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Relationships between sensory processing patterns and metabolic risk factors among community dwelling people with metabolic syndrome: A cross-sectional and correlational research design
Sensory processing patterns and metabolic risks
https://orcid.org/0000-0003-0280-6297
Pomngen Ilada Conceptualization Data curation Formal analysis Funding acquisition Investigation Methodology Project administration Resources Software Supervision Validation Visualization Writing – original draft Writing – review & editing 1
Sirisatayawong Pornpen Supervision Validation Writing – review & editing 1
Kumsaiyai Warunee Supervision Writing – review & editing 2
Kaunnil Anuchart Supervision Writing – original draft Writing – review & editing 1
Srikhamjak Tiam Conceptualization Methodology Supervision Validation Writing – original draft Writing – review & editing 1 *
1 Faculty of Associated Medical Sciences, Department of Occupational Therapy, Chiang Mai University, Chiang Mai, Thailand
2 Faculty of Associated Medical Sciences, Department of Medical Technology, Chiang Mai University, Chiang Mai, Thailand
Mesz Bruno Alejandro Editor
Universidad Nacional de Tres de Febrero, ARGENTINA
Competing Interests: The authors have declared that no competing interests exist.

* E-mail: tiamsrikhamjak@gmail.com
6 9 2024
2024
19 9 e030842122 2 2024
22 7 2024
© 2024 Pomngen et al
2024
Pomngen et al
https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Background

Metabolic Syndrome (MetS) increases the risk of other serious health problems, particularly cardiovascular diseases and stroke. Sensory processing patterns (SPPs) are internal factors shaping behaviors and emotions, both healthy and unhealthy. There is a lack of studies directly examining the relationship between the SPPs and metabolic risk factors.

Method

This study aimed to investigate SPPs and their association with metabolic risk factors in individuals with metabolic syndrome (MetS). One hundred and seventeen individuals with MetS completed questionnaires on demographic characteristics and the Thai Sensory Patterns Assessment-adult version. Data on metabolic risk factors, including fasting blood glucose, blood pressure, and waist circumference, were collected.

Results

The findings revealed high arousal levels in proprioceptive and auditory senses among the participants. The fasting blood glucose was significantly correlated with a preference in the tactile sense (r = -0.150, P<0.05), while waist circumference was associated with arousal level in the auditory and smell-taste senses (r = 0.140, -0.160, P<0.05). Moreover, the GLMM revealed that fasting blood glucose was associated with preferences in tactile, vestibular, and proprioceptive senses (r = -0.481, 0.726, -0.386, P<0.05). Furthermore, diastolic blood pressure was associated with preferences in vestibular sense (r = 0.099; P<0.05).

Conclusion

The SPPs might be related to metabolic risk factors, so it is important to recognize how individual SPPs relate to metabolic risk factors. However, further studies using a larger sample may be needed to deeply explore the mechanisms underlying these associations.

http://dx.doi.org/10.13039/100022893 Faculty of Associated Medical Sciences, Chiang Mai University AMS-2023 https://orcid.org/0000-0003-0280-6297
Pomngen Ilada This study was supported by Faculty of Associated Medical Sciences, Chiang Mai University, Thailand, Grant Number AMS-2023.The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Data AvailabilityAll relevant data are within the manuscript and its Supporting Information files.
Data Availability

All relevant data are within the manuscript and its Supporting Information files.
==== Body
pmcIntroduction

Non-communicable diseases (NCDs) are the leading causes of death worldwide [1]. Currently, one of the main global public-health challenges is metabolic syndrome (MetS), which is defined as a cluster of metabolic abnormalities, such as insulin resistance, visceral obesity, hypertension, and dyslipidemia [2]. Following the occurrence of MetS, people are more likely to be exposed to and develop other serious health problems, in particular cardiovascular diseases [3] and stroke [4,5]. Over the last decades, MetS has been considered a worldwide epidemic because of its increased prevalence in the general population, which is estimated to be at 25% of the world population [6,7] and 20–27% of Thai adults [8]. Understanding contributing factors to minimize the risks of all-cause morbidity and mortality associated with MetS is crucial.

Sensory processing is defined as the ability of the nervous system regarding reception, organization, and response to surrounding sensory input every minute of the day [9]. Each individual is unique and has different ways of processing and responding to sensory information. These ways of processing are called sensory processing patterns (SPPs) [10]. The SPPs reflect how individuals detect, process, and respond in a certain way to environmental and internal sensory stimuli. This includes what sensory stimuli individuals prefer, those they do not prefer, those they have tolerance for, and those they have experienced pleasure with. It also reflects how the amount of sensory stimuli that an individual’s brain receives can affect how quickly they notice [11]. In general, people are neurobiologically programmed to adapt their responses to environmental stimuli in appropriate ways. However, some people have more difficulties in processing stimuli, especially those with high or low sensory arousal (or sensory sensitivity) and sensory preference, and they may experience difficulties in adapting their behavior or psychological responses to their environmental stimuli, leading them to avoid or prefer certain sensory experiences [12], which can interfere with performance, participation, and engagement in daily activities, and also impacts health and well-being [13].

SPPs may be linked to the development of MetS due to their influence on human emotions, behaviors, and physiological responses. According to neuroscience, the brain initially serves as a site where sensory information is stored and managed for future use by creating maps of body and environment through sensory experiences and memories accumulated throughout one’s lifespan [9,14]. These maps essentially represent one’s unique SPPs [11]. The brain needs sensory information to operate and respond, and it relies on these patterns to figure out what to do each day. Our daily decisions, such as what to do, wear, or eat, are related to the amount and types of sensory input we can manage and prefer, as influenced by SPPs [11]. Moreover, when sensory input is processed by the brain it can trigger various physiological responses and hormones are released from the endocrine glands, influencing metabolic processes and potentially contribute to MetS, such as insulin [15] and cortisol [16]. Interestingly, the mismatch between sensory input and SPPs, like sensory overload, can activate stress responses that impact metabolic regulation through the release of cortisol and can further activate the hypothalamic-pituitary-adrenal (HPA) axis and sympathetic nervous system, a condition previously found in people with Type 1 diabetes [17]. This can lead to changes in heart rate, blood pressure, and energy expenditure, potentially contributing to the development of MetS.

Previous studies found that SPPs are related to health behaviors and psychological factors that contribute to MetS, such as stress [18–20], unhealthy eating behaviors [21], and physical inactivity [22,23]. These associations are mostly found in people with high sensory sensitivity or high sensory arousal patterns. This is because people in this group are more quickly to notice and respond to certain sensory stimuli than those who have typical sensory processing or moderate sensory arousal. Conversely, individuals with low sensory arousal or sensitivity tend to miss and may not respond to certain stimuli. Most of the previous studies have consistently shown that individuals with high sensory sensitivity are more prone to sensory overload in daily life, such as exposure to noise, light, or tactile sensations, leading to chronic stress [19]. Moreover, individuals with greater sensory sensitivity are more likely to engage in emotional eating behaviors triggered by sensory cues from food, such as looking or smelling of food, often as a means of coping with emotions [24]. This occurs because they show higher rates of negative emotion and respond more quickly to food cues than others [18–20]. Additionally, individuals with sensory sensitivity exhibit reduced motivation to engage in physical activity [23], because they easily feel overwhelmed by sensory stimuli associated with exercise environments, such as crowded or noisy gyms or sports events, as well as in environment where intense physical contact is taking place [11].

Based on the evidence provided, the SPPs may indeed play a crucial role in influencing unhealthy psychological and behavioral risks associated with the development and progression of MetS. Previously, although the SPPs have been studied in several groups of people, such as healthy workers [20], healthy adults [18,24], older persons [23], adolescents with Type 1 diabetes [25], and people with multiple sclerosis [26], there currently are no studies specifically focusing on SPPs in people with MetS. Moreover, although previous studies found an association between SPPs and health conditions, such as perceived symptoms of ill health [27] and children’s Body Mass Index [28], there are no studies reporting an association between SPPs with metabolic risk variables, such as fasting blood glucose (FBG), blood pressure (BP), waist circumference (WC), or low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol [2]. Additionally, those studies used assessments, such as the Adolescent/Adult Sensory Profile (AASP) or the Highly Sensitive Person Scale (HSPS), which did not report the SPPs in each specific sensory modality [14,16,19,20,23–26].

The SPPs in adults can be measured through various tools and methods. In past decades, simply asking the person what stimuli they prefer was used [29], but then behavioral observations were later used by presenting specific stimuli and assessing the response of the patient [29,30]. However, behavioral observation requires considerable amounts of time, equipment, and cooperation from the patient. To address these challenges, questionnaires were developed. The most frequently used questionnaire is the Adolescent/Adult Sensory Profile (AASP) [12], which is a self-report used for evaluating behavioral responses to everyday sensory experiences across six sensory domains: taste and smell, movement (vestibular and proprioceptive senses), visual, touch, activity level, and auditory. However, the AASP exhibits some limitations. While its items are organized according to six sensory domains, the scores of all items are summed and interpreted as the SPPs of all sensory domains, including four patterns: low registration, sensation seeking, sensory sensitivity, and sensation avoiding without specifying particular sensory modalities [31]. In fact, individuals may actively seek out some sensory stimuli while avoiding others. Another tool is the Highly Sensitive Person Scale (HSPS), which includes a broad range of items related to high levels of sensory sensitivity or arousal [32]. While interpreting scores of the HSPS can identify individuals with high levels of sensory sensitivity or arousal, it does not provide detailed information about the specific senses involved, which may not offer specific guidance or interventions tailored to individual needs. Importantly, most of the existing tools have been developed in western countries that might be culturally and contextually inappropriate for other cultures [31].

In Thailand, an assessment tool called the Thai Sensory Patterns Assessment-adult version (TSPA) was developed by modifying the items of AASP and changing the interpreting method by separately interpreting the SPPs in each specific sensory modality: visual, auditory, tactile, smell and taste, proprioceptive, and vestibular senses [33]. This tool not only provides understanding of SPPs and insight into each sensory modality, but also provides better understanding of what specific types of sensory input an individual prefers, and how the arousal of the nervous system operates in detecting and responding to specific sensory stimuli in daily life, which is called sensory preferences and sensory arousal, respectively [33]. Moreover, the TSPA has acceptable and similar levels of internal consistency compared with the ASSP (Cronbach’s alpha of TSPA = 0.62–0.89, Cronbach’s alpha of ASSP = 0.639–0.775) [12,33]. Understanding sensory preferences and arousal levels via TSPA can indeed be crucial in understanding behavioral responses to specific sensory input in daily living that serves as a specific guide for tailoring interventions to meet individual needs for health promotion or prevention [31]. Although the TSPA has been used in research, such as using TSPA to understand a student’s lifestyle related SPPs during the COVID-19 crisis [34] and using TSPA to classify the participants for Mind-Body intervention [35], the TSPA tool has not been used in research to study people with MetS.

To fill the gaps, research that specifically investigates SPPs and their association with metabolic risk factors among individuals with MetS is needed in order to specify what sensory processing patterns in specific sensory modalities are associated with metabolic risk factors. Moreover, in Thailand, the prevalence of MetS is continuously increasing, especially in rural areas, which have a higher prevalence than urban areas [36]. Therefore, the purpose of this study was to examine the SPPs of community-dwelling people with MetS and to determine their association with metabolic risk factors that serve as diagnostic criteria for this condition, such as fasting blood glucose (FBG), systolic blood pressure (SBP) and diastolic blood pressure (DBP), and/or waist circumference (WC). Because the evidence commonly shows that behavioral risks of MetS are sedentary lifestyle [37], physical inactivity [38], and unhealthy eating [39], the hypothesis is that (1) people with MetS have a high sensory arousal in the proprioceptive senses or a high preference in smell and taste senses and that (2) levels of sensory preference and/or sensory arousal in smell-taste and/or proprioceptive senses are expected to be significantly associated with the metabolic risk variables: FBG, SBP and DBP, and/or WC.

Materials and methods

Study design

This study used a cross-sectional and correlational design to understand the sensory patterns among people with MetS and examined the association between sensory processing patterns, both sensory preference and sensory arousal, in six sensory modalities (visual, auditory, smell-taste, tactile, vestibular, and proprioceptive senses) and metabolic risk factors, including fasting blood glucose (FBG), systolic blood pressure (SBP), diastolic blood pressure (DBP), and waist circumference (WC).

Ethics statement

This study has been approved by the Research Ethics Committee of the Faculty of Associated Medical Sciences, Chiang Mai University (No. AMSEC-65EX-071) and was conducted in accordance with the Declaration of Helsinki. Written, informed consent to participate in this study was obtained from all patients and the data was analyzed anonymously.

Participants

G* power version 3.1 was used to calculate the sample size (p = 0.05, effect size = 0.30, power = 0.90). The minimum total sample size was 112 participants. The test used for the power calculation in G* power was the correlation test, employing a bivariate normal model.

This study collected data among people with MetS who voluntary participated in the annual health checkup and screening for metabolic diseases at Nam Phrae Health Promotion Hospital in Hang Dong District, Chiang-Mai Province, Thailand during January 1st, 2023 to April 30th, 2023. After health checkup and screening, there were 145 people who met the inclusion criteria and were potentially eligible to participate in this study. Of all those eligible participants, 117 participants with MetS (42 males and 75 females), aged between 35–85 years (mean = 54.31±10.77), completed the questionnaire.

Inclusion criteria was having three of the metabolic risk factors as defined by harmonized criteria for MetS [2], including elevated FBG ≥100 mg/dL, elevated BP ≥130/85 mmHg, and WC >90 cm for males and >80 cm for females. Exclusion criteria was a history of serious mental illness (depression, schizophrenia, bipolar disorder, or anxiety disorder), diagnosis with sensory impairment or chronic diseases (thyroid, respiratory, liver, kidney, and cardiovascular diseases), or the presence of cognitive impairments detected by screening. Because this study used self-reported assessments for collecting the data, the screening of cognitive impairment was needed to ensure that participants were able to assess themselves accurately. The Mental State Examination Thai 10 (MSET-10) [40], which was validated and modified from the Mini-Mental State Examination (MMSE)–Thai version was used. This tool has high sensitivity and specificity to detect cognitive impairment, and the items in this tool were modified to be appropriate for Thai culture, particularly for poorly educated people. The total score is 29, and the cutoff score for cognitive impairment was set at 22 for individuals who completed higher than primary school (sensitivity = 100.00% and specificity = 98.40%), 17 for individuals who complete primary school (sensitivity = 100.00% and specificity = 99.30%), or 14 for individuals who are illiterate or cannot read and write (sensitivity = 100.00% and specificity = 94.00%) [41].

Procedure

Following approval of the study protocol by the Research Ethics Committee of Faculty of Associated Medical Sciences, Chiang Mai University, the participants were drawn from the Nam Phrae Health Promotion Hospital in Hang Dong District, Chiang-Mai Province, Thailand. Purposive sampling was used to recruit the participants. A purposive sampling was the method used to select and recruit specific individuals who are deemed to be the most relevant or most representative of the population being studied by using specific criteria to ensure that participants met the inclusion criteria and were more likely to provide valuable information that aligns with the objectives of the study [42]. The criteria for purposive sampling in this study included: people who (1) have elevated FBG ≥100 mg/dL; (2) have elevated BP ≥130/85 mmHg; (3) have WC >90 cm for males and >80 cm for females; (4) are aged 35 years and above; (5) are able to communicate in the Thai language; (6) are without serious mental illness such as sensory impairment, chronic diseases, or cognitive impairments.

Initially, a physician, who works at Nam Phrae Health Promotion Hospital, screened people who voluntary participated in the annual health checkup and screening for metabolic diseases took place during January 1st, 2023 and April 30th, 2023 by using the purposive sampling criteria. Following the initial screening by a physician, there were a total of 145 individuals with MetS who met the study criteria and were potentially eligible to participate in this study. They were then invited to take part in the study through an advertisement process done by village health volunteers that involved distributing informational flyers and participant information sheets as well as providing relevant details through word-of-mouth to ensure that individuals had access to all relevant details needed to make a decision about participation in the study. Interested individuals were asked to contact the researcher directly via phone. An assessor asked them to complete the demographic questionnaire and used the MSET-10 to ensure they met the inclusion criteria. Finally, 117 participants (the response rate was 80.69%), who met the criteria and agreed to participate in the study were asked to sign a written informed consent and complete the TSPA. The written informed consent for the study was obtained from all participants, all survey responses were anonymous, and the data were analyzed anonymously.

Instruments

Demographic questionnaire

This questionnaire was used to gather data, including age, gender, education levels, career, household income, and marital status.

Measures of metabolic risk factors

Data on metabolic risk factors was collected by a trained nurse from the Health Promotion Hospital in order to ensure the quality of the measurements. Fasting blood glucose (FBG) was collected at early morning and after a 12-hour fasting period by fasting capillary blood glucose testing. Blood pressure (BP) was measured in a sitting position after a 10-minute resting period by using an autonomic sphygmomanometer. The mean of the two measures were used to estimate blood pressure [43]. Waist circumference (WC) was measured to the nearest 0.1 cm, midway between the lowest rib and the iliac crest, using a non-elastic circumference measuring tape in a standing position.

The Thai Sensory Patterns Assessment-adult version (TSPA)

The TSPA was chosen as the tool for measuring SPPs because the TSPA was designed specifically for Thai adults and can specify sensory processing patterns, including sensory preferences and sensory arousals, in specific sensory modalities [33], while other tools, such as the AASP and HSPS, cannot provide detailed information about SPPs in a specific sense.

The Thai Sensory Patterns Assessment (TSPA) tool was developed in Thailand by adapting the items of Dunn’s sensory profile into two parts: sensory preferences and sensory arousals. A sensory preference is defined as the type of sensory stimulus that tends to make individuals feel affirmed and more comfortable, and is even pleasurable when receiving sensory input. Sensory arousals are defined as the level of the nervous system’s alertness to detect, register, and respond to sensory input in daily life.

The TSPA is a self-report measurement, which consists of 60 items and is divided into two parts: one for sensory preferences with 35 items and the second for sensory arousals with 25 items. Each part is divided into six categories based on the type of sensory modalities: visual, auditory, smell and taste, tactile, proprioceptive, and vestibular senses, as confirmed by confirmatory factor analysis (CFA) [33]. In this self-reported assessment, the participants indicated by answering questions on each item about how often they respond to the sensory event in everyday life by rating on a 5-Likert scale in each item: 1 = never, 2 = seldom, 3 = occasionally, 4 = frequently, 5 = always in the part one: sensory preferences. In part two the rating scale for sensory arousals was as follows: 1 = never, 2 = seldom, 3 = occasionally, 4 = frequently, 5 = always in items with high arousal, and 5 = never, 4 = seldom, 3 = occasionally, 2 = frequently, 1 = always in items with low arousal.

The examples of items include: smell-taste sensory preference (“Like eating sweets or smelling food”); proprioceptive sensory preference (“Prefer doing activities that involve pulling, pushing, banging, such as boxing, jumping rope, lifting weights, etc.”); smell-taste sensory arousal (“Can eat food that has a strong or pungent smell”); proprioceptive sensory arousal (“Often break or damage items because of excessive force while handling”). The scores for each sensory modality were summed, interpreted, and reported separately as a percentage (below 25% = low, at 25–75% = moderate, and above 75% = high sensory preferences or levels of sensory arousals).

For psychometric properties, the content validity was determined by examination of the index of item–objective congruence (IOC) of Part One: sensory preferences and Part Two: sensory arousals ranging from 0.60 to 1.00. The internal consistency reliability was an α coefficient of 0.89 for Part One and 0.62 for Part Two. The test–retest reliability with intraclass correlation coefficient (ICC) method was 0.93 in Part One and 0.77 in Part Two. The construct validity by confirmatory factor analysis (CFA) found that there were six factors in each part, and all of the items had a high factor loading (ranging from 0.422 to 0.815 for Part One and 0.484 to 0.849 for Part Two). In conclusion, the TSPA was both valid and reliable at an acceptable level [33].

To avoid bias from self-reporting, before participants completed the questionnaire, researchers provided them with instructions regarding the study’s purpose, the importance of honesty and accuracy in responses, and the anonymity of their answers. To avoid missing data, after participants completed the questionnaire, the researcher rechecked the responses to make sure that all of items were completed.

Data analysis

Statistical analyses were undertaken using the Statistical Package for Social Science (SPSS) software for Windows-Version 20 (SPAA inc., USA). Descriptive statistics were used to analyze data on participant demographical characteristics, metabolic risk factors, and sensory processing patterns. The results were presented as means and standard deviations (SD) for continuous variables (sensory processing pattern and metabolic risk variables), and as percentages for categorical variables (sex, education levels, career, household income, marital status, and age groups). The Kolmogorov-Smirnov test was applied to determine the normal distribution of variables. The test found that sensory patterns and metabolic risk factors were not distributed normally. Differences between age groups and sex for metabolic risk factors and MSET-10 scores were tested using Kruskal-Wallis Test and Mann-Whitney U Test, respectively. Kendall’s Tau was used to examine the relationship between sensory processing patterns, including sensory preferences and arousals in specific modalities, and metabolic risks factors including SBP and DBP, WC, and FBG. The Generalized Linear Mixed Model (GLMM) was employed to examine the association between each metabolic risk factor and sensory patterns in specific sensory modalities. The sensory patterns, both sensory preferences and sensory arousals, in each specific sensory modality were used as explanatory variables, which were included in a single model. Each metabolic risk factor, including SBP, DBP, WC and FBG, was used as target variables (dependent variables) in a separate analysis. SPSS software (Version 20) was used to conduct the GLMM. For the GLMM, a Gaussian family distribution was chosen based on the continuous nature of the dependent variables (metabolic risk variables). The identity link function was selected for each regression model to effectively model the linear relationship between predictors (sensory processing patterns) and outcome variables (metabolic risk factors). Model fit was assessed using Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC), both based on -2 Log Likelihood values, to compare the adequacy of different models. Statistical significance was determined with p-values below 0.05.

Results

After screening, there were a total of 145 individuals with MetS who met the study criteria and were potentially eligible to participate in this study. After an advertisement process, a total of 117 participants agreed to participate in the study and were included in the analysis, while 28 people decided not to participate in the study because of individual reasons regarding time limitations and their personal interests. There was no missing data and there were no participants with incomplete data.

Demographical characteristics

The demographic characteristics of 117 participants with MetS are presented in Table 1. The majority of participants were female (64.1%) aged between 35 and 64 years old (61.5%). In addition, the findings reported that most participants had undertaken primary school (50.3%), had low household income of 5,001–10,000 THB per month (29.9%), and more than 50 percent of all the participants were married (65.8%).

10.1371/journal.pone.0308421.t001 Table 1 Demographic characteristics in people with MetS (n = 117).

Variable	All (n = 117)
n (%)	Male (n = 42)
n (%)	Female (n = 75)
n (%)
	
Sex
    Male
    Female	
42 (35.9)
75 (64.1)	
42 (35.9)
	
75 (64.1)
	
Education Levels
    Under primary school
    Primary school
    High school
    Bachelor’s degree	
17 (14.5)
60 (51.3)
32 (27.4)
8 (6.8)	
6 (14.3)
15 (35.7)
16 (38.1)
5 (11.9)	
11 (14.7)
45 (60.0)
16 (21.3)
3 (4.0)	
Career
    No career
    Contractors
    Merchant
    Government official
    Agriculture
    Officer
    Others: Owner	
22 (18.8)
45 (38.5)
25 (21.4)
4 (3.4)
12 (10.3)
8 (6.8)
1 (0.9)	
6 (14.3)
19 (45.2)
5 (11.9)
2 (4.8)
7 (16.7)
3 (7.1)
0 (0)	
16 (21.3)
26 (34.7)
20 (26.7)
2 (2.7)
5 (6.7)
5 (6.7)
1 (1.3)	
Household income (THB per month)
    Less than 5,000
    5,001–10,000
    10,001–15,000
    15,001–20,000
    20,001–25,000
    More than 25,000	
19 (16.2)
35 (29.9)
27 (23.1)
14 (12.0)
11 (9.4)
11 (9.4)	
8 (19.0)
10 (23.8)
9 (21.4)
6 (14.3)
3 (7.1)
6 (14.3)	
11 (14.7)
25 (33.3)
18 (24.0)
8 (10.7)
8 (10.7)
5 (6.7)	
Marital status
    Single
    Married
    Divorced
    Widowed	
18 (15.4)
77 (65.8)
9 (7.7)
13 (11.1)	
9 (21.4)
28 (66.7)
2 (4.8)
3 (11.9)	
9 (12.0)
49 (65.3)
7 (9.3)
10 (13.3)	
Age
    35–44 years
    45–64 years
    65 years and over
    Age (Mean ± SD)	
19 (16.2)
72 (61.5)
26 (22.2) 54.31±10.77	
9 (21.4)
25 (59.5)
8 (7.1)
53.83±11.74	
10 (13.3)
47 (62.7)
18 (24.0)
54.57±10.26	

The metabolic risk factors and the MSET-10 scores of 117 participants with MetS are presented in Table 2. All participants were without cognitive impairment (mean = 26.98±1.59). The majority of participants were prediabetes (76.07%), stage 1 of hypertension (SBP = 80.34%, DBP = 69.24%), and wrist circumference was 90–95 cm. in males and 80–85 cm. in females (52.14). In addition, there were no significant differences between sex and age in the metabolic risk factors and MSET-10 scores, except for WC that found significant difference between sex (p = <0.001).

10.1371/journal.pone.0308421.t002 Table 2 Metabolic risk factors and MSET-10 scores in people with MetS (n = 117).

Variable	All
(n = 117)
	Male
(n = 42)
	Female
(n = 75)
	P value	
Between sex	Between age	
MSET-10 (Mean ± SD)	26.98±1.59	27.04±1.41	26.94±1.69	0.840a
	0.211b	
FBG
Prediabetes (100–125 mg/dL)
    Mean ± SD
    n (%)
    Diabetes (≥ 126 mg/dL)
    Mean ± SD
    n (%)	115.61±18.17
107.11±8.73
89 (76.07)
142.64±13.20
28 (23.93)	114.14±17.04
106.15±7.66
32 (76.19)
139.70±13.00
10 (23.81)	116.44±18.83
107.64±9.29
57 (76.00)
144.27±13.39
18 (24.00)	0.721a
0.741a
0.302a
	0.515b
0.297b
0.017b*	
SBP
    Stage 1 (130–139 mmHg)
    Mean ± SD
    n (%)
    Stage 2 (≥ 140 mmHg)
    Mean ± SD
    n (%)	135.06±6.56
132.41±2.90
94 (80.34)
145.86±6.24
23 (19.66)	134.76±6.10
132.32±2.87
34 (80.95)
145.12±5.22
8 (19.05)	135.22±6.83
132.46±2.94
60 (80.00)
146.26±6.87
15 (20.00)	0.705a
0.688a
0.922a
	0.057b
0.409b
0.608b	
DBP
    Stage1 (80–89 mmHg)
    Mean ± SD
    n (%)
    Stage 2 (≥ 90 mmHg)
    Mean ± SD
    n (%)	86.88±3.30
85.09±1.85
81 (69.24)
90.88±2.06
36 (30.76)	86.69±2.89
85.10±1.91
29 (69.05)
90.23±0.59
13 (30.95)	86.98±3.51
85.09±1.83
52 (69.33)
91.26±2.49
23 (30.67)	0.954a
0.995a
0.489a
	0.230b
0.167b
0.685b	
WC
    90–95 cm (for male) or 80–85 cm (for female)
    Mean ± SD
    n (%)
    >95 cm (for male) or > 85 cm (for female)
    Mean ± SD
    n (%)	91.36 ± 9.37
86.01±4.95
61 (52.14)
97.17±9.60
56 (47.86)	94.09 ± 6.44
90.63±2.07
30 (71.43)
102.75±5.39
12 (28.57)	89.82 ± 10.38
81.54±1.72
31 (41.33)
95.65±9.97
44 (58.67)	<0.001a**
<0.001a**
0.001a**
	0.308b
0.658b
0.206b	
FBG, Fasting blood glucose; SBP, Systolic blood pressure; DBP, Diastolic blood pressure; WC, Wrist circumference.

ap-values were calculated using the Mann-Whitney U Test; p ≤ 0.05*, P ≤ 0.01**, p ≤ 0.001***.

bp-values were calculated using Kruskal-Wallis Test, p ≤ 0.05*, p ≤ 0.01**, p ≤ 0.001***.

Sensory processing patterns

The scores of sensory processing patterns from the TSPA, including sensory preference and sensory arousals in specific sensory modalities, are presented in Table 3. Most of the participants had moderate preferences (median 30.00–60.00) and moderate arousals (median 40.00–73.00) in all senses. There were high arousal levels (median 80.00 and 82.85), only in proprioceptive and auditory senses. In addition, the highest score of sensory preferences was found in the auditory sense (median 64.00), while the lowest was found in the vestibular sense (median 30.00).

10.1371/journal.pone.0308421.t003 Table 3 Scores of sensory processing patterns from the TSPA in people with MetS (n = 117).

Sensory patterns	Minimum	Maximum	Median	Mean	Std. Deviation	Levels of sensory preferences/
sensory arousals	
Sensory preferences
 Visual
 Auditory
 Smell and taste
 Tactile
 Vestibular
 Proprioceptive	
20.00
20.00
28.86
20.00
20.00
20.00	
95.00
100.00
88.80
100.00
60.00
80.00	
60.00
64.00
59.94
40.00
30.00
36.00	
57.38
67.00
57.86
42.82
33.12
38.11	
16.50
17.17
11.90
15.52
11.03
13.06	
Moderate
Moderate
Moderate
Moderate
Moderate
Moderate	
Sensory arousals
 Visual
 Auditory
 Smell and taste
 Tactile
 Vestibular
 Proprioceptive	
20.00
20.00
20.00
20.00
20.00
40.00	
100.00
100.00
100.00
100.00
100.00
100.00	
73.33
80.00
60.00
40.00
40.00
82.85	
70.86
78.15
61.53
41.98
39.29
81.32	
21.06
13.00
18.45
16.36
17.87
14.29	
Moderate
High
Moderate
Moderate
Moderate
High	
Levels of sensory preferences/sensory arousals interpreted by TSPA scores, Low = a percentage of score below 25%, Moderate = a percentage of score at 25–75%, High = a percentage of score above 75%.

Correlation between sensory patterns and metabolic risk factors

The correlation between sensory processing patterns and metabolic risk factors is presented in Table 4. The metabolic risks, in particular fasting blood glucose (FBG), were correlated negatively with tactile preferences (r = -0.150, P<0.05), while there was no significant correlation between other metabolic risks (SBP, DBP, and WC) and sensory preferences in any sensory modalities. Moreover, only WC was correlated positively with arousal levels in the auditory sense and negatively with arousal levels in the smell-taste senses (r = 0.140, -0.160, P<0.05), while there was no significant correlation between other metabolic risks (FPG, SBP, and DBP) and sensory arousals in any sensory modality.

10.1371/journal.pone.0308421.t004 Table 4 Correlation between sensory processing patterns and metabolic risk factors (n = 117).

Metabolic risk factors	Sensory preferences	
Visual	Auditory	Smell and taste	Tactile	Vestibular	Proprioceptive	
FBG
Correlation Coefficient
Sig (2-tailed)	
0.045
0.510	
0.108
0.109	
-0.020
0.761	
-0.150*
0.027	
0.075
0.268	
-0.026
0.695	
SBP
Correlation Coefficient
Sig (2-tailed)	
-0.026
0.708	
-0.064
0.356	
-0.089
0.195	
-0.084
0.231	
-0.118
0.089	
-0.096
0.171	
DBP
Correlation Coefficient
Sig (2-tailed)	
-0.136
0.061	
0.002
0.974	
-0.053
0.459	
-0.052
0.478	
0.129
0.075	
0.060
0.411	
WC
Correlation Coefficient
Sig (2-tailed)	
0.051
0.488	
0.069
0.302	
0.091
0.166	
0.040
0.550	
0.069
0.302	
0.105
0.118	
Metabolic risk factors	Sensory arousals	
Visual	Auditory	Smell and taste	Tactile	Vestibular	Proprioceptive	
FBG
Correlation Coefficient
Sig (2-tailed)	
-0.021
0.760	
-0.095
0.155	
0.048
0.482	
0.049
0.474	
0.050
0.469	
-0.034
0.615	
SBP
Correlation Coefficient
Sig (2-tailed)	
0.036
0.607	
0.056
0.422	
0.036
0.612	
-0.015
0.835	
-0.020
0.776	
-0.011
0.876	
DBP
Correlation Coefficient
Sig (2-tailed)	
-0.095
0.192	
-0.068
0.345	
0.024
0.747	
-0.001
0.986	
0.034
0.646	
-0.051
0.482	
WC
Correlation Coefficient
Sig (2-tailed)	
0.071
0.291	
0.140*
0.036	
-0.160*
0.017	
-0.109
0.106	
-0.039
0.572	
0.078
0.238	
FBG, Fasting blood glucose; SBP, Systolic blood pressure; DBP, Diastolic blood pressure; WC, Wrist circumference.

p-values were calculated using Kendall’s Tau; p ≤ 0.05*, p ≤ 0.01**, p ≤ 0.001***.

As presented in Table 5, the general linear mixed model revealed that sensory processing patterns were the only sensory preferences associated with metabolic risk factors, particular FBG and DPB. Specifically, FBP was negatively associated with sensory preferences in the tactile and proprioceptive senses (R = -0.481, -0.386; p = 0.001, 0.038, respectively), and positively associated with sensory preference in the vestibular sense (R = 0.726; p = 0.002). Moreover, DBP was positively associated with sensory preference in the vestibular sense (R = 0.099; p = 0.021). However, as shown in Table 5, SBP and WC were not significantly associated with either sensory preferences or sensory arousals in any sensory modality.

10.1371/journal.pone.0308421.t005 Table 5 Relationship between sensory processing patterns and metabolic risk factors (n = 117).

	source	coefficient	SE	t	F	Sig.	95% confidence interval	
lower	upper	
FBG	Intercept
P-visual
P-auditory
P-smell and taste
P-tactile
P-vestibular
P-proprioceptive
A-visual
A-auditory
A-smell and taste
A-tactile
A-vestibular
A-proprioceptive	100.588
0.063
0.181
0.094
-0.481
0.726
-0.386
-0.030
-0.262
-0.165
0.112
0.046
0.136	22.702
0.126
0.118
0.194
0.140
0.228
0.184
0.088
0.154
0.109
0.114
0.108
0.145	4.431
0.496
1.532
0.484
-3.429
3.187
-2.105
-0.338
-1.704
1.520
0.988
0.427
0.940	1.996
0.246
2.347
0.234
11.755
10.154
4.431
0.114
2.904
2.310
0.975
0.182
0.883	<0.001***
0.621
0.129
0.629
0.001**
0.002**
0.038*
0.736
0.091
0.132
0.326
0.670
0.349	55.569
-0.188
-0.053
-0.291
-0.760
0.274
-0.750
-0.204
-0.568
-0.050
-0.113
-0.167
0.151	145.608
0.313
0.415
0.478
-0.203
1.178
-0.022
0.145
0.043
0.381
0.337
0.259
0.424	
SBP	Intercept
P-visual
P-auditory
P-smell and taste
P-tactile
P-vestibular
P-proprioceptive
A-visual
A-auditory
A-smell and taste
A-tactile
A-vestibular
A-proprioceptive	138.343
0.038
-0.011
-0.082
0.011
-0.084
-0.028
0.016
0.031
-0.005
0.030
-0.033
0.003	8.762
0.049
0.046
0.075
0.054
0.088
0.071
0.034
0.059
0.042
0.044
0.041
0.056	15.790
0.779
-0.239
-1.097
0.197
-0.960
-0.391
0.486
0.515
-0.123
0.679
-0.801
0.050	0.657
0.657
0.057
1.204
0.039
0.922
0.153
0.236
0.266
0.015
0.462
0.642
0.003	<0.001***
0.438
0.812
0.275
0.845
0.339
0.697
0.628
0.607
0.902
0.498
0.425
0.960	120.968
-0.059
-0.101
-0.231
-0.097
-0.259
-0.168
-0.051
-0.087
-0.088
-0.057
-0.116
-0.108	155.718
0.135
0.080
0.066
0.118
0.090
0.113
0.084
0.148
0.078
0.117
0.049
0.114	
DBP	Intercept
P-visual
P-auditory
P-smell and taste
P-tactile
P-vestibular
P-proprioceptive
A-visual
A-auditory
A-smell and taste
A-tactile
A-vestibular
A-proprioceptive	90.657
-0.036
-0.004
-0.013
-0.030
0.099
-0.035
-0.012
-0.050
0.009
0.001
0.012
0.029	4.223
0.023
0.022
0.036
0.026
0.042
0.034
0.016
0.029
0.020
0.021
0.020
0.027	21.469
-1.535
-0.194
-0.354
-1.165
2.339
-1.003
-0.715
-1.743
0.438
0.027
0.576
1.087	1.474
2.357
0.038
0.125
1.358
5.472
1.067
0.511
3.037
0.192
0.001
0.331
1.182	<0.001***
0.128
0.846
0.724
0.247
0.021*
0.304
0.476
0.084
0.663
0.979
0.566
0.279	82.283
-0.083
-0.048
-0.084
-0.082
0.015
-0.103
-0.044
-0.107
-0.031
-0.041
-0.028
-0.024	99.031
0.011
0.039
0.059
0.021
0.183
0.032
0.021
0.007
0.049
0.042
0.051
0.083	
WC	Intercept
P-visual
P-auditory
P-smell and taste
P-tactile
P-vestibular
P-proprioceptive
A-visual
A-auditory
A-smell and taste
A-tactile
A-vestibular
A-proprioceptive	79.130
0.017
0.017
0.078
-0.016
-0.067
0.159
-0.011
0.137
-0.056
-0.065
-0.013
-0.010	12.346
0.069
0.064
0.105
0.076
0.124
0.100
0.048
0.084
0.059
0.062
0.058
0.079	6.409
0.242
0.270
0.742
-0.205
-0.542
1.594
-0.239
1.638
-0.943
-1.051
-0.223
-0.128	0.916
0.058
0.073
0.550
0.042
0.294
2.540
0.057
2.684
0.889
1.104
0.050
0.016	<0.001***
0.809
0.787
0.460
0.838
0.589
0.114
0.812
0.104
0.348
0.296
0.824
0.898	54.647
-0.119
-0.110
-0.131
-0.167
-0.313
-0.039
-0.106
-0.029
-0.173
-0.187
-0.129
-0.167	103.613
0.153
0.145
0.287
0.136
0.178
0.357
0.083
0.303
0.062
0.058
0.103
0.146	
FBG, Fasting blood glucose; SBP, Systolic blood pressure; DBP, Diastolic blood pressure; WC, Wrist circumference.

p-value were calculated using Generalized Linear Mixed Model; p ≤ 0.05*, p ≤ 0.01**, p ≤ 0.001***.

Discussion

This study aimed to investigate the sensory processing patterns (SPPs) among people with MetS in the community and examined the association between the SPPs and the metabolic risk factors, including fasting blood glucose (FBG), systolic blood pressure (SBP) and diastolic blood pressure (DBP), and/or waist circumference (WC). Key findings revealed that high arousal levels in the proprioceptive and auditory senses were found among the participants, and that the SPPs in tactile, auditory, smell-taste, vestibular and proprioceptive senses were significantly associated with metabolic risk factors, particularly FBG, WC, and DBP.

The sensory processing patterns of people with MetS

This study was the first investigation of the SPPs among people with MetS in this community. The results from this study supported our hypothesis that a pattern of high sensory arousal in proprioceptive sense was found among the participants with MetS. However, a pattern of high preference in smell and taste sense was not found among the participants, while they showed moderate sensory preference in the smell-taste sense.

The findings were consistent with a previous study which showed that individuals with high sensitivity to sensory stimuli were also found to have metabolic health problems, such as Type 1 diabetes [25]. However, the previous study did not look into sensory processing patterns in specific sensory modalities [25], and no research on people with MetS has been conducted. Thus, these findings added to the earlier understanding by specifying sensory processing patterns in specific sensory modalities among people with MetS by using the TSPA tool, which discovered that high levels of arousal in the proprioceptive and auditory senses were found in participants with MetS.

Moreover, the primary characteristic of people with high levels of arousal in the proprioceptive sense is that they tend to more quickly detect certain proprioceptive stimuli compared to others [11]. Consequently, they experience certain physical activities as overwhelming or uncomfortable due to the intense sensory input involved in forceful movements, leading to negative experiences, such as discomfort, pain, or injury, thus allowing them to avoid engaging in physical activities. This was consistent with the findings of previous studies that showed that the majority of people with MetS represent a sedentary activity type and that there is a decrease in physical activity [44]. Similarly, previous research indicated a link between sensory sensitivity pattern in the AASP and reduced physical activity among healthy older adults, but this research doesn’t specify which sensory modality has the most significant impact [23].

Therefore, providing specific information on sensory processing patterns in specific senses can greatly assist therapists in understanding individual behaviors better and helps to tailor targeted intervention aimed at promoting healthier routines, habits, and daily environments that minimize the risks of MetS. This can be applied by promoting increased physical activities in ways that match their sensory patterns. For instance, low-intensity proprioceptive activities like yoga, walking, or muscle stretching, could be appropriate for individuals with high sensory arousal.

Association between sensory processing patterns and metabolic risk factors

The results from this study supported our hypothesis that levels of sensory preference and/or sensory arousal in smell-taste and/or proprioceptive senses were significantly associated with the metabolic risk variables. Although the correlations were low, the findings suggest potential associations that might enhance awareness among healthcare professionals regarding the relationship between sensory processing patterns and metabolic health, which might help in the development of more comprehensive treatment plans or further research in this area.

The GLMM revealed the association between fasting blood glucose (FBG) levels and sensory preference in the proprioceptive sense. This suggests that individuals with higher FBG levels tend to exhibit lower sensory preference for proprioceptive senses. The characteristic of people with low sensory preference in proprioceptive sense is that they tend to not prefer or decline to do any activity requiring high-intensity of proprioceptive senses, such as certain sports, weight training, or physical activities involving joint compression or forceful movement. Similarly, prior research has indicated that participants with MetS showed higher amounts of sedentary time compared to those without MetS [45], and more time spent in sedentary behavior was predictive of significant increases in hyperglycemic time [46]. Therefore, the findings emphasize the need for the development of individualized interventions aimed at reducing sedentary time to decrease hyperglycemia.

Specifically, in wrist circumference (WC), the significantly negative relationship between WC and arousal levels in smell-taste senses were both consistent with and different from previous studies. Naish and Harris [47], found significantly higher food intake, particularly chocolate, in individuals with high sensory arousal compared to those with low arousal. This previous finding suggests that people with high sensory arousal are more likely to exhibit increased WC which contrasts with the findings of this study. However, this previous study faced limitations in specifying which senses predominantly influence food intake, because factors beyond taste preference, such as visual appraisal, smell, and texture, also can influence eating behaviors. Nevertheless, the findings of this study align with other studies indicating that individuals with low arousal level in smell-taste senses prefer intensely flavored or condiment-rich foods, such as those that are sweet or salty [48–51]. This, in turn, contributes to weight gain and increased WC [52]. Based on the findings, healthcare professionals should consider individuals with low arousal levels in the smell-taste sense when offering dietary advice or interventions. Understanding how sensory processing patterns influence food choices, allows for tailored recommendations to support individuals in developing sensory-based strategies for healthier food choices in their daily lives. The incorporation of mindful eating practices may prove beneficial for this group in preventing increased WC.

Previous research has suggested a link between high sensory arousal and obesity indicators, such as BMI among children [28]. However, our findings revealed a low positive association between waist circumference (WC) and sensory arousal specifically in the auditory sense. Due to the nature of our data and the observed low correlation, we cannot draw a direct link between WC and sensory arousal in the auditory sense. Consequently, further research is necessary to confirm and establish a causal relationship.

Furthermore, the findings revealed a negative relationship between FBG levels and sensory preference in the tactile senses. This finding suggests that higher levels of FBG are associated with a lower preference for tactile sense, while a previous study found that tactile sensitivity was significantly associated with an increase in BMI among children [28]. As a result, sensory processing in the tactile sense might potentially be involved in metabolic health not only in BMI but also in FBG. The authors of previous studies stated that sensory processing in the tactile sense may be an important contributor to food acceptance because sensory properties of foods include not only taste and olfactory characteristics, but also visual and tactile ones [28]. Because sensory sensitivity is linked to perception and preference for food texture [53], people with low preference for tactile sensations tend to dislike specific textures (e.g., mushy, crunchy, slimy). This often leads to the avoidance of specific kinds of foods that possess these textures [54]. For example, some individuals dislike mushy textures, leading them to avoid foods like bananas or cooked vegetables. In this regard, eating problems in adults, such as picky eating, selective eating, or inflexible eating behaviors, have been linked to less healthy food choices [55], and an unbalanced diet can have long-term effects on metabolic outcomes related to FBG levels. Additionally, sensory stimuli that do not match a person’s preferences can be overwhelming [11], especially tactile senses, which are strongly linked to emotion and security [56]. People with a low tactile preference may be easily overwhelmed by certain sensory environments, such as crowded areas, food textures, and clothing materials. This sensory overload can activate the sympathetic-adrenal-medullary (SAM) and hypothalamic-pituitary-adrenal (HPA) axes, resulting in elevated cortisol levels. Over time, this chronic activation can contribute to metabolic abnormalities [57,58], such as insulin resistance, which causes high FBG levels. The findings suggest that increasing awareness of the potential impact of the tactile senses on metabolic health, as well as implementing sensory-based strategies for dealing with the unpleasantness of sensory events in daily life, are critical.

Finally, the study found positive associations between sensory preferences in vestibular sense and metabolic risk factors, including FBG and DBP. Previous studies indicated the role of the vestibular system connected to the vestibulosympathetic reflexes in regulating blood pressure [59]. The effect of vestibular stimulation varies depending on its type and intensity. Previous research has shown that gentle vestibular stimulation, such as a gentle front and back swinging, can reduce blood pressure and blood glucose levels [60,61]. Conversely, sudden movements or changes in posture can trigger responses in the sympathetic nervous system, resulting in an increase in blood pressure and blood glucose [62]. Individuals with a high sensory preference in the vestibular sense typically exhibit characteristics such as a tendency to seek out experiences that provide vestibular stimulation, whereas the TSPA items involved both gentle and sudden changes in posture. As a result, further research on this association is needed to establish a clearer link, particularly specifying sensory preferences in specific types of vestibular stimulation associated with FBP and/or DBP.

In summary, this is the first study to discover that sensory processing patterns are associated with metabolic risk factors, such as FBG, DBP, and WC. Although, these correlations were low, these findings suggest the possible role of sensory processing patterns in metabolic risk factors. However, additional research, preferably with longitudinal data, is crucial to achieve a clearer understanding of the causal links between sensory processing patterns and metabolic risk factors. Importantly, knowledge regarding sensory processing patterns of people with MetS may help healthcare professionals increase awareness about the potential impact of sensory processing patterns on metabolic health. Moreover, by considering an individual’s sensory processing patterns, healthcare professionals can develop personalized healthcare strategies based on individual sensory needs necessary for designing environments or they can provide dietary advice and healthy lifestyle recommendations that align with individual sensory processing patterns, aimed to mitigate specific MetS risk factors.

Study limitations

However, this study had some limitations when applying these findings in practice. Although the significant associations between sensory processing patterns and metabolic risk factors were found, these correlations are still low. Moreover, sensory processing patterns are complex because each person differs in terms of their needs and their ability to not being overwhelmed while responding to sensory input. Therefore, to effectively implement the findings of this study into practice, it is suggested that knowledge gained should be combined with other relevant information, such as observations of how patients respond to sensory input in their daily lives or through an in-depth interview, in order to provide deep and reliable information. In addition, this study has some methodological limitations, such as a limited generalizability due to a relatively small sample size through the use of a purposive sampling method, and reliance on self-reported data from the TSPA tool, which can be subject to bias or inaccuracies that might impact the study’s reliability. To further validate the findings and enhance the study’s generalizability, a larger-scale study with more diverse participants is necessary. This would provide more comprehensive insights into the relationships between sensory patterns and metabolic risk factors across different populations. The authors suggest that upcoming research should implement advanced neuroimaging techniques, such as functional magnetic resonance imaging (fMRI). This involves exposing individuals to targeted sensory stimuli and observing subsequent brain and physiological responses related to metabolic functions, thereby elucidating connections with the development of MetS. Additionally, exploring biochemical responses, and encompassing hormonal and metabolic markers, are suggested in order to provide a comprehensive understanding of the physiological mechanisms involving or underpinning the relationship between sensory patterns and MetS.

Conclusion

This study examined sensory processing patterns and their association with metabolic risks among community-dwelling people with MetS. Its findings showed that levels of arousal in the proprioceptive and auditory senses were high. Moreover, sensory processing patterns are associated with metabolic risk factors, particularly FBG, DBP, and WC. The findings showed that the FBG levels are associated with sensory preferences in tactile, vestibular, and the proprioceptive senses, the DBP is associated with sensory preferences in vestibular sense, and the WC is associated with sensory arousal in the auditory and smell-taste senses. The findings contribute to raising awareness about the potential impact of sensory processing patterns on metabolic health. Understanding this association can help in designing interventions and for selecting appropriate strategies to reduce the risks and improve overall health and well-being for community-dwelling people with MetS in the future. Moreover, this study provides a foundation for further studies to explore and refine these associations, potentially leading to more targeted and effective interventions.

Supporting information

S1 File The Thai Sensory Patterns Assessment (TSPA).

(PDF)

S2 File STROBE-checklist-cross-sectional studies.

(PDF)

S3 File Data -stress score-metabolic risk variables.

(PDF)

This research was supported by the Department of Occupational Therapy, Faculty of Associated Medical Sciences, Chiang Mai University.

10.1371/journal.pone.0308421.r001
Decision Letter 0
Mesz Bruno Alejandro Academic Editor
© 2024 Bruno Alejandro Mesz
2024
Bruno Alejandro Mesz
https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Submission Version0
1 Apr 2024

PONE-D-24-06360Sensory processing patterns as internal factors determining metabolic risk factors among community dwelling people with Metabolic SyndromePLOS ONE

Dear Dr. Pomngen,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Two experts in the field have carefully reviewed the manuscript entitled “Sensory processing patterns as internal factors determining metabolic risk factors among community dwelling people with Metabolic Syndrome”. Their comments are appended below.

In light of these reviews and my own reading of the manuscript, I am requesting a major revision and resubmission, in which you will need to respond to each point in each review. Let me focus in some major points that the reviewers and I would like to see addressed. These are: 1) The non-compliance with STROBE guidelines for cross-sectional studies. Note that this is a requirement for publication in Plos ONE (https://journals.plos.org/plosone/s/submission-guidelines#loc-guidelines-for-specific-study-types)2) Both reviewers and I have concerns regarding the TSPA, which we can not access due to language barriers (it is apparently written in Thai language) and the requirement of institutional access to see the relevant documentation. I am requesting that you include the English translation of the TSPA as supplemental material, and clarify on its content, reliability and the rationale behind its use.

3) One reviewer requires more appropriate data analysis and reevaluating the Discussion based on this, and I wish to highlight this requirement as well, together with the recommendation made by the other reviewer, who is an expert in medical sciences, to perform a descriptive analysis grouping variables according to categories such as prediabetes/diabetes, hypertension stage 1/stage 2, etc.  

4) I ask you to do a careful revision of the manuscript in terms of grammar and language. For example, in lines 231-233 you say that "there were high arousal levels...except for propioceptive  and auditory senses", while Table 2 shows the opposite.

There are other points brought out in the reviews and I will carefully attend to your item-by-item responses to them.

Please submit your revised manuscript by May 16 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

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Reviewer #1: The authors report on a study on the relationship between preference patterns in different sensory modalities and metabolic risk factors in Thai individuals with metabolic syndrome. The study has the potential to advance our understanding about sensory processing, metabolism, and non-communicable diseases. However, I have some concerns about the statistical analysis and questions about the tools used.

Major concerns

The link between sensory processing and metabolic risk factors is not presented. The authors should clearly explain how there can be a relationship and what might be expected and why.

The rationale and motivation behind the use of the Thai Sensory Profile Assessment Tool is missing, which makes is hard to evaluate the appropriateness of the tool. Why specifically was this tool used? How does it compare to other potential tools? What are the advantages and disadvantages? Has it been used before? Is there a refereed version of this tool? Furthermore, the authors should provide a better description of the tool. For instance, they should explain the rating scales and provide examples of items.

The authors argue they used kernel regression because the data was not normally distributed. However, OLS regression does not make assumptions as to the Gaussian nature of the data but the errors. More tests as to the behavior of the data should be conducted. Using kernel regression does not seem an appropriate method given the high likelihood of omitted variable biases. All the variables from sensory processing patterns data should be included in a single model. There are several ways in which this can be tackled. As a first approximation, OLS with robust standard errors can be used. Furthermore, using generalized linear mixed model and a family that best fits the data may yield better fitting models.

As the authors mentioned, the data is not normally distributed, but they use Spearman’s correlation tests. A correlation test that accounts for non-normality (e.g., Kendall’s Tau). Related to the correlation analysis, even though two sensory pattern variables were found to be significantly correlated with different metabolic risk factors, these correlations were still low.

The Discussion should be reevaluated based on more appropriate statistical analyses.

Reviewer #2: General assessment

This study investigates the potential relationship between sensory processing patterns (sensory preferences and arousals) and metabolic risks in individuals with metabolic syndrome (MetS) (n=117).

I have several suggestions that might improve the manuscript.

While well-written, the manuscript contains grammatical errors requiring thorough revision by authors or an English specialist (ie. Ln68 “Sensory processing refers to ability of…”).

For cross-sectional studies like this, adherence to STROBE guidelines (https://www.strobe-statement.org/) is crucial and I suggest including the checklist indicating the lines where the corresponding items are clearly attended

Also, this is an observational study, so please avoid language implying unsupported causal relationships in all the manuscript (ie. “...internal factors determining metabolic risk factors…”). This editorial might be helpful doi: 10.1111/jan.14311

Finally, I have several concerns related to the Thai Sensory Patterns Assessment-adult version (TSPA), Ref. 15:

Pomngen I, Srikhamjak T, Putthinoi S. Development of the Sensory Patterns Assessment. Chiang Mai: Chiang Mai University; 2020

This appears to be a thesis that probably corresponds to http://cmuir.cmu.ac.th/jspui/handle/6653943832/69493; however, the abstract is in Thai language, probably the full manuscript, and its requires institutional access.

In addition, there is a similar thesis and works with shared authors and links to Google Scholar citations (link for Ref 18 is broken) in the following article

Sutthachai, R.; Kaunnil, A.; Phadsri, S.; Pomngen, I.; Stanley, M.; Srikhamjak, T. Development of Thai Sensory Patterns Assessment Tool for Children Aged 3–12 Years: Caregiver-Version. Healthcare 2022, 10, 1968. https://doi.org/10.3390/healthcare10101968 :

Ref 15: Srikhamjak, T.; Sawlom, S.; Munkhetvit, P.; Apikimonkon, H. Thai Sensory Profile Assessment Tool; Chiang Mai University: Chiang Mai, Thailand, 2007. (In Thai)

Ref 16: Pomngen, I. Development of the Sensory Patterns Assessment. Master’s Thesis, Chiang Mai University, Chiang Mai, Thailand, 24 February 2020

Ref 17: Pomngen, I.; Srikhamjak, T.; Putthinoi, S. Development of Thai’s Sensory Patterns Assessment Tool for Adolescents and Adults. J. Health Sci. Res. 2020, 14, 76–85

Tracked here: https://he01.tci-thaijo.org/index.php/JHR/article/view/228407/164593 (In Thai)

Ref 18: Srikamjak, T.; Saolarm, S.; Munkhetvit, P.; Apikonekorn, H. The sensory profile assessment tool: TSPA. In Proceedings of the Opening Word Optimizing Occupational Therapy, The 5th Asia Pacific Occupational Therapy Congress, Chiang Mai, Thailand, 19–24 November 2011; Volume A0193, p. 183

Ref 19: Kanchanawong, T.; Prasoetsang, T.; Limvongvatana, F.; Ooraikul, L.; Kanupan, S.; Srikamjak, T.; Gomutbutra, P. The Feasibility of the Thai Sensory Profile Assessment Tool (TSPA) for Classifying the participants for Mind-Body intervention. medRxiv 2022, 1–15

Tracked here: https://www.medrxiv.org/content/10.1101/2022.06.05.22275861v2.full

A preprint was withdrawn for being “enormous modified”, probably the same as Ref 19 https://osf.io/preprints/psyarxiv/726qr

Found here: https://scholar.archive.org/work/rdcu4j7mfnghrkeef3nt5zod2i/access/wayback/https://files.osf.io/v1/resources/726qr/providers/osfstorage/622d0c5953a4e806b7516047?action=download&direct&version=2

The authors indicate that the Thai Sensory Profile Assessment Tool (TSPA) “...can be accessed via the website www.tspatools.com”, but the link is broken.

In this case the authors must include the English translation for the Thai Sensory Patterns Assessment-adult version (TSPA) as supplemental material, and clarify in its content, constructs, reliability, administration and scoring procedures, results from factor analysis for the assessment of the intended dimensions in the questionnaire.

Title

I suggest a simplification of the title and avoiding causal language such as “determining”, as the study (cross-sectional / correlational) was not intended to identify causality but to explore potential relationships ie. “Relationships between sensory processing patterns and metabolic risk factors”

Abstract

Background: Metabolic syndrome is a non-communicable disease, please clarify.

Methods: The authors must clarify data categorization and analysis procedures, specifying the variables used and their objectives

Conclusion: What were the most relevant study findings? and optionally incorporate perspectives or future directions.

Keywords: I suggest that the suggested keywords be different from those used in the Title to expand the visibility of the work

Introduction

Ln 58-60, metabolic syndrome is also a non-communicable disease, please clarify

Ln 70-72, As this is central to the study, I suggest that the authors expand the definition of “sensory processing patterns”, including how it is measured (ie. Are there different instruments for its assessment? With the same sensory domains?), what are the possible resulting categories, and how can the results be interpreted. Also, this information might be useful for discussing the results by contrasting these tools with the one used in this study (Thai Sensory Patterns Assessment-adult, TSPA).

Ln 74-76, sensory processing patterns might be related to the development of chronic diseases including MetS, but the authors have yet to present a strong and specific argument to support that possibility

Ln77-86 Please clarify if the studies used the TSPA or other test(s) for sensory processing patterns. If there are individuals classified with “high sensory sensitivity”, are there those with low or moderate sensory sensitivities? What are the characteristics of these groups?

Ln92, please clarify how limited is the direct evidence on the relationship between sensory processing patterns and MetS/metabolic risks, and how this has been explored.

Ln 97–99, please include specific studies and references.

Ln100-106, in addition to my concerns outlined in the general assessment, please provide clarification in this section regarding the development, domains, usage and validity of the Thai Sensory Patterns Assessment-adult (TSPA) as well as how it has been used previously. Given that REF 15 is a thesis written in Thai language with restricted access to institutional members, it is essential that the authors make the questionnaire available in English as supplemental material.

Ln111-115, while acknowledging the importance of this aspect, the design of this study does not facilitate the assessment of the influence of sensory processing patterns in the development and progression of metabolic syndrome (MetS) and its associated factors. Please rephrase.

Ln120-125, this section is about perspectives. However, I suggest that the authors clarify the hypothesis being explored and expected outcomes based on the information presented in Introduction. For example, it would be beneficial to specify which sensory processing pattern(s) are expected to be associated with the metabolic risk variables: fasting blood glucose (FBG), systolic blood pressure (SBP) and diastolic blood pressure (DBP), and/or waist circumference (WC). By elucidating these relationships in the Introduction, the rationale behind the hypothesis may become clearer.

Methods

Ln143-144, I am not familiar with the demographics of Thailand, but the current wording may imply that only 117 individuals with MetS resided in the Namprea sub-district. Please confirm if this is accurate? Also, is it the same Namprea than Nam Phrae?

Ln153, please elaborate on the impact of the level of education and how it was implemented in this study. In addition, I am not familiar with the Mental State Examination T10 (MSET-10). Please provide clarification of this tool and why it was selected to screen cognitive impairments. Also, include a relevant and appropriate reference for further context and insight.

Ln158, I am not familiar with purposive sampling, so it would be helpful to give a concise overview, the rationale behind its use, and the specific criteria used to fulfill that purpose. Furthermore, please incorporate this information into the discussion of the study’s limitations, particularly regarding its ability to generalize findings to the population.

Ln160 Please clarify the screening and identification process.

Ln161-163, previously it was mentioned 117 participants, please clarify and also the current wording may imply that only 145 individuals with MetS resided in the community. If that is the case, why was there not a direct invitation instead of “...flyers and word-of-mouth”?

Ln168 wasn’t the demographic questionnaire already completed along with the MSET-10? (Ln165). Also, where are the results of the MSET-10?

Ln185, please, include the English version of the TSPA

Ln189, why are smell and taste combined?

Ln190 please provide the reference for the factor analysis conducted for TSPA

Ln195-197 Given language institutional access barriers to the referred thesis (Ref 15), the authors must provide the English version of the Thai Sensory Patterns Assessment-adult version (TSPA). In addition, it would be beneficial to provide a translation of the referenced thesis for verification and reproducibility purposes, ie. the meaning of IOC/ICC and parts I and II.

Analysis

I recommend conducting a comprehensive descriptive analysis, which should involve grouping variables as follows:

Blood pressure (BP): participants with hypertension could be categorized into Stage 1 (130-139 / 80-89) and Stage 2 (≥ 140 / ≥ 90)

Fasting blood glucose (FBG): Prediabetes (100-125 mg/dL) and diabetes (≥ 126 mg/dL)

Waist circumference (WC): For example, 80-85cm and >85 (for women); 90-95 and >95 (for men)

Are there any differences by sex or age?

Ln208-210 Please, clarify how this was implemented

Ln210-211 If you are referring to p-values, these are not just probsbilities so I suggest to rephrase: "p-values below 0.05 were considered statistically significant."

Results

Table 1

Ln225, Please, include the total participants in the title

I suggest to modify “Gender” to “Sex” (as suggested in: 10.1001/jama.2016.16405)

There is no need of “Postgraduate” category as there are no individuals in that group

Please, verify the data in “Household income” as there are reported only 116 individuals

Also, include the values for metabolic risks

Table 2.

Please clarify “Results” as well as low, moderate and high

Ln239, the results from this section should be explained in Discussion section

Table 3.

Please clarify the test performed to calculate p-values

Ln241-242 How is this result explained? For the Discussion section

Ln255 Please clarify here the test used to calculate p-values, rather than in the title of the table

Ln257, rephrase “Predicting” and remove causal language in all the manuscript and tables

Table 4

I suggest caution and to take into account limitations regarding prediction purposes, especially when assumptions, model complexity, and evaluation metrics are not clearly reported. It would be more appropriate to use terms like “association” or “relationship” instead of “prediction” in this context

Discussion

Overall, this section requires revision for clarity and to maintain focus on metabolic-related factors rather than “stress”. Speculation should be avoided, and the true impact of the findings should be accurately assessed

Ln273, I suggest that the authors compare their results with what has been previously studied, including how it was studied and specifying the sensory modalities involved.

Ln302 What are “sensory sensitivities”, “heightened sensory sensitivity” (Ln312), “sensory sensitivity” (Ln414)?

Conclusions

Please be specific on which sensory patters were associated with metabolic risk factors. Omit any redundant mentions of limitations in this section, as they have already been addressed previously

Author contributions

Ln454 There is no visualization in this manuscript, please clarify.

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Reviewer #2: No

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10.1371/journal.pone.0308421.r002
Author response to Decision Letter 0
Submission Version1
13 May 2024

Response to Reviewer #1:

We greatly appreciate your thoughtful comments concerning our manuscript "Sensory processing patterns as internal factors determining metabolic risk factors among community dwelling people with Metabolic Syndrome" (Manuscript ID: PONE-D-24-06360). Those comments are all valuable and very helpful for revising and improving our paper. We have studied the comments carefully and have made correction which we hope meet your approval. Revised portion are marked in yellow highlighting in the paper and and indicated by blue text.

The major concerns in the paper and the responds to the reviewer’s comments are as flows:

Point 1: The link between sensory processing and metabolic risk factors is not presented. The authors should clearly explain how there can be a relationship and what might be expected and why:

Response 1: We appreciate your comments and suggestions. We have addressed the potential link between sensory processing and metabolic risk factors in the Introduction section, specifically on pages 4-5, lines 85-101.

In summary, Sensory processing patterns influence human emotions and behaviors, including what we eat, what make us feel stressful. Previous studies have shown associations between emotions and behaviors relevant to Metabolic Syndrome (such as eating habits, physical inactivity, and stress) and sensory processing patterns. However, these relationships have been observed in other groups, such as healthy workers, adults, adolescents with Type 1 diabetes, and individuals with multiple sclerosis.

Furthermore, previous research has indicated a relationship between sensory processing patterns and metabolic risk variables, such as BMI. However, there are currently no studies focusing on individuals with MetS or exploring other metabolic risk variables, such as blood pressure, fasting blood glucose, and waist circumference. Therefore, we anticipate finding a relationship between sensory processing patterns and metabolic risk factors, which serve as diagnostic criteria for MetS.

Point 2: The rationale and motivation behind the use of the Thai Sensory Profile Assessment Tool is missing, which makes is hard to evaluate the appropriateness of the tool. Why specifically was this tool used? How does it compare to other potential tools? What are the advantages and disadvantages? Has it been used before? Is there a refereed version of this tool? Furthermore, the authors should provide a better description of the tool. For instance, they should explain the rating scales and provide examples of items.

Response 2: We appreciate and agree with your comments and suggestions regarding the Thai Sensory Profile Assessment Tool (TSPA). We have now included additional information about the TSPA to clarify the rationale and motivation behind its use. This includes comparisons to other potential tools, discussion of its advantages and disadvantages, previous research studies that have utilized the TSPA, an explanation of the rating scales and examples of items as well as other important information. This information can be found in the Introduction section on pages 6-7, lines 132-168, and in the Instruments section on pages 12-13, lines 267-305.

Point 3: The authors argue they used kernel regression because the data was not normally distributed. However, OLS regression does not make assumptions as to the Gaussian nature of the data but the errors. More tests as to the behavior of the data should be conducted. Using kernel regression does not seem an appropriate method given the high likelihood of omitted variable biases. All the variables from sensory processing patterns data should be included in a single model. There are several ways in which this can be tackled. As a first approximation, OLS with robust standard errors can be used. Furthermore, using generalized linear mixed model and a family that best fits the data may yield better fitting models.

Response 3: We appreciate the reviewer's helpful suggestion regarding an appropriate statistical analysis method. We have now made a change from kernel regression to a generalized linear mixed model, as suggested, on page 14, lines 322-328. Consequently, the results have also been updated on pages 18-19, lines 382-393.

Point 4: As the authors mentioned, the data is not normally distributed, but they use Spearman’s correlation tests. A correlation test that accounts for non-normality (e.g., Kendall’s Tau). Related to the correlation analysis, even though two sensory pattern variables were found to be significantly correlated with different metabolic risk factors, these correlations were still low.

Response 4: We truly appreciate your comments regarding the need for more appropriate statistical analyses. Following your suggestion, we have now changed the statistical analysis method from Spearman correlation to Kendall’s tau, on page 13, line 319. Consequently, the results have also been updated on pages 17-18, lines 371, 375, 377-380. Moreover, in your concern that the correlations were still low, we have acknowledged the limitation of the study in the limitation section, specifically regarding the low correlations found. This limitation highlights the caution needed when interpreting and applying these findings in practice on pages 24, lines 513-516, 526-528.

Point 5: The Discussion should be reevaluated based on more appropriate statistical analyses.

Response 5: We would like to thank you for your comments and suggestion. We have now changed the statistical analyses medthod based on your suggestion (from Spearman correlation to Kendall’s tau and from Kernel regression to General Linear Mixed Model, both of which are more appropriate for non-parametric or non- normally distributed data), and we also revised and ubdated the discussion section. Now, it is on the page 19-24, line 394-524.

Special thanks to you for your good comments and suggestion. We tried our best to improve the manuscript and made some changes in the manuscript.

We appreciate for reviewers’ warm work earnestly and hope that the correction will meet with approval. Once again, thank you very much indeed for your comments and suggestions.

Best regards,

Ilada Pomngen and research team

Response to Reviewer #2:

We greatly appreciate your thoughtful comments concerning our manuscript "Sensory processing patterns as internal factors determining metabolic risk factors among community dwelling people with Metabolic Syndrome" (Manuscript ID: PONE-D-24-06360). Those comments are all valuable and very helpful for revising and improving our paper. We have studied the comments carefully and have made correction which we hope meet your approval. Revised portion are marked in yellow highlighting in the paper and indicated by blue text.

The major concerns in the paper and the responds to the reviewer’s comments are as flows:

Point 1: While well-written, the manuscript contains grammatical errors requiring thorough revision by authors or an English specialist (ie. Ln68 “Sensory processing refers to ability of…”).

Response 1: We would like to apologize for this mistake and thank you for your comments and suggestion about the grammatical errors. After we have made revision carefully based on your comments and suggestion, we already sent the manuscript to an English specialist, who is a native English, for revision.

Point 2: For cross-sectional studies like this, adherence to STROBE guidelines (https://www.strobe-statement.org/) is crucial and I suggest including the checklist indicating the lines where the corresponding items are clearly attended.

Response 2: We are thankful with your comments and suggestion regarding the non-compliance with STROBE guidelines for cross-sectional studies. We have carefully reviewed our manuscript to ensure it meets the requirements for publication by utilizing the STROBE guidelines for cross-sectional studies. Additionally, we have included the importan information required from the STROBE guidelines in our manuscript, and included a checklist indicating the lines where the corresponding items are clearly addressed and have uploaded this checklist as supplemental material.

Point 3: Also, this is an observational study, so please avoid language implying unsupported causal relationships in all the manuscript (ie. “...internal factors determining metabolic risk factors…”). This editorial might be helpful doi: 10.1111/jan.14311.

Response 3: We thank the reviewer for this useful suggestion about avoiding causal language. We have now addressed it in the title of the manuscript on page 1 by using a simplified version: 'Relationships between sensory processing patterns and metabolic risk factors among community dwelling people with Metabolic Syndrome’, on page 1, lines 1-3.

Point 4: Finally, I have several concerns related to the Thai Sensory Patterns Assessment-adult version (TSPA), Ref. 15:

Pomngen I, Srikhamjak T, Putthinoi S. Development of the Sensory Patterns Assessment. Chiang Mai: Chiang Mai University; 2020.

This appears to be a thesis that probably corresponds to http://cmuir.cmu.ac.th/jspui/handle/6653 943832/ 69493; however, the abstract is in Thai language, probably the full manuscript, and its requires institutional access.

In addition, there is a similar thesis and works with shared authors and links to Google Scholar citations (link for Ref 18 is broken) in the following article

Sutthachai, R.; Kaunnil, A.; Phadsri, S.; Pomngen, I.; Stanley, M.; Srikhamjak, T. Development of Thai Sensory Patterns Assessment Tool for Children Aged 3–12 Years: Caregiver-Version. Healthcare 2022, 10, 1968. https://doi.org/10.3390/healthcare10101968.

Ref 15: Srikhamjak, T.; Sawlom, S.; Munkhetvit, P.; Apikimonkon, H. Thai Sensory Profile Assessment Tool; Chiang Mai University: Chiang Mai, Thailand, 2007. (In Thai)

Ref 16: Pomngen, I. Development of the Sensory Patterns Assessment. Master’s Thesis, Chiang Mai University, Chiang Mai, Thailand, 24 February 2020

Ref 17: Pomngen, I.; Srikhamjak, T.; Putthinoi, S. Development of Thai’s Sensory Patterns Assessment Tool for Adolescents and Adults. J. Health Sci. Res. 2020, 14, 76–85

Tracked here: https://he01.tci-thaijo.org/index.php/JHR/article/view/228407/164593 (In Thai)

Ref 18: Srikamjak, T.; Saolarm, S.; Munkhetvit, P.; Apikonekorn, H. The sensory profile assessment tool: TSPA. In Proceedings of the Opening Word Optimizing Occupational Therapy, The 5th Asia Pacific Occupational Therapy Congress, Chiang Mai, Thailand, 19–24 November 2011; Volume A0193, p. 183

Ref 19: Kanchanawong, T.; Prasoetsang, T.; Limvongvatana, F.; Ooraikul, L.; Kanupan, S.; Srikamjak, T.; Gomutbutra, P. The Feasibility of the Thai Sensory Profile Assessment Tool (TSPA) for Classifying the participants for Mind-Body intervention. medRxiv 2022, 1–15

Tracked here: https://www.medrxiv.org/content/10.1101/2022.06.05.22275861v2.full

A preprint was withdrawn for being “enormous modified”, probably the same as Ref 19 https://osf.io/preprints/psyarxiv/726qr

Found here: https://scholar.archive.org/work/rdcu4j7mfnghrkeef3nt5zod2i/access/wayback/https://files.osf.io/v1/resources/726qr/providers/osfstorage/622d0c5953a4e806b7516047?action=download&direct&version=2

The authors indicate that the Thai Sensory Profile Assessment Tool (TSPA) “...can be accessed via the website www.tspatools.com”, but the link is broken.

In this case the authors must include the English translation for the Thai Sensory Patterns Assessment-adult version (TSPA) as supplemental material, and clarify in its content, constructs, reliability, administration and scoring procedures, results from factor analysis for the assessment of the intended dimensions in the questionnaire.

Response 4: We truly appreciate your comments and suggestions regarding the Thai Sensory Patterns Assessment-adult version (TSPA), Ref. 15. In response, we have included the English translation of the Thai Sensory Patterns Assessment-adult version (TSPA), as well as the thesis abstract in English version of Ref. 15. Additionally, we have provided related information to clarify its content, constructs, validity, reliability, administration, and scoring procedures. These details have been included as supplemental material.

Point 5: Title I suggest a simplification of the title and avoiding causal language such as “determining”, as the study (cross-sectional / correlational) was not intended to identify causality but to explore potential relationships ie. “Relationships between sensory processing patterns and metabolic risk factors”.

Response 5: We thank the reviewer for this useful suggestion about avoiding causal language. We have now addressed it in the title of the manuscript on page 1 by using a simplified version: 'Relationships between sensory processing patterns and metabolic risk factors among community dwelling people with Metabolic Syndrome’, on page 1, lines 1-3.

Point 6: Abstract Background: Metabolic syndrome is a non-communicable disease, please clarify.

Response 6: We would like to apologize for this mistake and thank you for your comments and suggestion. We have now rephased the sentence for make it clearer that “Metabolic Syndrome (MetS) is a cluster of metabolic risk factors that increases the risk of other serious health problems, particularly cardiovascular diseases and stroke”, on page 2, lines 27-28.

Point 7: Abstract Methods: The authors must clarify data categorization and analysis procedures, specifying the variables used and their objectives.

Response 7: We appreciate and would like to thank you for your comments and suggestions. We have clarified and specified the variables used (metabolic risk variables and sensory processing patterns in six sensory modalities) and their objectives for examining the relationship on page 2, lines 35-42. However, due to the word limit (300 words), we attempted to include the required information. If you have any further suggestions, please let us know.

Point 8: Abstract Conclusion: What were the most relevant study findings? and optionally incorporate perspectives or future directions.

Response 8: We. We appreciate and would like to thank you for your comments and suggestions. We have clarified the study findings and provided suggestions for future research. This information is now included on page 3, lines 52-54.

Point 9: Abstract Keywords: I suggest that the suggested keywords be different from those used in the Title to expand the visibility of the work.

Response 9: We appreciate the reviewer's useful suggestion. To expand the visibility of our work, we have added some keywords that are different from those used in the title, such as 'association', Correlation’ and ‘Metabolic health’. This addition can help potential readers better understand the focus of our study. The keywords are now included on page 3, lines 57."

Point 10: Introduction Ln 58-60, metabolic syndrome is also a non-communicable disease, please clarify

Response 10: We would like to apologize for this mistake and thank you for your comments and suggestion. We have now rephased the sentence for make it clearer ‘Currently, one of the main global public-health challenges is metabolic syndrome (MetS), which is defined as a cluster of metabolic abnormalities, such as insulin resistance, visceral obesity, hypertension, and dyslipidemia [2]. Following the occurrence of MetS, people are more likely to be exposed to and develop other serious health problems, in particular cardiovascular diseases[3] and stroke [4, 5].’, on page 3, lines 61-65.

Point 11: Ln 70-72, As this is central to the study, I suggest that the authors expand the definition of “sensory processing patterns”, including how it is measured (ie. Are there different instruments for its assessment? With the same sensory domains?), what are the possible resulting categories, and how can the results be interpreted. Also, this information might be useful for discussing the results by contrasting these tools with the one used in this study (Thai Sensory Patterns Assessment-adult, TSPA).

Response 11: We appreciate the reviewer's useful suggestion. To enhance clarity, we have expanded the definition of 'sensory processing patterns' on page 4, in lines 74-84.

Attachment Submitted filename: Response to Editor.docx

10.1371/journal.pone.0308421.r003
Decision Letter 1
Mesz Bruno Alejandro Academic Editor
© 2024 Bruno Alejandro Mesz
2024
Bruno Alejandro Mesz
https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Submission Version1
5 Jul 2024

PONE-D-24-06360R1Relationships between sensory processing patterns and metabolic risk factors among community dwelling people with Metabolic Syndrome: A cross-sectional and correlational research designPLOS ONE

Dear Dr. Pomngen,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Thank you for submitting your revision of your article “Relationships between sensory processing patterns and metabolic risk factors among community dwelling people with Metabolic Syndrome: A cross-sectional and correlational research design” I have read your revised manuscript, with the last round of reviewers’

comments in hand. Thank you for your careful attention to these corrections,

additions, and clarifications. I will not send your revision back to them for another reading, but I am requesting you to address the following points (see the reviews below).

 The GLMM needs work. Please report the family and link function used in the model and why. Report the model fit statistics, including the null models. Please report the software used to conduct the analyses.

 Report the specific test used for the power calculation in G*Power.

 Be careful not to overstretch the results, given that the correlations you obtained are weak, for example when you speak of “unexpected results” on relationship between WC and auditory arousal.

Please revise the “other comments” at the end of  review 1 and the minor points made by reviewer 2.

Please do a new English check. I have seen the language check document you attached, but new mistakes appeared, such as “The example of items…” (line 289), “For psychometric properties. The…”(line 297), line 304 should be 0.849,  lines 408 to 411, and several others. Avoid anthropomorphizing, as reviewer 1 says, for example “Kendall’s Tau found” in the abstract.

Line 440: should it be tactile sense?  

Please submit your revised manuscript by Aug 19 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

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If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

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We look forward to receiving your revised manuscript.

Kind regards,

Bruno Alejandro Mesz, Ph.D.

Academic Editor

PLOS ONE

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: (No Response)

Reviewer #2: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: No

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: No

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: No

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The authors have improved the manuscript. However, several issues still require attention. Overall most of the discussion and conclusions do not seem to be well supported by the results. Furthermore, the statistical analysis needs to be reported with more clarity and transparency. As of now, the specific GLMM used was not disclosed.

Major comments

The abstract is too long and convoluted. Please make the abstract more succinct. Briefly state the background, motivation, methodology, and findings. Do not report statistics.

Report the specific test used for the power calculation in G*Power.

There is basically no correlation between any of the variables. The only couple that are significant are too low. The authors are overinterpreting this correlations.

The GLMM needs work. Please report the family and link function used in the model and why. Report the model fit statistics, including the null models. Please report the software used to conduct the analyses.

The discussion on the link between auditory sensory preference and WC given that this is based only on a (low) correlation. In addition, the GLMM showed no significant effect.

The discussion on tactile sensory preference needs some work. There is no direction in the preference for food texture. Are all food textures disliked? Or are specific textures dislike, which drives dislike to specific kinds of foods.

Other comments

L.75, what is body stimuli?

Please capitalize COVID-19

What is behaviorally observing methods?

L.315, what does percentage mean? Percentage of what?

L.382, "the general linear mixed model discovered". Please avoid anthropomorphism here. The analysis did not "discover", it may have revealed.

Reviewer #2: The authors attended my suggestions. It was fundamental to include an English version of Thai Sensory Patterns Assessment-adult version (TSPA) as well as the adherence to STROBE guidelines (in text and with a supplementary checklist). The descriptive analysis provides an in-depth exploration to the data and the readability has been improved. The manuscript can be accepted

I have minor suggestions after which the manuscript can be published:

Ln 171: I suggest removing the parenthesis in "pattern(s)".

Ln 281: Please modify to "confirmatory factor analysis (CFA)".

Ln 297: Please modify to "For psychometric properties, the content...".

Ln 350: Please modify to "p<0.001". Correct throughout the document, including tables. Although the software used generates an output of 0.000 or similar, this does not mean the result is literally zero, but rather a problem with the software displaying the true value. Hence, to avoid confusion, this should be converted, i.e., from p = 0.000 to p < 0.001.

Ln 408-411 This section requires rephrasing for clarity

Ln 578 There is a typo in “A,nuchart Kaunnil”

**********

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Reviewer #1: No

Reviewer #2: No

**********

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10.1371/journal.pone.0308421.r004
Author response to Decision Letter 1
Submission Version2
16 Jul 2024

Response (round-2) to editor

We greatly appreciate your thoughtful comments concerning our manuscript entitled "Sensory processing patterns as internal factors determining metabolic risk factors among community dwelling people with Metabolic Syndrome" (Manuscript ID: PONE-D-24-06360R1). Those comments are all valuable and very helpful for revising and improving our paper. We have studied comments carefully and have made correction which we hope meet with approval. Revised portion are marked in yellow highlighting in the paper and indicated by blue text.

The major points in the paper and the responds to the reviewers and editor comments are as flowing:

Point 1: The GLMM needs work. Please report the family and link function used in the model and why. Report the model fit statistics, including the null models. Please report the software used to conduct the analyses.

Response 1: We truly appreciate your comments regarding the GLMM. Following your suggestion, we have now added the information regarding the GLMM analysis, including the family, link function, model fit statistics and software used to conduct the analyses. Now, the revision is on page 14, lines 324-331.

Point 2: Report the specific test used for the power calculation in G*Power

Response 2: We appreciate on your comments and suggestions. We have added the specific test for the power calculation in G*Power on page 8, lines 194-195.

Point 3: Be careful not to overstretch the results, given that the correlations you obtained are weak, for example when you speak of “unexpected results” on relationship between WC and auditory arousal.

Response 3: We would like to thank you for your comments and suggestion. We have carefully revised the manuscript and rephased this part, ensuring not to overstretch the interpretation of the results. Now, it is on the page 22, line 473-478.

Point 4: Please revise the “other comments” at the end of review 1 and the minor points made by reviewer 2.

Response 4: We truly appreciate and agree with your and reviewers’ comments. We have carefully revised all of the feedback and suggestions from both reviewers.

Point 5: Please do a new English check. I have seen the language check document you attached, but new mistakes appeared, such as “The example of items…” (line 289), “For psychometric properties. The…” (line 297), line 304 should be 0.849, lines 408 to 411, and several others. Avoid anthropomorphizing, as reviewer 1 says, for example “Kendall’s Tau found” in the abstract.

Response 5: We truly appreciate and agree with your comments regarding the manuscript’s grammar and language. After carefully revising the manuscript based on your feedback and the suggestions of the two reviewers, we have sent it again to an English specialist who is a native English speaker for further revision. Additionally, we have a copy of the manuscript showing track changes by a native English as supporting information.

- “The examples of items…” (line 284)

- “For psychometric properties. The…” (line 292)

- “0.849” (line 299)

- line 412-414

- the abstract (line 38 and 42)

Point 6: Line 440: should it be tactile sense?

Response 6: Thank you for your comment. We have reviewed the manuscript and confirmed that the use of the term "tactile sense" in line 440 is correct, and this finding showed in Table 5, which analyzed by the GLMM. However, to avoid any confusion, we have added an explanation in the manuscript referencing the specific statistics that support the significance to provide clearer understanding for the readers. Now, the revision is on page 21, line 445.

Special thanks to you for your good comments and suggestion. We tried our best to improve the manuscript and made some changes in the manuscript.

We appreciate for editor and reviewers’ warm work earnestly and hope that the correction will meet with approval. Once again, thank you very much indeed for your comments and suggestions.

Best regards,

Ilada Pomngen and research team

Response to Reviewer (Round-2) #1:

We greatly appreciate your thoughtful comments concerning our manuscript "Sensory processing patterns as internal factors determining metabolic risk factors among community dwelling people with Metabolic Syndrome" (Manuscript ID: PONE-D-24-06360R1). Those comments are all valuable and very helpful for revising and improving our paper. We have studied the comments carefully and have made correction which we hope meet your approval. Revised portion are marked in yellow highlighting in the paper and and indicated by blue text.

The major concerns in the paper and the responds to the reviewer’s comments are as flows:

Point 1: The abstract is too long and convoluted. Please make the abstract more succinct. Briefly state the background, motivation, methodology, and findings. Do not report statistics.

Response 1: Thank you for your valuable feedback. We have revised the abstract to be more succinct without the report of statistics, while retaining the information that another reviewer was concerned about. This revision is on page 2, lines 26-48.

Point 2: Report the specific test used for the power calculation in G*Power.

Response 2: We appreciate on your comments and suggestions. We have added the specific test for the power calculation in G*Power on page 8, lines 194-195.

Point 3: There is basically no correlation between any of the variables. The only couple that are significant are too low. The authors are overinterpreting this correlations.

Response 3: We appreciate the reviewer's helpful suggestion. We have carefully revised the manuscript, ensuring not to overstretch the interpretation of the results. We have added the sentence to inform the readers to pay attention to the low correlations observed on page 21, lines 441-444. Moreover, in your concern that the correlations were still low, we have acknowledged the limitation of the study in the limitation section, specifically regarding the low correlations found. This limitation highlights the caution needed when interpreting and applying these findings in practice on page 24, lines 518-522; page 25, lines 532-534.

Point 4: The GLMM needs work. Please report the family and link function used in the model and why. Report the model fit statistics, including the null models. Please report the software used to conduct the analyses.

Response 4: We truly appreciate your comments regarding the GLMM. Following your suggestion, we have now added the information regaeding the GLMM analysis, including the family, link function, medel fit statistics and software used to conduct the analyses, on page 14, lines 324-331.

Point 5: The discussion on the link between auditory sensory arousal and WC given that this is based only on a (low) correlation. In addition, the GLMM showed no significant effect.

Response 5: We would like to thank you for your comments and suggestion. We have carefully revised the manuscript, ensuring not to overstretch the interpretation of the results. Now, it is on the page 22, lines 473-478.

Point 6: The discussion on tactile sensory preference needs some work. There is no direction in the preference for food texture. Are all food textures disliked? Or are specific textures dislike, which drives dislike to specific kinds of foods.

Response 6: Thank you for your insightful comment. We have revised the section to clarify the relationship between sensory sensitivity and food texture preferences. The revised sentence now specifies that individuals with low preference for certain tactile sensations tend to dislike specific textures, which often leads to the avoidance of foods with those textures. Now, it is on the page 23, line 487-491.

Point 7: L.75, what is body stimuli?

Response 7: We would like to apologize and thank you for your comments and suggestion. We have now corrected it to be internal body stimuli. Now, it is on the page 3, line 69.

Point 8: Please capitalize COVID-19

Response 8: We would like to thank you for your comments and suggestion. We have now correted it. Now, it is on the page 7, line 161.

Point 9: What is behaviorally observing methods?

Response 9: We would like to thank you for your comments and suggestion. We have modified it to make it clearer. Now, it is on the page 6, line 128-129.

Point 10: L.315, what does percentage mean? Percentage of what?

Response 10: We appreciate the reviewer's helpful suggestion regarding an appropriate statistical analysis method. We have now made a change by incorporating a more detailed description of the descriptive analyses. This revision is on page 13, lines 310-313.

Point 11: L.382, "the general linear mixed model discovered". Please avoid anthropomorphism here. The analysis did not "discover", it may have revealed.

Response 11: We would like to apologize and thank you for your comments and suggestion. We have now revised it. Now, it is on the page 18, line 386.

Special thanks to you for your good comments and suggestion. We tried our best to improve the manuscript and made some changes in the manuscript.

We appreciate for reviewers’ warm work earnestly and hope that the correction will meet with approval. Once again, thank you very much indeed for your comments and suggestions.

Best regards,

Ilada Pomngen and research team

Response (round-2) to Reviewer #2:

We greatly appreciate your thoughtful comments concerning our manuscript "Sensory processing patterns as internal factors determining metabolic risk factors among community dwelling people with Metabolic Syndrome" (Manuscript ID: PONE-D-24-06360R1). Those comments are all valuable and very helpful for revising and improving our paper. We have studied the comments carefully and have made correction which we hope meet your approval. Revised portion are marked in yellow highlighting in the paper and indicated by blue text.

The major concerns in the paper and the responds to the reviewer’s comments are as flows:

Point 1: Ln 171: I suggest removing the parenthesis in "pattern(s)".

Response 1: We would like to apologize for this mistake and thank you for your comments. Based on your comments and suggestion, we have already checked and corrected it, on page 7, lines 165-166.

Point 2: Ln 281: Please modify to "confirmatory factor analysis (CFA)".

Response 2: We would like to apologize for this mistake and thank you for your comments and suggestion. We have now checked and corrected it, on page 12, line 277.

Point 3: Ln 297: Please modify to "For psychometric properties, the content...".

Response 3: We would like to apologize for this mistake and thank you for your comments and suggestion. We have now checked and corrected it, on page 12, line 292.

Point 4: Ln 350: Please modify to "p<0.001". Correct throughout the document, including tables. Although the software used generates an output of 0.000 or similar, this does not mean the result is literally zero, but rather a problem with the software displaying the true value. Hence, to avoid confusion, this should be converted, i.e., from p = 0.000 to p < 0.001.

Response 4: We truly appreciate your comments and useful suggestions. We have carefully checked and correted them, on page 15, line 354; page 16, Table 2; page 18-19, Table 5.

Point 5: Ln 408-411 This section requires rephrasing for clarity

Response 5: We thank the reviewer for this useful suggestion. We have now rephrased this section, on page 20, lines 412-414.

Point 6: Ln 578 There is a typo in “A,nuchart Kaunnil”

Response 6: We would like to apologize for this mistake and thank you for your comments and suggestion. We have now checked the typo and corrected, on page 27, line 585.

Special thanks to you for your good comments and suggestion. We tried our best to improve the manuscript and made some changes in the manuscript.

We appreciate for reviewers’ warm work earnestly and hope that the correction will meet with approval. Once again, thank you very much indeed for your comments and suggestions.

Best regards,

Ilada Pomngen and research team

Attachment Submitted filename: Response to Editor.docx

10.1371/journal.pone.0308421.r005
Decision Letter 2
Mesz Bruno Alejandro Academic Editor
© 2024 Bruno Alejandro Mesz
2024
Bruno Alejandro Mesz
https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Submission Version2
23 Jul 2024

Relationships between sensory processing patterns and metabolic risk factors among community dwelling people with Metabolic Syndrome: A cross-sectional and correlational research design

PONE-D-24-06360R2

Dear Dr. Pomngen,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Bruno Alejandro Mesz, Ph.D.

Academic Editor

PLOS ONE

10.1371/journal.pone.0308421.r006
Acceptance letter
Mesz Bruno Alejandro Academic Editor
© 2024 Bruno Alejandro Mesz
2024
Bruno Alejandro Mesz
https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
25 Jul 2024

PONE-D-24-06360R2

PLOS ONE

Dear Dr. Pomngen,

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team.

At this stage, our production department will prepare your paper for publication. This includes ensuring the following:

* All references, tables, and figures are properly cited

* All relevant supporting information is included in the manuscript submission,

* There are no issues that prevent the paper from being properly typeset

If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps.

Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

If we can help with anything else, please email us at customercare@plos.org.

Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Dr. Bruno Alejandro Mesz

Academic Editor

PLOS ONE
==== Refs
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