the progression of CKD, as adjusting the protein, phosphorus, and omega-3 fatty acid content of a cat’s diet can significantly influence kidney health and slow disease progression (Samblas et al., 2019). Studies have shown that diets with reduced protein and phosphorus content, as well as increased omega-3 fatty acids, can alleviate some of the strain on the kidneys by modulating gene expression involved in inflammatory and fibrotic pathways (Parker, 2021). This has been supported by research identifying changes in gene expression related to kidney fibrosis and inflammation in feline CKD, where nutrients play a direct role in regulating these pathways (Lawson et al., 2018).
Additionally, emerging research suggests that certain genetic markers in cats may predict susceptibility to CKD and guide more personalized dietary interventions. MicroRNAs, small non-coding RNAs that regulate gene expression, have been found to play a role in the development of CKD in cats. These microRNAs can influence the expression of genes involved in inflammation and fibrosis, making them potential biomarkers for early detection of kidney disease. By identifying cats with specific genetic predispositions, veterinarians can recommend dietary adjustments that may mitigate the progression of CKD, offering a more targeted approach to treatment (Bateman, 2020). This intersection of genetics and nutrition in managing feline kidney health represents a promising area of research for extending the quality and length of life in affected cats.
4.3 Genomic approaches in managing pet allergies
Pet allergies, particularly food-related allergies, are increasingly understood through genomic research. Genetic predispositions to allergies in both dogs and cats can be identified through the presence of specific genetic markers. Nutritional strategies, such as hypoallergenic diets, can be developed based on an animal’s genetic profile. Studies have shown that genomic approaches, including gene-expression analysis, can identify immune response genes activated during allergic reactions, allowing for tailored nutritional interventions (Yamazaki et al., 2021). For example, elimination diets have been found to reduce the expression of inflammatory genes associated with food allergies in pets, helping manage symptoms more effectively.
5 Advances in Nutritional Genomics Technologies for Pets
5.1 High-throughput genomic analysis in pet nutrition
High-throughput genomic technologies, such as next-generation sequencing (NGS) and other omics-based approaches, have revolutionized the study of pet nutrition by enabling comprehensive genomic profiling. These technologies allow researchers to analyze vast amounts of genetic data efficiently, helping identify genes and biomarkers related to nutrient absorption, metabolism, and disease resistance in pets (Giza et al., 2022). Techniques like whole-genome sequencing (WGS) and transcriptomics have been applied to various animal species, offering insights into breed-specific nutritional needs and the genetic underpinnings of obesity, metabolic disorders, and other conditions that can be managed through diet.
These genomic analyses also help in the development of nutritionally tailored interventions by identifying how different nutrients interact with pet genomes. Such data has been critical in studying microbiome composition, gut health, and metabolic pathways in pets, contributing to a better understanding of how diet can influence gene expression and overall health (Opetz et al., 2022).
5.2 Development of personalized pet diets
Personalized pet diets have emerged as a major application of nutritional genomics. With the ability to analyze individual genetic profiles, veterinarians and pet nutritionists can develop customized diets that meet the specific nutritional needs of each pet, taking into account factors such as breed, age, weight, and genetic predispositions. High-throughput technologies have made it possible to identify genetic markers related to nutrient metabolism, which allows for more precise dietary recommendations to prevent and manage conditions like obesity and kidney disease (Quijada et al., 2020).
For example, personalized diets designed for pets with genetic susceptibility to metabolic diseases can include adjusted protein or fat content to promote healthier body weight and metabolic function. These diets can also be used to manage chronic conditions like diabetes or allergies, improving quality of life through targeted nutrition (Yang, 2019).
5.3 Integration of genomics with veterinary practices
The integration of genomics into routine veterinary practices has the potential to significantly enhance pet healthcare. Genomic testing can be used to screen for genetic predispositions to dietary-related conditions, allowing for early interventions that prevent the onset of disease. Moreover, genomic data can inform more accurate diagnosis and treatment plans based on the individual genetic makeup of pets, thereby improving the efficacy of dietary and medical interventions (Gutierrez et al., 2018).
Additionally, veterinarians are beginning to use genomics to understand how pets metabolize medications, which can guide the selection of appropriate pharmaceutical treatments. By integrating genomics into everyday veterinary care, pet healthcare providers can create a more holistic approach to managing health, combining diet, genetics, and medication for optimized outcomes (Nikas and Ryu, 2022).
6 Challenges and Future Directions
6.1 Ethical considerations in nutritional genomics for pets
Nutritional genomics raises several ethical questions, particularly concerning the welfare of animals. Genetic testing for personalized pet nutrition must balance the benefits of improved health outcomes with concerns about genetic privacy, consent (for pets), and the potential misuse of genomic data. Ethical concerns also extend to whether testing and treatments serve the animal's best interests or are primarily driven by owner preferences (Horton and Lucassen, 2022). Furthermore, over-reliance on genomic testing may lead to prioritizing expensive and unnecessary interventions that could disproportionately affect pets from lower-income households, raising issues of equity in pet healthcare.
6.2 Technological and economic barriers
Despite advancements in genomic technologies, several challenges hinder their widespread adoption in veterinary practices. One key barrier is the high cost of genomic testing and personalized diet formulation, which can be prohibitive for many pet owners. Additionally, the technological infrastructure required to process and analyze high-throughput genomic data is often unavailable in standard veterinary clinics, limiting access to these services (Yang, 2019). Furthermore, the integration of genomic data with clinical outcomes requires sophisticated bioinformatics tools and trained personnel, which adds to the cost and complexity of implementing personalized pet nutrition (Moore, 2020).
6.3 Future research opportunities
The future of nutritional genomics in pet animals holds great promise, particularly in the development of more precise and cost-effective genetic tests. Research into breed-specific genetic markers and the role of the microbiome in pet nutrition could lead to novel, personalized diets that address common health concerns like obesity, diabetes, and kidney disease. There is also significant potential to explore epigenetic changes in response to diet, which could provide insights into how nutrition can influence gene expression over an animal’s lifetime and across generations (Garcia et al., 2019). Additionally, there is a need for more extensive clinical trials that assess the long-term benefits of genomic-based diets on pet health outcomes, which would help validate the efficacy of these personalized nutrition plans (Bonner, 2020).
7 Concluding Remarks
Nutritional genomics in pet animals is an emerging field that provides valuable insights into the interactions between diet and genetics, offering opportunities to optimize health outcomes. Throughout this review, we have discussed the critical role genetic variability plays in determining the specific nutritional needs of pets, emphasizing how genetic markers can guide tailored diets. Breed-specific genetic traits also influence nutrient absorption and metabolism, making personalized nutrition an essential tool for managing health conditions. Nutrient-gene interactions highlight how particular nutrients regulate gene expression, which can prevent or manage chronic diseases. Advances in high-throughput genomic technologies have made it possible to conduct comprehensive genomic profiling, enabling the development of more personalized nutrition plans. However, despite these technological advancements, ethical, technological, and economic challenges remain, which must be addressed to ensure that personalized pet diets can be implemented widely and equitably.
The potential impact of nutritional genomics on pet health is significant. By understanding the genetic basis of nutrient metabolism and disease predisposition, veterinarians and pet owners can design diets that not only meet basic nutritional requirements but also target specific genetic susceptibilities. This approach has the potential to reduce the incidence of chronic conditions like obesity, diabetes, and kidney disease, especially in breeds that are predisposed to these health issues. Personalized diets based on genetic profiles can lead to better health outcomes, improved quality of life, and potentially longer lifespans for pets. Additionally, by addressing health issues through nutrition, pet owners may experience reduced veterinary care costs over time. The integration of breed-specific and personalized nutrition into routine pet care could revolutionize the way veterinarians approach disease prevention and management.
As genomic technologies become more widely available and accessible, the field of veterinary medicine stands to benefit greatly from these advancements. Veterinarians will need to develop a deeper understanding of genomics to offer personalized dietary and medical interventions for pets. This shift will require ongoing education, as well as collaboration between veterinarians, geneticists, and nutritionists. Despite the promise of nutritional genomics, it is important to consider the ethical implications and economic barriers that may limit access to these advancements, ensuring that all pet owners and their animals can benefit from personalized care. Ultimately, nutritional genomics has the potential to transform veterinary medicine, offering new insights into the complex relationships between genetics, diet, and disease, and improving the overall health and well-being of pets in the process.
Acknowledgments
Thank you to the reviewers for their rigorous academic approach in reviewing this study’s manuscript and offering many constructive suggestions.
Conflict of Interest Disclosure
The authors affirm that this research was conducted without any commercial or financial relationships that could be construed as a potential conflict of interest.
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