Title: Association between the Red Blood Cell Distribution Width-to-Albumin Ratio and Risk
of Colorectal and Gastric Cancers: A Cross-Sectional Study Using NHANES 2005–2018
Version: 0 Date: 16 Dec 2024
Reviewer's report:
This study provides an interesting investigation into the association between the red blood
cell distribution width-to-albumin ratio (RAR) and the risk of digestive tract tumors (DTT),
particularly colorectal cancer (CC). While the findings are novel and provide useful insights,
the manuscript requires major revisions to address methodological concerns, expand upon
the novelty, and improve clarity and organization. Below are specific recommendations for
improvement:
1. Clarify the Novelty:
Highlight in the introduction how this study differs from existing research on inflammation and
nutritional markers for DTT. Emphasize the novelty of RAR as a predictive marker compared
to conventional biomarkers.
2. Expand the Discussion on Mechanisms:
Provide a more comprehensive discussion of the potential biological mechanisms linking
RAR to colorectal cancer. Include how inflammation and nutritional status influence tumor
progression.
3. Explain Subgroup Results:
The results for subgroup analyses (e.g., Mexican Americans and overweight individuals) showed
no significant association. Provide possible explanations for these findings and discuss their
implications.
4. Incorporate Tumor Staging:
The study lacks information on tumor staging. If possible, include a brief explanation of
how staging might influence the observed association and suggest future work to address this
limitation.
5. Interpret U-Shaped Relationship:
The restricted cubic spline analysis identified a U-shaped relationship between RAR and CC
risk. Provide a detailed interpretation of this finding and discuss its implications for clinical use.
6. Expand on Mendelian Randomization Limitations:
The Mendelian randomization analysis did not directly assess RAR due to the absence of GWAS
data. Discuss how this limitation may affect the causal inference and suggest potential avenues
for future genetic research.
7. Address Gastric Cancer Findings:
The study found no significant association between RAR and gastric cancer (GC). Expand on
why this might be the case, considering potential differences in pathophysiology or sample size
limitations.
8. Broaden Clinical Implications:
Elaborate on how the findings can be translated into clinical practice. Discuss how RAR might
complement existing screening tools for early detection of colorectal cancer.
9. Consistency in Terminology:
Ensure consistency in referring to RAR throughout the manuscript. Avoid using multiple terms
or abbreviations interchangeably, which may confuse readers.
10. Future Directions:
Suggest specific follow-up studies, such as longitudinal analyses or validation studies in non-
European populations, to confirm the findings and explore their broader applicability.
Title: Association between the Red Blood Cell Distribution Width-to-Albumin Ratio and Risk
of Colorectal and Gastric Cancers: A Cross-Sectional Study Using NHANES 2005–2018
Version: 0 Date: 16 Dec 2024
Reviewer's report:
This study provides an interesting investigation into the association between the red blood
cell distribution width-to-albumin ratio (RAR) and the risk of digestive tract tumors (DTT),
particularly colorectal cancer (CC). While the findings are novel and provide useful insights,
the manuscript requires major revisions to address methodological concerns, expand upon
the novelty, and improve clarity and organization. Below are specific recommendations for
improvement:
1. Clarify the Novelty:
Highlight in the introduction how this study differs from existing research on inflammation and
nutritional markers for DTT. Emphasize the novelty of RAR as a predictive marker compared
to conventional biomarkers.
2. Expand the Discussion on Mechanisms:
Provide a more comprehensive discussion of the potential biological mechanisms linking
RAR to colorectal cancer. Include how inflammation and nutritional status influence tumor
progression.
3. Explain Subgroup Results:
The results for subgroup analyses (e.g., Mexican Americans and overweight individuals) showed
no significant association. Provide possible explanations for these findings and discuss their
implications.
4. Incorporate Tumor Staging:
The study lacks information on tumor staging. If possible, include a brief explanation of
how staging might influence the observed association and suggest future work to address this
limitation.
5. Interpret U-Shaped Relationship:
The restricted cubic spline analysis identified a U-shaped relationship between RAR and CC
risk. Provide a detailed interpretation of this finding and discuss its implications for clinical use.
6. Expand on Mendelian Randomization Limitations:
The Mendelian randomization analysis did not directly assess RAR due to the absence of GWAS
data. Discuss how this limitation may affect the causal inference and suggest potential avenues
for future genetic research.
7. Address Gastric Cancer Findings:
The study found no significant association between RAR and gastric cancer (GC). Expand on
why this might be the case, considering potential differences in pathophysiology or sample size
limitations.
8. Broaden Clinical Implications:
Elaborate on how the findings can be translated into clinical practice. Discuss how RAR might
complement existing screening tools for early detection of colorectal cancer.
9. Consistency in Terminology:
Ensure consistency in referring to RAR throughout the manuscript. Avoid using multiple terms
or abbreviations interchangeably, which may confuse readers.
10. Future Directions:
Suggest specific follow-up studies, such as longitudinal analyses or validation studies in non-
European populations, to confirm the findings and explore their broader applicability.
Please review this paper.
user
Title: Association between the Red Blood Cell Distribution Width-to-Albumin Ratio and Risk
of Colorectal and Gastric Cancers: A Cross-Sectional Study Using NHANES 2005–2018
Version: 0 Date: 16 Dec 2024
Reviewer's report:
This study provides an interesting investigation into the association between the red blood
cell distribution width-to-albumin ratio (RAR) and the risk of digestive tract tumors (DTT),
particularly colorectal cancer (CC). While the findings are novel and provide useful insights,
the manuscript requires major revisions to address methodological concerns, expand upon
the novelty, and improve clarity and organization. Below are specific recommendations for
improvement:
1. Clarify the Novelty:
Highlight in the introduction how this study differs from existing research on inflammation and
nutritional markers for DTT. Emphasize the novelty of RAR as a predictive marker compared
to conventional biomarkers.
2. Expand the Discussion on Mechanisms:
Provide a more comprehensive discussion of the potential biological mechanisms linking
RAR to colorectal cancer. Include how inflammation and nutritional status influence tumor
progression.
3. Explain Subgroup Results:
The results for subgroup analyses (e.g., Mexican Americans and overweight individuals) showed
no significant association. Provide possible explanations for these findings and discuss their
implications.
4. Incorporate Tumor Staging:
The study lacks information on tumor staging. If possible, include a brief explanation of
how staging might influence the observed association and suggest future work to address this
limitation.
5. Interpret U-Shaped Relationship:
The restricted cubic spline analysis identified a U-shaped relationship between RAR and CC
risk. Provide a detailed interpretation of this finding and discuss its implications for clinical use.
6. Expand on Mendelian Randomization Limitations:
The Mendelian randomization analysis did not directly assess RAR due to the absence of GWAS
data. Discuss how this limitation may affect the causal inference and suggest potential avenues
for future genetic research.
7. Address Gastric Cancer Findings:
The study found no significant association between RAR and gastric cancer (GC). Expand on
why this might be the case, considering potential differences in pathophysiology or sample size
limitations.
8. Broaden Clinical Implications:
Elaborate on how the findings can be translated into clinical practice. Discuss how RAR might
complement existing screening tools for early detection of colorectal cancer.
9. Consistency in Terminology:
Ensure consistency in referring to RAR throughout the manuscript. Avoid using multiple terms
or abbreviations interchangeably, which may confuse readers.
10. Future Directions:
Suggest specific follow-up studies, such as longitudinal analyses or validation studies in non-
European populations, to confirm the findings and explore their broader applicability.
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