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. 2024 Dec 3;11:1433612. doi: 10.3389/fmed.2024.1433612

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Copyright © 2024 Jia, Zhou, Liu and Li.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

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Diagrams illustrating the associations examined in this study. (A) Total effect between inflammatory proteins and PCOS. Parameter c represents the total effect of genetically predicted inflammatory proteins on PCOS, while d represents the total effect of genetically predicted PCOS on inflammatory proteins. (B) The total effect is decomposed into: (i) the indirect effect, assessed via a two-step approach, where a denotes the effect of inflammatory proteins on serum metabolites, and b denotes the effect of serum metabolites on PCOS, with the product method (a × b) capturing this indirect pathway; and (ii) the direct effect, calculated as c′ = c – a × b. The proportion mediated was determined by dividing the indirect effect by the total effect.