Title: Relationship between body composition and the histology of non-alcoholic fatty liver
disease: a cross-sectional study
Version: 3 Date: 11 Feb 2021
Reviewer:  Victoria Meadows
Reviewer's report:
The authors provide a needed investigation into the relationship between body composition (fat
mass and muscle mass), hepatic fibrosis, and NAS score/NAFL progression. The manuscript
presents limitations with patient diversity in this study, but lends evidence to the theory that
fat mass is indicative of liver steatosis and fibrosis the field of NAFL. Despite presenting
novel information, there are some issues that must be addressed before this manuscript can be
considered for publication:
- There was no threshold used to determine if patients in this study were clinically overweight
or obese. The authors should consider detailing the reasons for excluding organization of the
patients by BMI.
- The authors claim that this is the first investigation of  muscle mass and fat mass effect on
NAFL, but a few manuscripts have been published that look into this hypothesis, with alternate
methods. The authors should read over these publication and consider the relevance to their work
(supportive or not) PMID: 33562473, 33424768, 33535004, 33164304. These may help increase
the clinical impact of this study since the cohorts may be from different races and countries.
The discussion overall should include more recent publications that investigate the relationship
between muscle mass, fat mass, and/or NAFL stage, since many are previous to 2017.
- This manuscript would greatly benefit from publication of histological images that demonstrate
the results in this study. However, this can be ignored if the proper permissions cannot be
obtained.
- The authors may want to consider correlation analysis between fat/ht^2, fibrosis and NAS
score. This may provide a tool for clinicians to assess NAFL to NASH risk early in patient
diagnosis.
- The authors analyzed HbA1c levels, which may provide insight into the development of
insulin resistance in NAFL patients that are not yet diabetic. This might be an interesting future
direction, or expansion of the current manuscript, to increase clinical impact.
Title: Relationship between body composition and the histology of non-alcoholic fatty liver
disease: a cross-sectional study
Version: 3 Date: 11 Feb 2021
Reviewer:  Victoria Meadows
Reviewer's report:
The authors provide a needed investigation into the relationship between body composition (fat
mass and muscle mass), hepatic fibrosis, and NAS score/NAFL progression. The manuscript
presents limitations with patient diversity in this study, but lends evidence to the theory that
fat mass is indicative of liver steatosis and fibrosis the field of NAFL. Despite presenting
novel information, there are some issues that must be addressed before this manuscript can be
considered for publication:
- There was no threshold used to determine if patients in this study were clinically overweight
or obese. The authors should consider detailing the reasons for excluding organization of the
patients by BMI.
- The authors claim that this is the first investigation of  muscle mass and fat mass effect on
NAFL, but a few manuscripts have been published that look into this hypothesis, with alternate
methods. The authors should read over these publication and consider the relevance to their work
(supportive or not) PMID: 33562473, 33424768, 33535004, 33164304. These may help increase
the clinical impact of this study since the cohorts may be from different races and countries.
The discussion overall should include more recent publications that investigate the relationship
between muscle mass, fat mass, and/or NAFL stage, since many are previous to 2017.
- This manuscript would greatly benefit from publication of histological images that demonstrate
the results in this study. However, this can be ignored if the proper permissions cannot be
obtained.
- The authors may want to consider correlation analysis between fat/ht^2, fibrosis and NAS
score. This may provide a tool for clinicians to assess NAFL to NASH risk early in patient
diagnosis.
- The authors analyzed HbA1c levels, which may provide insight into the development of
insulin resistance in NAFL patients that are not yet diabetic. This might be an interesting future
direction, or expansion of the current manuscript, to increase clinical impact.
Please review this paper.
user
Title: Relationship between body composition and the histology of non-alcoholic fatty liver
disease: a cross-sectional study
Version: 3 Date: 11 Feb 2021
Reviewer:  Victoria Meadows
Reviewer's report:
The authors provide a needed investigation into the relationship between body composition (fat
mass and muscle mass), hepatic fibrosis, and NAS score/NAFL progression. The manuscript
presents limitations with patient diversity in this study, but lends evidence to the theory that
fat mass is indicative of liver steatosis and fibrosis the field of NAFL. Despite presenting
novel information, there are some issues that must be addressed before this manuscript can be
considered for publication:
- There was no threshold used to determine if patients in this study were clinically overweight
or obese. The authors should consider detailing the reasons for excluding organization of the
patients by BMI.
- The authors claim that this is the first investigation of  muscle mass and fat mass effect on
NAFL, but a few manuscripts have been published that look into this hypothesis, with alternate
methods. The authors should read over these publication and consider the relevance to their work
(supportive or not) PMID: 33562473, 33424768, 33535004, 33164304. These may help increase
the clinical impact of this study since the cohorts may be from different races and countries.
The discussion overall should include more recent publications that investigate the relationship
between muscle mass, fat mass, and/or NAFL stage, since many are previous to 2017.
- This manuscript would greatly benefit from publication of histological images that demonstrate
the results in this study. However, this can be ignored if the proper permissions cannot be
obtained.
- The authors may want to consider correlation analysis between fat/ht^2, fibrosis and NAS
score. This may provide a tool for clinicians to assess NAFL to NASH risk early in patient
diagnosis.
- The authors analyzed HbA1c levels, which may provide insight into the development of
insulin resistance in NAFL patients that are not yet diabetic. This might be an interesting future
direction, or expansion of the current manuscript, to increase clinical impact.
assistant