Title: Prevalence of constipation in adults with obesity class II and III and associated factors
Version: 2 Date: 16 Nov 2020
Reviewer:  Vera Lucia Conceicao De Gouveia Santos
Reviewer's report:
The paper contains all necessary items of a scientific paper although there are some issues to be
revised by the authors. Besides the methodological comments, the authors will find additional
comments as following:
- Background: its content is well written based on a specialized and updated literature, although
it lacks in a better justification. I would like to suggest the authors start this chapter with bowel
constipation content as this is the dependent variable instead of obesity. Include constipation
definition as this appears only in Methods section. Besides the authors must improve the
relationship between the two conditions also to justify the manuscript in a more consistent way
(as it is based on a previous RCT database).
- Aims: “…to evaluate the prevalence of constipation and its risk factors in adults with class II
and III obesity and to describe their intestinal habits profile.” It is not possible to find risk factors
in prevalence studies but just associated factors (risk factors are observed just in prospective
studies such as cohort ones). Maybe intestinal habits profile is included in the main objective (?)
- Results: Table 1: why the authors categorized the bowel movements frequence just in two
categories for statistical analysis: 1 to 4 times per week may be related to a normal or to an
abnormal bowel habit! To facilitate statistical analysis, maybe the authors could stratify the stool
forms referring the categories to the presence or absence of constipation.
- Discussion: it is based in a broad and update literature including those mentioned in
background. Anyway, there are other epidemiological studies about constipation in Brazilian
population which could be mentioned.
- Limitations: According to the previous comment, the inclusion criterium related to the sample´s
age range can be one of the study limitations as constipation is frequently associated to elderlies.
Title: Prevalence of constipation in adults with obesity class II and III and associated factors
Version: 2 Date: 16 Nov 2020
Reviewer:  Vera Lucia Conceicao De Gouveia Santos
Reviewer's report:
The paper contains all necessary items of a scientific paper although there are some issues to be
revised by the authors. Besides the methodological comments, the authors will find additional
comments as following:
- Background: its content is well written based on a specialized and updated literature, although
it lacks in a better justification. I would like to suggest the authors start this chapter with bowel
constipation content as this is the dependent variable instead of obesity. Include constipation
definition as this appears only in Methods section. Besides the authors must improve the
relationship between the two conditions also to justify the manuscript in a more consistent way
(as it is based on a previous RCT database).
- Aims: “…to evaluate the prevalence of constipation and its risk factors in adults with class II
and III obesity and to describe their intestinal habits profile.” It is not possible to find risk factors
in prevalence studies but just associated factors (risk factors are observed just in prospective
studies such as cohort ones). Maybe intestinal habits profile is included in the main objective (?)
- Results: Table 1: why the authors categorized the bowel movements frequence just in two
categories for statistical analysis: 1 to 4 times per week may be related to a normal or to an
abnormal bowel habit! To facilitate statistical analysis, maybe the authors could stratify the stool
forms referring the categories to the presence or absence of constipation.
- Discussion: it is based in a broad and update literature including those mentioned in
background. Anyway, there are other epidemiological studies about constipation in Brazilian
population which could be mentioned.
- Limitations: According to the previous comment, the inclusion criterium related to the sample´s
age range can be one of the study limitations as constipation is frequently associated to elderlies.
Please review this paper.
user
Title: Prevalence of constipation in adults with obesity class II and III and associated factors
Version: 2 Date: 16 Nov 2020
Reviewer:  Vera Lucia Conceicao De Gouveia Santos
Reviewer's report:
The paper contains all necessary items of a scientific paper although there are some issues to be
revised by the authors. Besides the methodological comments, the authors will find additional
comments as following:
- Background: its content is well written based on a specialized and updated literature, although
it lacks in a better justification. I would like to suggest the authors start this chapter with bowel
constipation content as this is the dependent variable instead of obesity. Include constipation
definition as this appears only in Methods section. Besides the authors must improve the
relationship between the two conditions also to justify the manuscript in a more consistent way
(as it is based on a previous RCT database).
- Aims: “…to evaluate the prevalence of constipation and its risk factors in adults with class II
and III obesity and to describe their intestinal habits profile.” It is not possible to find risk factors
in prevalence studies but just associated factors (risk factors are observed just in prospective
studies such as cohort ones). Maybe intestinal habits profile is included in the main objective (?)
- Results: Table 1: why the authors categorized the bowel movements frequence just in two
categories for statistical analysis: 1 to 4 times per week may be related to a normal or to an
abnormal bowel habit! To facilitate statistical analysis, maybe the authors could stratify the stool
forms referring the categories to the presence or absence of constipation.
- Discussion: it is based in a broad and update literature including those mentioned in
background. Anyway, there are other epidemiological studies about constipation in Brazilian
population which could be mentioned.
- Limitations: According to the previous comment, the inclusion criterium related to the sample´s
age range can be one of the study limitations as constipation is frequently associated to elderlies.
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