“…However, the association reported between HSEH and MSI is inconsistent. Some studies report that as HSEH increases [ 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ] the risk of MSI increases, while others report it decreases [ 17 , 29 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ] or does not change [ 17 , 19 , 44 , 45 ]. Furthermore, other studies report increasing HSEH has a curvilinear effect on the risk of MSI, whereby as HSEH continues to increase, the risk of MSI initially decreases, plateaus, then increases again [ 17 , 36 , 38 , 40 ].…”