Title: Dietary protein intake and mortality among survivors of liver cirrhosis: a prospective
cohort study
Version: 1 Date: 24 Mar 2023
Reviewer's report:
The authors investigated the association of dietary protein intake with the cirrhosis-related
mortality. This study is clinically valuable. But there are some comments.
Major comments:
1.The current study aimed to evaluate the potential association of dietary protein intake with the
cirrhosis-related mortality. What are the causes of patients death?The authors have described
the exclusion criteria. Were there any patients accepted liver transplantation?
2.Whether complications such as gastrointestinal bleeding and infection affected the results?
How about the impact of treatment ? For example, patients with advanced liver cirrhosis usually
have hypoalbuminemia and albumin transfusion, which should also be considered as a potential
confounder when investigating the association of dietary protein intake and cirrhosis-related
mortality. So more important  potential confounders should be considered.
3.As the authors mentioned, the present study has limitations that should be considered,
including relatively small study population, inevitable recall bias using food frequency
questionnaire (FFQ) and missing of about 15% of enrolled patients. So further details of the
study quality control protocol should be provided, such as how the FFQ data was obtained from
the patients.
Minor comments:
1.In page 7 line 150-151, the author described that “the prevalence of malnutrition was
significantly higher in nondynapenic obese patients than in non-dynapneic obese patients”. Two
groups are same?Please check again.
2.Please check the data for more clarification statement such as Table 2,etc.
Title: Dietary protein intake and mortality among survivors of liver cirrhosis: a prospective
cohort study
Version: 1 Date: 24 Mar 2023
Reviewer's report:
The authors investigated the association of dietary protein intake with the cirrhosis-related
mortality. This study is clinically valuable. But there are some comments.
Major comments:
1.The current study aimed to evaluate the potential association of dietary protein intake with the
cirrhosis-related mortality. What are the causes of patients death?The authors have described
the exclusion criteria. Were there any patients accepted liver transplantation?
2.Whether complications such as gastrointestinal bleeding and infection affected the results?
How about the impact of treatment ? For example, patients with advanced liver cirrhosis usually
have hypoalbuminemia and albumin transfusion, which should also be considered as a potential
confounder when investigating the association of dietary protein intake and cirrhosis-related
mortality. So more important  potential confounders should be considered.
3.As the authors mentioned, the present study has limitations that should be considered,
including relatively small study population, inevitable recall bias using food frequency
questionnaire (FFQ) and missing of about 15% of enrolled patients. So further details of the
study quality control protocol should be provided, such as how the FFQ data was obtained from
the patients.
Minor comments:
1.In page 7 line 150-151, the author described that “the prevalence of malnutrition was
significantly higher in nondynapenic obese patients than in non-dynapneic obese patients”. Two
groups are same?Please check again.
2.Please check the data for more clarification statement such as Table 2,etc.
Please review this paper.
user
Title: Dietary protein intake and mortality among survivors of liver cirrhosis: a prospective
cohort study
Version: 1 Date: 24 Mar 2023
Reviewer's report:
The authors investigated the association of dietary protein intake with the cirrhosis-related
mortality. This study is clinically valuable. But there are some comments.
Major comments:
1.The current study aimed to evaluate the potential association of dietary protein intake with the
cirrhosis-related mortality. What are the causes of patients death?The authors have described
the exclusion criteria. Were there any patients accepted liver transplantation?
2.Whether complications such as gastrointestinal bleeding and infection affected the results?
How about the impact of treatment ? For example, patients with advanced liver cirrhosis usually
have hypoalbuminemia and albumin transfusion, which should also be considered as a potential
confounder when investigating the association of dietary protein intake and cirrhosis-related
mortality. So more important  potential confounders should be considered.
3.As the authors mentioned, the present study has limitations that should be considered,
including relatively small study population, inevitable recall bias using food frequency
questionnaire (FFQ) and missing of about 15% of enrolled patients. So further details of the
study quality control protocol should be provided, such as how the FFQ data was obtained from
the patients.
Minor comments:
1.In page 7 line 150-151, the author described that “the prevalence of malnutrition was
significantly higher in nondynapenic obese patients than in non-dynapneic obese patients”. Two
groups are same?Please check again.
2.Please check the data for more clarification statement such as Table 2,etc.
assistant