Reviewer ’s report  
 
Title: Combined Effects of Lifestyle Risk Factors  on Fatty Liver Index  
 
Version: 2 Date: 23 Feb 2020  
 
Reviewer: Claudio Tiribelli  
 
Reviewer's report:  
 
This is an interesting and comprehensive study analyzing the risk factors of fatty liver (FL) 
defined based on Fatty Liver Index (FLI) in a very large Finnish database of the general 
population. Data are reported indicating that FL increases with lack of physical activity, alcohol 
consumption and rather surprisingly coffee consumption. The Ms is well writt en and 
demonstrate on a solid statistical analysis what has been suggested since the beginning of FL era 
i.e that lack of physical activity is crucial in determining the hepatic condition.  
 
Specific critiques  
 
1. The Ms can be improved by providing the fasti ng glucose level and including this 
variable in the assessment pf different risk scores. This will allow to define the so called 
"metabolic health" in adults (Cell Metab 2017;26:292 -300).  
 
2. The gender difference must be better analyzed and discussed. Data  in an animal 
modern suggested profound gender -related difference (PLoS One, 
https://doi.org/10.1371/journal.pone.0158817) and the data of this Ms support what described in 
that model. This point needs to be better described.  
 
3. The discrepancy of the coff ee data must be better discussed.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required  in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the qua lity of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salar y from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publicati on of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has  applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I decla re that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my repor t to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creativ e Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Combined Effects of Lifestyle Risk Factors  on Fatty Liver Index  
 
Version: 2 Date: 23 Feb 2020  
 
Reviewer: Claudio Tiribelli  
 
Reviewer's report:  
 
This is an interesting and comprehensive study analyzing the risk factors of fatty liver (FL) 
defined based on Fatty Liver Index (FLI) in a very large Finnish database of the general 
population. Data are reported indicating that FL increases with lack of physical activity, alcohol 
consumption and rather surprisingly coffee consumption. The Ms is well writt en and 
demonstrate on a solid statistical analysis what has been suggested since the beginning of FL era 
i.e that lack of physical activity is crucial in determining the hepatic condition.  
 
Specific critiques  
 
1. The Ms can be improved by providing the fasti ng glucose level and including this 
variable in the assessment pf different risk scores. This will allow to define the so called 
"metabolic health" in adults (Cell Metab 2017;26:292 -300).  
 
2. The gender difference must be better analyzed and discussed. Data  in an animal 
modern suggested profound gender -related difference (PLoS One, 
https://doi.org/10.1371/journal.pone.0158817) and the data of this Ms support what described in 
that model. This point needs to be better described.  
 
3. The discrepancy of the coff ee data must be better discussed.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required  in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the qua lity of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salar y from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publicati on of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has  applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I decla re that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my repor t to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creativ e Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Combined Effects of Lifestyle Risk Factors  on Fatty Liver Index  
 
Version: 2 Date: 23 Feb 2020  
 
Reviewer: Claudio Tiribelli  
 
Reviewer's report:  
 
This is an interesting and comprehensive study analyzing the risk factors of fatty liver (FL) 
defined based on Fatty Liver Index (FLI) in a very large Finnish database of the general 
population. Data are reported indicating that FL increases with lack of physical activity, alcohol 
consumption and rather surprisingly coffee consumption. The Ms is well writt en and 
demonstrate on a solid statistical analysis what has been suggested since the beginning of FL era 
i.e that lack of physical activity is crucial in determining the hepatic condition.  
 
Specific critiques  
 
1. The Ms can be improved by providing the fasti ng glucose level and including this 
variable in the assessment pf different risk scores. This will allow to define the so called 
"metabolic health" in adults (Cell Metab 2017;26:292 -300).  
 
2. The gender difference must be better analyzed and discussed. Data  in an animal 
modern suggested profound gender -related difference (PLoS One, 
https://doi.org/10.1371/journal.pone.0158817) and the data of this Ms support what described in 
that model. This point needs to be better described.  
 
3. The discrepancy of the coff ee data must be better discussed.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required  in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the qua lity of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salar y from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publicati on of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has  applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I decla re that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my repor t to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creativ e Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant