Title: Impact of blood lead and manganese levels on metabolic dysfunction-associated steatotic
liver disease prevalence: insights from NHANES (2017–2020)
Version: 1 Date: 31 Jan 2025
Reviewer's report:
1. MASLD should be spelled out in the title.
2. MASLD, NAFLD, and CAP should be defined in the abstract.
3. Definition/spelling out of MET under covariate assessment is needed.
4. Assumptions of linear regression models should be checked and information should be
provided.
5. In Table 1 and Table 2, why is there a p-trend test at each quartile of Lead and Manganese?
Shouldn’t it be an overall test for trend across different levels of the variable? Whether those p-
values are for trend test needed to be made clear. How do the authors interpret the p-trend for
continuous variable and categorical variables if the results are different, for example, for Lead
in Model 3, as well as for Manganese in all three models?
6. For the association between blood lead and manganese with CAP, Model 2 showed no
significant association between blood lead and CAP, while Model 1 and Model 3 showed
statistically significant association between blood lead and CAP, how do you interpret these
findings and the differences observed across different models? More discussions is needed.
7. Why nonlinear relationships were only examined between lead, manganese, and MASLD,
have the authors also checked whether the relationships could be nonlinear with CAP?
8. Difference between p-overall and p-nonlinear need to be further explained.
9. Why subgroup analysis was performed even though none of the interactions tested were
statistically significant, indicating there were no significant subgroup differences?
10. Both “gender” and “sex” were used in the paper, if it referred to biologic sex, please use
“sex”.
Title: Impact of blood lead and manganese levels on metabolic dysfunction-associated steatotic
liver disease prevalence: insights from NHANES (2017–2020)
Version: 1 Date: 31 Jan 2025
Reviewer's report:
1. MASLD should be spelled out in the title.
2. MASLD, NAFLD, and CAP should be defined in the abstract.
3. Definition/spelling out of MET under covariate assessment is needed.
4. Assumptions of linear regression models should be checked and information should be
provided.
5. In Table 1 and Table 2, why is there a p-trend test at each quartile of Lead and Manganese?
Shouldn’t it be an overall test for trend across different levels of the variable? Whether those p-
values are for trend test needed to be made clear. How do the authors interpret the p-trend for
continuous variable and categorical variables if the results are different, for example, for Lead
in Model 3, as well as for Manganese in all three models?
6. For the association between blood lead and manganese with CAP, Model 2 showed no
significant association between blood lead and CAP, while Model 1 and Model 3 showed
statistically significant association between blood lead and CAP, how do you interpret these
findings and the differences observed across different models? More discussions is needed.
7. Why nonlinear relationships were only examined between lead, manganese, and MASLD,
have the authors also checked whether the relationships could be nonlinear with CAP?
8. Difference between p-overall and p-nonlinear need to be further explained.
9. Why subgroup analysis was performed even though none of the interactions tested were
statistically significant, indicating there were no significant subgroup differences?
10. Both “gender” and “sex” were used in the paper, if it referred to biologic sex, please use
“sex”.
Please review this paper.
user
Title: Impact of blood lead and manganese levels on metabolic dysfunction-associated steatotic
liver disease prevalence: insights from NHANES (2017–2020)
Version: 1 Date: 31 Jan 2025
Reviewer's report:
1. MASLD should be spelled out in the title.
2. MASLD, NAFLD, and CAP should be defined in the abstract.
3. Definition/spelling out of MET under covariate assessment is needed.
4. Assumptions of linear regression models should be checked and information should be
provided.
5. In Table 1 and Table 2, why is there a p-trend test at each quartile of Lead and Manganese?
Shouldn’t it be an overall test for trend across different levels of the variable? Whether those p-
values are for trend test needed to be made clear. How do the authors interpret the p-trend for
continuous variable and categorical variables if the results are different, for example, for Lead
in Model 3, as well as for Manganese in all three models?
6. For the association between blood lead and manganese with CAP, Model 2 showed no
significant association between blood lead and CAP, while Model 1 and Model 3 showed
statistically significant association between blood lead and CAP, how do you interpret these
findings and the differences observed across different models? More discussions is needed.
7. Why nonlinear relationships were only examined between lead, manganese, and MASLD,
have the authors also checked whether the relationships could be nonlinear with CAP?
8. Difference between p-overall and p-nonlinear need to be further explained.
9. Why subgroup analysis was performed even though none of the interactions tested were
statistically significant, indicating there were no significant subgroup differences?
10. Both “gender” and “sex” were used in the paper, if it referred to biologic sex, please use
“sex”.
assistant