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. 2025 Sep 14;8(9):e71222. doi: 10.1002/hsr2.71222

The Relationship Between Lipid Peroxidation, Serum Antioxidant Vitamin, Inflammatory Biomarker, Trace Elements, and Macro‐Minerals With Bangladeshi Fibromyalgia Patients: A Case‐Control Study

Md Ashiqul Islam 1,2, Md Ashraful Alam 2,3, Shahriar Ahmed 2, Ahmed Rakib 2, Md Giash Uddin 2, Mohammad Nazmul Islam 4, Fariha Sultana Etu 3, Md Iftikhar Uddin Masud 5, S M Naim Uddin 2,✉
PMCID: PMC12434171  PMID: 40959188

ABSTRACT

Background and Aims

Fibromyalgia is an emerging health concern in Bangladesh, with symptoms that tend to worsen over time. This study sought to measure serum lipid peroxidation, nonenzymatic antioxidant, C‐reactive protein (CRP), macro‐minerals, and trace elements in fibromyalgia syndrome (FMS) patients to explore their association with disease progression.

Methods

The investigation involved 50 fibromyalgia patients (cases) and 50 healthy individuals (controls) in Bangladesh. Serum malondialdehyde (MDA) was measured to assess lipid peroxidation utilizing spectrophotometry. UV spectrophotometric technique was employed for the determination of vitamin C, while serum levels of macro‐minerals (Mg and Ca) and trace elements (Zn and Cu) were quantified using atomic absorption spectroscopy. CRP level was ascertained by using CRP‐Latex agglutination assay.

Results

Our study identified markedly increased levels of MDA (4.26 ± 0.04 nmol/mL, p < 0.001), CRP (17.13 ± 8.95 mg/L, p < 0.001), and notably reduced vitamin C levels (17.6 ± 1.84 µmol/L, p < 0.001) in the FMS group compared with healthy controls (HC). Mean serum values of Ca, Mg, Zn, and Cu were 7725.2 ± 202.43 µg/dL, 1173.6 ± 6.00 µg/dL, 69.62 ± 0.69 µg/dL, and 144.66 ± 0.80 µg/dL for the patient group and 8718 ± 169.95 µg/dL, 1619.4 ± 10.32 µg/dL, 91.4 ± 0.86 µg/dL, and 115.28 ± 0.96 µg/dL for the control group, respectively. A significant difference was observed for all macro‐minerals and trace elements between the FMS and the HC groups. Moreover, Pearson's correlation study revealed a significant positive and negative correlation between Mg and Cu in the FMS group (r = 0.328, p = 0.02) and in the HC group (r = −0.305, p = 0.032), respectively.

Conclusion

The findings suggest that elevated serum MDA, depleted serum concentrations of vitamin C, and altered trace elements and macro‐mineral concentrations characterize the FMS patients in Bangladesh.

Keywords: antioxidant, Bangladesh, CRP, fibromyalgia, macro‐minerals, MDA, trace elements

Abbreviations

CRP

C‐reactive protein

FMS

fibromyalgia syndrome

HC

healthy controls

MDA

malondialdehyde

1. Introduction

Fibromyalgia is characterized as a musculoskeletal disorder that is followed by severe muscle pain, tenderness, fatigue, sleeping problems, and cognitive difficulties. Although it is a prevalent disorder harming at least five million persons in the United States [1], the exact etiology of the disease is yet to be elucidated. The prevalence of the disease is 0.2%–6.6% of the general population and is more common among females (2.4%–6.8%) [2, 3, 4]. According to a comprehensive survey, fibromyalgia affected 4.4% Bangladeshi individuals dwelling in rural village areas, 3.3% of those residing in rich urban regions, and 3.2% living in impoverished parts of the city [2, 5, 6]. In Bangladesh, this has also become a significant health concern, and the management of the disease is troublesome for physicians and patients.

It has recently been proposed that oxidative stress is a relevant event in the development of fibromyalgia [7, 8, 9]. Reactive oxygen species (ROS) and an imbalance of antioxidants develop oxidative stress. Generation of excess ROS from exogenous and endogenous sources greater than antioxidants leads to oxidative stress [10, 11]. ROS approaches the cell layer's polyunsaturated fatty acids, leading to lipid peroxidation [12, 13]. Tissue antioxidants defend against ROS, which contains enzymatic and nonenzymatic enzymes [14]. Malondialdehyde (MDA), a lipid peroxidation product, is used as a biological marker for cell membrane lipid damage by ROS. A high level of MDA affects the cell membrane permeability. The hazardous level of MDA is neutralized by antioxidants via the transformation of superoxide to hydrogen peroxide and oxygen molecules. Superoxide dismutase is the most powerful antioxidant [15]. Hydrophilic vitamin C can directly scavenge ROS and lipid hydroperoxides [16]. An acute‐phase protein, C‐reactive protein, or CRP, is produced by liver cells. It can be used as a biological marker for inflammation. The serum level of CRP increases with a high level of inflammation. CRP level in fibromyalgia syndrome (FMS) can be utilized as a convenient pathological tool for measuring inflammation. To our knowledge, there is a lack of information about CRP and FMS involvement [10, 17].

Macro‐minerals and trace elements such as zinc (Zn), magnesium (Mg), copper (Cu), and calcium (Ca) are crucial for the homeostasis of the human body. Imbalances of these elements are responsible for the development of numerous human diseases [18]. Several studies have suggested that the pathogenesis of FMS and its symptoms may involve imbalanced trace elements and elevated levels of toxic metals [19, 20, 21]. Zn has essential antioxidant potential by acting as a cofactor for a plethora of antioxidant enzymes [22]. It has numerous metabolic functions, in addition to its roles in the immune system, wound healing, protein synthesis, and the regulation of normal cell division and growth. It also has antioxidant functions and protects against ageing [23, 24, 25, 26, 27]. Mg is a trace element required for muscle metabolism by playing a role in the ATP synthesis process. A lower level of ATP triggers the way of fibromyalgia [28]. It also plays a role in aerobic and anaerobic glycolysis [29]. Apart from Zn and Mg, Ca is responsible for pivotal biological processes. It is essential for the release of neurotransmitters and the excitability of cell membranes. A previous study also showed the involvement of Ca ions in pain and antinociception [30]. The lower level of Ca is associated with muscle spasms and cramping. To this end, an adequate Ca level is necessary for the healthy regulation of the human body [31]. Cu also plays a role in metabolism [25], which is usually absorbed into the gut. This essential element regulates skin strength, epithelial tissue, and connective tissue of the human body, as well as produces hemoglobin, regulates the function of myelin and melanin, and maintains regular thyroid activity [25, 32]. Additionally, Cu also functions as an antioxidant and pro‐oxidant [33, 34, 35].

Although various previous research studies have been performed to assess the impact of oxidative stress in FMS cases, there is a dearth of information about the relationship between oxidative stress, macro‐minerals, trace elements, and the expression of inflammation in FMS. Furthermore, recognizing that the cause and severity of many diseases are related to cultural and ethnic differences, it is vital to study FMS in different nationalities and geographical locations. As the above study parameters and their correlation were not previously studied on Bangladeshi FMS patients, the present research work intends to observe oxidative stress and inflammation, as well as determine serum Zn, Mg, Ca, and Cu, and their association with other variables in Bangladeshi FMS patients. It is worthwhile to mention that people in Bangladesh typically use analgesics to manage their fibromyalgia, but these medications have significant adverse effects, such as hepatotoxicity, if used for a prolonged period of time. As a developing country, this also results in substantial economic losses for these patients without solving the root cause of their suffering. This study helps to find a correlation between antioxidants, trace elements, and macro‐minerals with fibromyalgia progression, which leads to a potential nutritional therapy and proper diet supplementation for FM patients.

2. Materials and Methods

2.1. Study Design and Blood Sample Collection

This study was carried out from April 2018 to April 2020. Dhaka Medical College and Hospital granted permission to carry out this investigation. Fifty FMS patients and 50 healthy control (HC) volunteers were recruited in this case‐control study. Each subject, including FMS patients and HC, agreed to participate in the research, and a written consent document was obtained from them. All investigations were conducted in accordance with the Declaration of Helsinki's principles. The institutional ethical research committee of the University of Chittagong approved the study protocol and granted ethical permission (Ref. No: ERC‐CU/PHAR/2018/44) in February 2018. All of the recruited patients met the criteria of the American College of Rheumatology to be classified as FMS [36]. FMS patients were recruited by physicians' referrals who were rheumatologists. Patients who had pathologic disorders except FMS were excluded from this study. During the study, the subjects were asked not to take antioxidants, macro‐minerals, and trace elements, which could have been used to intervene with the concentrations of antioxidants, macro‐minerals, and trace elements. Different biographical characteristics (height, weight, age) and BMI were also garnered for both FMS patients and the HC group.

The blood sample was withdrawn from each FMS and HC group in the overnight fasting condition. Subsequently, the collected blood was permitted to clot at room temperature for 1 h. Following a 15‐min centrifugation at 3000 rpm, the extracted serum was kept in microtubes at −80°C for further analysis. The held samples were applied to determine the serum level of MDA, vitamin C, CRP, macro‐minerals, and trace elements.

2.2. Chemicals and Reagents

Only analytical‐grade chemicals and reagents were employed throughout this investigation, and all of them were collected from commercial vendors. Standards of Mg, Zn, Ca, and Cu were purchased from Buck Scientific in the United States. Sigma Chemical Co. in the United States supplied the standards for alpha‐tocopheryl acetate. Reagents and chemicals of HPLC grade were procured from Active Fine Chemicals Limited, Bangladesh. Concentrated hydrochloric acid (37%) and nitric acid were acquired from Merck, Germany. Additional chemicals and laboratory provisions were provided by the Pharmacy Department at the University of Chittagong, Bangladesh.

2.3. Quantification of MDA Level

Serum MDA concentration was determined by following our earlier published method [37, 38] employing TBA reagent, or thiobarbituric acid. The supernatant absorbance was quantified using spectrophotometry at 530 nm. The concentration of MDA was expressed in nanomoles per milliliter.

2.4. Determination of Vitamin C

The phenyl‐hydrazine method, based on the principle of spectrophotometry, was employed for the determination of the ascorbic acid (vitamin C) concentration [39]. The absorbance readings for both the sample and standard were recorded at a wavelength of 520 nm.

2.5. Determination of CRP

In the determination of CRP level, serum drop and latex reagent drop were dispersed together. Then, it was subjected to rotation in a lab rotator at 100 rpm. The presence of agglutination determines the serum CRP level [10].

2.6. Determination of Macro‐Minerals and Trace Elements

Serum concentrations of macro‐minerals and trace elements were quantified by both graphite furnace atomic absorption spectrometry and flame atomic absorption spectrometry by following our earlier published article [40, 41, 42]. Serum samples were diluted at a 1:10 ratio using deionized water. Then, a calibration curve was generated using a series of mineral standards with concentrations of 0.5, 1.0, 2.0, 5.0, and 10.0 mg/L. Eventually, the final amounts of macro‐minerals and trace elements were quantified through the recording of absorbance measurements at 213.9, 285.2, 422.7, and 327.4 nm for Zn, Mg, Ca, and Cu, respectively.

2.7. Statistical Analysis

The MDA, vitamin C, macro‐mineral, and trace element levels were all presented as the mean ± SEM. Data was studied and analyzed using an independent sample t‐test to compare FMS patients and HC group obtained values. Using Pearson's correlation, different study factors were correlated, with a p‐value below 0.05 indicating statistical significance. SPSS software (version 19.0, IBM Corp., Armonk, NY) was employed to execute all statistical calculations.

3. Results

This study includes patients with FMS as cases and healthy individuals as controls. The following tables present the results of our evaluation of the parameters in HC volunteers and FMS patients.

3.1. Anthropometric and Demographic Profile of the Study Population

Table 1 displays the anthropometric and demographic characteristics of the 50 individuals in both the FMS and 50 HC groups. The average age of the FMS and HC groups was found to be 39.2 ± 6.8 and 37.9 ± 7.6 years old, respectively, and the mean BMI of the FMS (23.6 ± 0.4 kg/m2) and the HC groups (23.8 ± 0.3 kg/m2) did not differ significantly.

Table 1.

Anthropometric and demographic profile of the study population.

Parameter Values (mean ± SEM)
FMS HC p value
Age (years) 39.16 ± 6.76 37.93 ± 7.64 0.185NS
BMI (kg/m2) 23.64 ± 0.35 23.77 ± 0.25 0.379
Disease duration (months) 16.16 ± 1.08
Sex Value, n (%) 10 (20%)
Male 10 (20%)
Female 40 (80%) 40 (80%)
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Note: Values are expressed as mean ± SEM.

Abbreviations: BMI, body mass index; FMS, fibromyalgia syndrome; NS, not significant.

3.2. Serum MDA, Antioxidants (Vitamin C), and CRP Status of the Study Population

The serum concentrations of MDA, CRP, and vitamin C for both the FMS and HC populations are reported in Table 2, while Figures 1, 2, 3 display the respective levels of these biomarkers in the same groups. Here, FMS cases exhibited statistically significantly elevated MDA concentration (4.26 ± 0.04 nmol/mL, p < 0.001) compared to the HC (2.43 ± 0.04 nmol/mL, p < 0.001) at a 5% significance level. On the other hand, significantly depleted concentrations of vitamin C (17.6 ± 1.84 µmol/L, p < 0.001) were observed for FMS cases compared to the HC group (35.36 ± 1.22 µmol/mL, p < 0.001). Again, the CRP level was significantly higher in the FMS cases (17.13 ± 8.95 mg/L, p < 0.001) than in the HC (3.33 ± 2.53 mg/L, p < 0.001).

Table 2.

Serum level of vitamin C, MDA, and CRP in the study population.

Parameters Values (mean ± SEM)
FMS HC p value
Vitamin C (µmol/L) 17.6 ± 1.84 35.36 ± 1.22 p < 0.001
MDA (nmol/mL) 4.26 ± 0.04 2.43 ± 0.04 p < 0.001
CRP (mg/L) 17.13 ± 8.95 3.33 ± 2.53 p < 0.001
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Figure 1.

Figure 1

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Serum level of MDA in the study population.

Figure 2.

Figure 2

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Serum level of C‐reactive protein in the study population.

Figure 3.

Figure 3

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Serum level of vitamin C in the study population.

3.3. Status of Trace Elements and Minerals in the Study Population

Table 3, as well as Figures 4, 5, 6, 7, shows the average amounts of trace elements and minerals in the FMS and HC groups. The greater level of Zn, Mg, and Ca was seen in the control group (91.4 ± 0.86 µg/dL for Zn, 1619.4 ± 10.32 µg/dL for Mg, and 8718 ± 169.95 µg/dL for Ca) than in the FMS group. These values were of statistical significance (p < 0.001). On the contrary, Cu levels were significantly higher in FMS (144.66 ± 0.80 µg/dL, p < 0.001) than in the HC group.

Table 3.

Serum levels of Zn, Mg, Cu, and Ca in the study population.

Parameters Values (mean ± SEM)
FMS HC p value
Zn (µg/dL) 69.62 ± 0.69 91.4 ± 0.86 p < 0.001
Mg (µg/dL) 1173.6 ± 6.00 1619.4 ± 10.32 p < 0.001
Cu (µg/dL) 144.66 ± 0.80 115.28 ± 0.96 p < 0.001
Ca (µg/dL) 7725.2 ± 202.43 8718 ± 169.95 p < 0.001
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Figure 4.

Figure 4

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Serum level of zinc in the study population.

Figure 5.

Figure 5

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Serum level of magnesium in the study population.

Figure 6.

Figure 6

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Serum level of calcium in the study population.

Figure 7.

Figure 7

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Serum level of copper in the study population.

3.4. Correlation Study

Pearson's correlation analysis was employed to show inter‐element correlations between the FMS and HC groups for the observed elements. Tables 4 and 5 demonstrate the values of the correlation coefficient and indicate their levels of statistical significance. Out of all the established correlations between vitamins, trace elements, and minerals for HC and FMS groups, the FMS patient group displayed a significant positive association between Mg and Cu (r = 0.328, p = 0.02). HC group revealed a significant negative association between Mg and Cu (r = −0.305, p = 0.032). However, neither the positive nor the negative correlations between vitamins and other trace elements reached the level of statistical significance for either group.

Table 4.

Correlation study among various study parameters in the FMS and HC groups.

Correlation parameters FMS HC
r p r p
Vitamin C and MDA 0.026 0.856 0.027 0.850
Vitamin C and Zn 0.216 0.132 −0.262 0.066
Vitamin C and Mg −0.065 0.654 0.062 0.668
Vitamin C and Cu 0.072 0.621 −0.070 0.628
Vitamin C and Ca 0.157 0.277 0.025 0.862
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Note: Negative values specify opposite correlation.

Abbreviations: p, significance; r, correlation coefficient.

Table 5.

Comparison of inter‐element relationships between the FMS and HC groups.

Correlation parameters FMS HC
r p r p
Zn and Mg −0.060 0.677 0.111 0.441
Zn and Cu 0.090 0.533 −0.224 0.119
Zn and Ca −0.064 0.657 0.067 0.644
Mg and Cu 0.328 0.020** −0.305 0.032**
Mg and Ca 0.039 0.790 −0.059 0.682
Cu and Ca −0.117 0.419 0.192 0.181
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Note: Negative values specify opposite correlation.

Abbreviations: p, significance; r, correlation coefficient.

**

Correlation is significant at the 0.05 level (two‐tailed).

4. Discussion

Fibromyalgia is a persistent musculoskeletal disorder marked by pervasive pain, fatigue, sleep disruptions, and cognitive impairments. It affects roughly 0.2%–6.6% people globally, with a higher prevalence among women, exhibiting a female‐to‐male ratio of about 3:1 [2, 43, 44]. In this study, we found an elevated level of serum MDA and depleted vitamin C in FMS compared with HC groups, indicating an imbalance of oxidant and antioxidant capacity. This investigation further suggests that diminished serum levels of Zn, Mg, and Ca, along with elevated Cu levels, are significantly correlated with FMS patients.

ROS are not entirely beneficial to biological processes. The free radical chain reaction and oxygen molecules are responsible for the harmful lipid peroxidation [37]. MDA is generated as the end product of the lipid peroxidation process. Several studies found a marked elevation of serum MDA content in FMS patients, which agrees with our study's finding [45, 46]. MDA is also widely recognized as a prominent marker for oxidative stress. Oxidative stress can cause cell damage and the release of pro‐inflammatory cytokines [40]. It is responsible for many disorders, including inflammation, atherosclerosis, rheumatoid arthritis, carcinogenesis, diabetes, and peptic ulcer. It is evident that free radical‐induced oxidative damage is involved in the disease mechanism of fibromyalgia [15]. Prior research suggested that elevated level of lipid peroxidation is linked with fibromyalgia [3, 12, 15, 47]. Our current study also found a significantly increased level of lipid peroxidation with fibromyalgia than the HC group. Conversely, another study involving females with fibromyalgia revealed no variation in lipid peroxidation levels between the control group and the fibromyalgia patients [47].

Different antioxidant enzymes are responsible for the protection of oxidative stress. Vitamin C is the key antioxidant that serves as a cofactor in numerous enzymatic pathways and counteracts inflammatory biomarkers [48]. Fewer intakes of various fruits and vegetables cause a quick diminution of vitamin C from the body [49]. In this study, we found significantly decreased levels of vitamin C in the FMS group compared to the HC group. This finding of decreased vitamin C concentration in FMS patients may not be able to neutralize ROS, hence increasing MDA levels and facilitating the inflammatory reactions. A study revealed that the supplementation of vitamin C can increase the antioxidant functioning of FMS patients [50]. However, another study observed that there is no significant change in the level of vitamin C in FMS [28].

To a general extent, high CRP concentration is associated with inflammation in rheumatoid disorder, musculoskeletal pain, and polymyalgia. It is evident that high CRP level is involved in the pathogenesis of FMS [17]. Our study also demonstrated significantly elevated CRP levels in FMS patients (17.13 mg/L, p < 0.001) compared to the HC group. CRP is a crucial marker of systemic inflammation. While fibromyalgia has been historically classified as a noninflammatory disorder, emerging evidence suggests low‐grade inflammation may contribute to its pathophysiology. Elevated CRP levels have been associated with increased pain severity, fatigue, and psychological distress in FMS, potentially reflecting immune system dysregulation or comorbid metabolic conditions such as obesity [51, 52]. These findings support the hypothesis that inflammatory pathways may play a modulatory role in symptom expression among FMS patients.

Trace elements and minerals are important for the immune functioning of the body, and the imbalance of these levels adversely affects biological functioning, which leads to various undesired effects [38]. It is acknowledged that trace elements and minerals affect the normal physiological function, immune function, and the risk of comorbidity disorders [53, 54, 55]. Recently, different studies found the involvement of trace element levels in the disease mechanism of FMS [19, 56, 57]. In this current study, the serum levels of Zn, Mg, Cu, and Ca were measured, and the potential role and significance of FMS were explored.

Zn is a trace element essential for protein metabolism, nucleic acid synthesis, and normal cellular function [58]. Zn acts as an important antioxidant in the human body. It is reported that a decreased level of Zn is responsible for the disease mechanism of FMS [59, 60]. These observations align with our findings, which indicate a significant reduction in Zn levels in FMS cases. Again, Mg is responsible for the synthesis of ATP. It is evidenced that a lower level of ATP is involved in the disease mechanism of FMS. A previous study also reported fatigue, irritable bowel syndrome, and weakness of muscle linked to FMS due to a deficiency of Mg [60]. Our study also found a significantly decreased level of Mg in FMS patients. In addition, Ca is important for biological processes and for the body to function properly. It is reported that the Ca level is related to the pain mechanism. Ca is responsible for the contraction of muscle, and alteration of Ca level leads the way to muscle spasms and pain, which is linked to FMS. Hence, altered Ca levels may be related to FMS [30, 41]. Our study suggested a significantly lower level of Ca in FMS patients. Furthermore, Cu plays a role in metabolism and is essential for normal physiologic activity. Assavarittirong et al. [7] mentioned that consumption of Cu in excess may lead to a rise in fibromyalgia symptoms. Although the number of studies is limited, there have been reports of Cu content being elevated in FMS patients [41, 61]. Recently, a causal relationship has been found between FMS risk and Cu [19]. Our work revealed a significantly elevated level of Cu in FMS patients compared to HC groups, thereby reaffirming the findings of previous studies.

Finally, according to the preceding explanation and findings, it is shown that FMS is involved with lipid peroxidation, increased CRP, and changed vitamin and mineral intake during daily diet in all of the patients that participated in the studies. Moreover, it is reported that antioxidants can reduce inflammation in FMS patients [62]. Thus, results suggest that FMS patients should review their diet to ensure the intake of correct amounts of dietary antioxidants and minerals. The present study reinforces evidence for new FMS treatment approaches.

5. Conclusion

The current study revealed that the FMS patients of Bangladesh possess elevated serum MDA, CRP levels, and varying concentrations of serum macro‐minerals and trace elements in comparison to the HC group. It also turned out that FMS patients had lower serum concentrations of antioxidant vitamin C than the HC group. According to this study, serum Zn, Mg, and Ca levels were reduced in FMS patients compared to the HC group, but Cu levels were elevated. Hence, increased serum MDA, CRP, and altered serum antioxidants, macro‐minerals, and trace elements could play a role or be a consequence of the development of FMS among patients in Bangladesh. Therefore, appropriate dietary intervention using vitamins, trace elements, and minerals could be taken into account in the integrative treatment of FMS.

Author Contributions

Md. Ashiqul Islam: data curation, formal analysis, investigation, writing – original draft. Md. Ashraful Alam: formal analysis, writing – original draft, writing – review and editing. Shahriar Ahmed: data curation, project administration. Ahmed Rakib: data curation, project administration. Md. Giash Uddin: writing – review and editing. Mohammad Nazmul Islam: writing – original draft, writing – review and editing. Fariha Sultana Etu: writing – review and editing. Md. Iftikhar Uddin Masud: data curation, project administration. S. M. Naim Uddin: conceptualization, methodology, project administration, resources, supervision. All authors have read and approved the final version of the manuscript.

Conflicts of Interest

The authors declare no conflicts of interest.

Transparency Statement

The lead author, S. M. Naim Uddin, affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

Acknowledgments

The authors express sincere gratitude to the teachers and staff of pharmacy and chemistry at the University of Chittagong for their consistent technical and laboratory support throughout the study. Appreciation is also extended to the doctors, nurses, and staff at Dhaka Medical College and Hospital in Bangladesh for their assistance throughout the investigation process. The authors would also like to appreciate Eskayef Pharmaceuticals Limited, Gazipur, Bangladesh, for offering technical support. Finally, the authors thank everyone who took part in the study. This study was conducted without the aid of any external funding or specific grants.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request. The corresponding author, S. M. Naim Uddin, had full access to all of the data in this study and takes complete responsibility for the integrity of the data and the accuracy of the data analysis.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request. The corresponding author, S. M. Naim Uddin, had full access to all of the data in this study and takes complete responsibility for the integrity of the data and the accuracy of the data analysis.

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