Title: Association of Biological Aging and the Prevalence of Nonalcoholic Fatty Liver Disease:
a Population-based Study
Version: 0 Date: 28 Feb 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-A brief explanation of each biological aging metric (KDM-BA, PA, HD, AL) and how they
were calculated would be helpful for readers who are not familiar with these terms.
-It would be useful to elaborate on how missing data were handled in the analysis and if any
imputation or exclusion strategies were used.
-It would be helpful to briefly mention the advantages and limitations of using FLI # 60 as a
diagnostic criterion for NAFLD, especially in a diverse population.
While subgroup analyses are mentioned, more details about the specific subgroups analyzed
(e.g., by age, gender, race/ethnicity) would enhance clarity.
-While the discussion mentions epigenetic factors like DNA methylation and chromatin
remodeling, it could be enhanced by a more specific discussion of how these mechanisms
might directly influence NAFLD or its progression. For example, how could DNA methylation
patterns in liver tissue contribute to NAFLD? This connection would help bridge the findings
of biological aging with the specific pathology of NAFLD.
-While the discussion highlights NAFLD and its relation to biological aging, there could be more
exploration of how other coexisting conditions, such as diabetes, hypertension, or cardiovascular
disease, might further exacerbate the relationship between aging and NAFLD. -This might
provide a more holistic view of the health risks.
While the limitations of the study are acknowledged (cross-sectional design and sample size),
it could be helpful to expand on how these limitations might affect the interpretation of the
findings. For instance, while causality cannot be established, are there other ways in which the
results can still inform future longitudinal studies or clinical trials?
-While epigenetic aging is mentioned as the most accurate method of assessing biological age,
a little more explanation could be helpful for readers who may not be familiar with epigenetic
clocks. For example, how do these clocks work in practice, and what makes them more reliable
than other biomarkers?
-The conclusion could briefly mention the potential clinical or public health implications of these
findings. For example, would early interventions targeting biological aging metrics be beneficial
in preventing or managing NAFLD? Offering a hint at future directions or practical applications
would increase the impact of the conclusion.
Title: Association of Biological Aging and the Prevalence of Nonalcoholic Fatty Liver Disease:
a Population-based Study
Version: 0 Date: 28 Feb 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-A brief explanation of each biological aging metric (KDM-BA, PA, HD, AL) and how they
were calculated would be helpful for readers who are not familiar with these terms.
-It would be useful to elaborate on how missing data were handled in the analysis and if any
imputation or exclusion strategies were used.
-It would be helpful to briefly mention the advantages and limitations of using FLI # 60 as a
diagnostic criterion for NAFLD, especially in a diverse population.
While subgroup analyses are mentioned, more details about the specific subgroups analyzed
(e.g., by age, gender, race/ethnicity) would enhance clarity.
-While the discussion mentions epigenetic factors like DNA methylation and chromatin
remodeling, it could be enhanced by a more specific discussion of how these mechanisms
might directly influence NAFLD or its progression. For example, how could DNA methylation
patterns in liver tissue contribute to NAFLD? This connection would help bridge the findings
of biological aging with the specific pathology of NAFLD.
-While the discussion highlights NAFLD and its relation to biological aging, there could be more
exploration of how other coexisting conditions, such as diabetes, hypertension, or cardiovascular
disease, might further exacerbate the relationship between aging and NAFLD. -This might
provide a more holistic view of the health risks.
While the limitations of the study are acknowledged (cross-sectional design and sample size),
it could be helpful to expand on how these limitations might affect the interpretation of the
findings. For instance, while causality cannot be established, are there other ways in which the
results can still inform future longitudinal studies or clinical trials?
-While epigenetic aging is mentioned as the most accurate method of assessing biological age,
a little more explanation could be helpful for readers who may not be familiar with epigenetic
clocks. For example, how do these clocks work in practice, and what makes them more reliable
than other biomarkers?
-The conclusion could briefly mention the potential clinical or public health implications of these
findings. For example, would early interventions targeting biological aging metrics be beneficial
in preventing or managing NAFLD? Offering a hint at future directions or practical applications
would increase the impact of the conclusion.
Please review this paper.
user
Title: Association of Biological Aging and the Prevalence of Nonalcoholic Fatty Liver Disease:
a Population-based Study
Version: 0 Date: 28 Feb 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-A brief explanation of each biological aging metric (KDM-BA, PA, HD, AL) and how they
were calculated would be helpful for readers who are not familiar with these terms.
-It would be useful to elaborate on how missing data were handled in the analysis and if any
imputation or exclusion strategies were used.
-It would be helpful to briefly mention the advantages and limitations of using FLI # 60 as a
diagnostic criterion for NAFLD, especially in a diverse population.
While subgroup analyses are mentioned, more details about the specific subgroups analyzed
(e.g., by age, gender, race/ethnicity) would enhance clarity.
-While the discussion mentions epigenetic factors like DNA methylation and chromatin
remodeling, it could be enhanced by a more specific discussion of how these mechanisms
might directly influence NAFLD or its progression. For example, how could DNA methylation
patterns in liver tissue contribute to NAFLD? This connection would help bridge the findings
of biological aging with the specific pathology of NAFLD.
-While the discussion highlights NAFLD and its relation to biological aging, there could be more
exploration of how other coexisting conditions, such as diabetes, hypertension, or cardiovascular
disease, might further exacerbate the relationship between aging and NAFLD. -This might
provide a more holistic view of the health risks.
While the limitations of the study are acknowledged (cross-sectional design and sample size),
it could be helpful to expand on how these limitations might affect the interpretation of the
findings. For instance, while causality cannot be established, are there other ways in which the
results can still inform future longitudinal studies or clinical trials?
-While epigenetic aging is mentioned as the most accurate method of assessing biological age,
a little more explanation could be helpful for readers who may not be familiar with epigenetic
clocks. For example, how do these clocks work in practice, and what makes them more reliable
than other biomarkers?
-The conclusion could briefly mention the potential clinical or public health implications of these
findings. For example, would early interventions targeting biological aging metrics be beneficial
in preventing or managing NAFLD? Offering a hint at future directions or practical applications
would increase the impact of the conclusion.
assistant