Title: Association between Atherogenic Index of Plasma and Chronic Diarrhea: A Cross-
Sectional Study of the NHANES 2005-2010
Version: 1 Date: 26 Feb 2025
Reviewer's report:
This is a Chinese paper investigating the association between the atherogenic index of plasma
(AIP), a marker of lipid metabolism, and chronic diarrhea (CD) in US adults using data from the
2005–2010 NHANES, finding a positive correlation between higher AIP levels and increased
risk of CD.
Comments
1. The cross-sectional design of the study does not allow to determine whether higher levels of
the AIP lead to CD or if CD causes changes in lipid metabolism. While the findings show an
association, they cannot prove causality.
2. Although the Bristol Stool Form Scale (BSFS) is a practical tool, it lacks the accuracy of a
clinical diagnosis by a gastroenterologist. This could result in some participants being incorrectly
classified as having or not having CD, potentially skewing the results.
3. The authors did not collect information on dietary habits, which are known to affect both lipid
levels and gut health. Without this data, it is difficult to rule out the possibility that diet may
have influenced the observed associations.
4. The authors excluded a large number of participants from the NHANES dataset due to missing
data on AIP, CD, or other key variables. This raises concerns about selection bias, as the final
sample of 5,785 individuals may not accurately reflect the broader US adult population.
5. The analysis did not consider the potential effects of medications, such as statins or
antidiarrheal drugs, which could impact both AIP and CD.
6. Genetic factors or environmental influences could have affected the results, and they should
be taken into consideration as confounders.
7. Since the authors are from China, it would be reasonable and useful to compare the results
from the US population with their own country, as the outcomes from the US population may not
apply to populations outside the US. Differences in diet, lifestyle, and healthcare systems could
alter the relationship between AIP and CD. Highlighting such potential differences in different
ethnic groups, may be more interesting to the international audience.
Title: Association between Atherogenic Index of Plasma and Chronic Diarrhea: A Cross-
Sectional Study of the NHANES 2005-2010
Version: 1 Date: 26 Feb 2025
Reviewer's report:
This is a Chinese paper investigating the association between the atherogenic index of plasma
(AIP), a marker of lipid metabolism, and chronic diarrhea (CD) in US adults using data from the
2005–2010 NHANES, finding a positive correlation between higher AIP levels and increased
risk of CD.
Comments
1. The cross-sectional design of the study does not allow to determine whether higher levels of
the AIP lead to CD or if CD causes changes in lipid metabolism. While the findings show an
association, they cannot prove causality.
2. Although the Bristol Stool Form Scale (BSFS) is a practical tool, it lacks the accuracy of a
clinical diagnosis by a gastroenterologist. This could result in some participants being incorrectly
classified as having or not having CD, potentially skewing the results.
3. The authors did not collect information on dietary habits, which are known to affect both lipid
levels and gut health. Without this data, it is difficult to rule out the possibility that diet may
have influenced the observed associations.
4. The authors excluded a large number of participants from the NHANES dataset due to missing
data on AIP, CD, or other key variables. This raises concerns about selection bias, as the final
sample of 5,785 individuals may not accurately reflect the broader US adult population.
5. The analysis did not consider the potential effects of medications, such as statins or
antidiarrheal drugs, which could impact both AIP and CD.
6. Genetic factors or environmental influences could have affected the results, and they should
be taken into consideration as confounders.
7. Since the authors are from China, it would be reasonable and useful to compare the results
from the US population with their own country, as the outcomes from the US population may not
apply to populations outside the US. Differences in diet, lifestyle, and healthcare systems could
alter the relationship between AIP and CD. Highlighting such potential differences in different
ethnic groups, may be more interesting to the international audience.
Please review this paper.
user
Title: Association between Atherogenic Index of Plasma and Chronic Diarrhea: A Cross-
Sectional Study of the NHANES 2005-2010
Version: 1 Date: 26 Feb 2025
Reviewer's report:
This is a Chinese paper investigating the association between the atherogenic index of plasma
(AIP), a marker of lipid metabolism, and chronic diarrhea (CD) in US adults using data from the
2005–2010 NHANES, finding a positive correlation between higher AIP levels and increased
risk of CD.
Comments
1. The cross-sectional design of the study does not allow to determine whether higher levels of
the AIP lead to CD or if CD causes changes in lipid metabolism. While the findings show an
association, they cannot prove causality.
2. Although the Bristol Stool Form Scale (BSFS) is a practical tool, it lacks the accuracy of a
clinical diagnosis by a gastroenterologist. This could result in some participants being incorrectly
classified as having or not having CD, potentially skewing the results.
3. The authors did not collect information on dietary habits, which are known to affect both lipid
levels and gut health. Without this data, it is difficult to rule out the possibility that diet may
have influenced the observed associations.
4. The authors excluded a large number of participants from the NHANES dataset due to missing
data on AIP, CD, or other key variables. This raises concerns about selection bias, as the final
sample of 5,785 individuals may not accurately reflect the broader US adult population.
5. The analysis did not consider the potential effects of medications, such as statins or
antidiarrheal drugs, which could impact both AIP and CD.
6. Genetic factors or environmental influences could have affected the results, and they should
be taken into consideration as confounders.
7. Since the authors are from China, it would be reasonable and useful to compare the results
from the US population with their own country, as the outcomes from the US population may not
apply to populations outside the US. Differences in diet, lifestyle, and healthcare systems could
alter the relationship between AIP and CD. Highlighting such potential differences in different
ethnic groups, may be more interesting to the international audience.
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