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. 2026 Jul 13;17:1883051. doi: 10.3389/fendo.2026.1883051

Figure 3.

Risk of bias table assessing seventeen studies across seven bias domains, where green plus symbols indicate low risk, yellow minus symbols represent some concerns, and a red X shows high risk. Chen et al. (Clin Sci, 2015) exhibits high risk for D1. Most studies display low risk across all domains, with occasional concerns for D1, D3, D6, and D7. The lower bar graph summarizes domain-level judgments, showing the majority as low risk, some concerns mainly for D1, D3, D6, and D7, and very limited high risk only in D1.

Assessment of the study bias according to the ROBINS-E tool. Risk of bias judgments are interpreted as follows: Low risk: The study is comparable to a well-performed randomized trial with regard to this domain; Some concerns: The study provides sound evidence but has minor methodological limitations; High risk: The study has serious methodological flaws that weaken confidence in the results; Very high risk: The study has fundamental flaws making the findings highly unreliable.