Reviewer's report
Title:Overweight and constipation in adolescents
Version: 1Date:23 July 2010
Reviewer: Stefan A Mueller-Lissner
Reviewer's report:
This is an epidemiologic study in adolescents between the ages of 10 and 18
based on a questionnaire survey on stool habits and body weight. The authors
cross-tabulated constipation and BMI. A correlation was only found when
restricting the analysis to subjects with “fecal escape”.
Major Compulsory Revisions
o I do not understand what “fecal escape” means. The term is not listed in
PubMed. Is it fecal incontinence? Or fecal soiling (a condition well known in
children between the ages of 2 and 5 retaining their stools)?
o A major problem of the manuscript is the complete lack of precise definitions.
When exactly was constipation thought to be present? Was it hard
consistency/form AND difficult defecation AND low frequency? Or only one or
two of them? Had these symptoms to be present on each occasion or only on
certain circumstances? Why did the authors not follow the Rome criteria giving
practical and internationally accepted guidelines for the definition?
o Bleeding should not be considered a symptom defining constipation (even if it
may be caused by hard stools).
o Again I have to come to “fecal escape”. If it is soiling than one would ask how it
was defined. If it was e.g. defined by stained underwear than I would easily
understand that overweight children may have more problems cleaning their
anus and hence having this symptom. It would however not be related to
constipation.
o Potential confounders were not taken into account such as nutrition and
physical activity.
Minor essential Revisions
o Page 9, last paragraph. It is very unusual to give a median (non-parametric)
with standard deviation (parametric).
o Abstract 7th line. “Characterized” should probably read “defined”?
o Page 4, 8th line. What is an “adolescent article”, what do you mean by
“exclusivity”?
o Multiple statistical tests were performed without adjusting the level of
significance.
o The English needs thorough improvement.
Level of interest: An article of limited interest
Quality of written English: Not suitable for publication unless extensively edited
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
'I declare that I have no competing interests
Reviewer's report
Title:Overweight and constipation in adolescents
Version: 1Date:23 July 2010
Reviewer: Stefan A Mueller-Lissner
Reviewer's report:
This is an epidemiologic study in adolescents between the ages of 10 and 18
based on a questionnaire survey on stool habits and body weight. The authors
cross-tabulated constipation and BMI. A correlation was only found when
restricting the analysis to subjects with “fecal escape”.
Major Compulsory Revisions
o I do not understand what “fecal escape” means. The term is not listed in
PubMed. Is it fecal incontinence? Or fecal soiling (a condition well known in
children between the ages of 2 and 5 retaining their stools)?
o A major problem of the manuscript is the complete lack of precise definitions.
When exactly was constipation thought to be present? Was it hard
consistency/form AND difficult defecation AND low frequency? Or only one or
two of them? Had these symptoms to be present on each occasion or only on
certain circumstances? Why did the authors not follow the Rome criteria giving
practical and internationally accepted guidelines for the definition?
o Bleeding should not be considered a symptom defining constipation (even if it
may be caused by hard stools).
o Again I have to come to “fecal escape”. If it is soiling than one would ask how it
was defined. If it was e.g. defined by stained underwear than I would easily
understand that overweight children may have more problems cleaning their
anus and hence having this symptom. It would however not be related to
constipation.
o Potential confounders were not taken into account such as nutrition and
physical activity.
Minor essential Revisions
o Page 9, last paragraph. It is very unusual to give a median (non-parametric)
with standard deviation (parametric).
o Abstract 7th line. “Characterized” should probably read “defined”?
o Page 4, 8th line. What is an “adolescent article”, what do you mean by
“exclusivity”?
o Multiple statistical tests were performed without adjusting the level of
significance.
o The English needs thorough improvement.
Level of interest: An article of limited interest
Quality of written English: Not suitable for publication unless extensively edited
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
'I declare that I have no competing interests
Please review this paper.
user
Reviewer's report
Title:Overweight and constipation in adolescents
Version: 1Date:23 July 2010
Reviewer: Stefan A Mueller-Lissner
Reviewer's report:
This is an epidemiologic study in adolescents between the ages of 10 and 18
based on a questionnaire survey on stool habits and body weight. The authors
cross-tabulated constipation and BMI. A correlation was only found when
restricting the analysis to subjects with “fecal escape”.
Major Compulsory Revisions
o I do not understand what “fecal escape” means. The term is not listed in
PubMed. Is it fecal incontinence? Or fecal soiling (a condition well known in
children between the ages of 2 and 5 retaining their stools)?
o A major problem of the manuscript is the complete lack of precise definitions.
When exactly was constipation thought to be present? Was it hard
consistency/form AND difficult defecation AND low frequency? Or only one or
two of them? Had these symptoms to be present on each occasion or only on
certain circumstances? Why did the authors not follow the Rome criteria giving
practical and internationally accepted guidelines for the definition?
o Bleeding should not be considered a symptom defining constipation (even if it
may be caused by hard stools).
o Again I have to come to “fecal escape”. If it is soiling than one would ask how it
was defined. If it was e.g. defined by stained underwear than I would easily
understand that overweight children may have more problems cleaning their
anus and hence having this symptom. It would however not be related to
constipation.
o Potential confounders were not taken into account such as nutrition and
physical activity.
Minor essential Revisions
o Page 9, last paragraph. It is very unusual to give a median (non-parametric)
with standard deviation (parametric).
o Abstract 7th line. “Characterized” should probably read “defined”?
o Page 4, 8th line. What is an “adolescent article”, what do you mean by
“exclusivity”?
o Multiple statistical tests were performed without adjusting the level of
significance.
o The English needs thorough improvement.
Level of interest: An article of limited interest
Quality of written English: Not suitable for publication unless extensively edited
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
'I declare that I have no competing interests
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