Reviewer ’s report  
 
Title:  Strong As sociation between Metabolically -Abnormal Obesity and Gallstone Disease in 
Adults under 50 Years  
 
Version: 1 Date: 17 Apr 2019 
 
Reviewer:  Reviewer  2 
 
Reviewer’s report:  
 
PEER REVIEWER ASSESSMENTS:  
 
OBJECTIVE - Full research articles: is there a clear objective that addresses one or several 
testable re search questions? (Brief or other article types: is there a clear objective?)  
 
Yes - there is a clear objective  
 
 
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for the 
objective?  
 
Yes - the approach is appropriate  
 
 
EXECUTION - Are the experiments and analyses performed with sufficient technical rigor to 
allow confidence in the results?  
 
Yes - experiments and analyses were performed appropriately  
 
 
STATISTICS - Is the use of statistics in the manuscript appropriate?  
 
Yes - appropriate statistical analyses have been used in the study  
 
 
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not 
overstated?  
 
Yes - the author's interpretation is reasonable  
 
 
OVERALL MANUSCRIPT POTENTIAL - Has the  author addressed your concerns sufficiently 
for you to now recommend the work as a technically sound contribution? If not, can further 
revisions be made to make the work technically sound?  
 
Yes - current version is technically sound  
 
 
PEER REVIEWER COMMENTS :  
 
GENERAL COMMENTS: The authors have responded to all the questions raised by myself and 
the excellent review by the other reviewer.  
 
They have made the appropriate changes in the text of the manuscript as well.  
 
My overall impression is that they have con vincingly shown that their findings are appropriate 
for their specific population i.e. The Chinese population that they take care of. However, these 
findings  may very well NOT be applicable to non Asian populations not only because of the 
differences in B MI but also the predilection for diabetes in less obese subjects. Also the risk 
factor of HCV as the primary risk factor for gallstones in the elderly ill may not hold true in 
other countries where HCV is not endemic.  
 
 
ADDITIONAL REQUESTS/SUGGESTIONS:  
 
1. Page 4 line 74 change gender to sex  
 
2. Line 79 would the word "profiles" be better than statuses?  
 
3. Line 95 here I would strongly suggest that you add where in the world the study was done  
 
4 line 109 change "spot" to "area" or " mass"  
 
5. Line 148. Renal  function ( go back to line 146) is not "higher".    I would suggest that on line 
146 you change the sentence to say "had higher blood pressure and more abnormal levels of "  
 
6. Line 184 -186 specify again that this study is in an Asian population  
 
7. Line 2 03. Change to "In addition to age, the levels of serum uric acid, liver function tests, and 
renal function significantly differed amongst the four groups, being more abnormal in"  
 
8. Line 214. When you say surgical complications, specify " after cholecystectomy"  
 
9. Table 1. Though there are statistically different mean values, many of these are are statistically 
different due to a house n value but otherwise they are clinically unim portant like Bun, Cr, LDL, 
GOT, GPT,  
 
10. How can you explain the incidence in table 2 and table 4 that the MANO has a higher 
incidence than the MAO Group is this a typo or did the MANO group have a higher HCV 
incidence?  
 
I think you should discuss it in a separate paragraph or if explain it  if you can.  
 
Are the methods appropriate and well described?  
If not, please specify wha t is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects req uire further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interest s? 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
This reviewer has been recruited by a partner organization, Research Square. Reviewers with 
declared or apparent competing interest s are not utilized for these reviews. This reviewer has 
agreed to publication of their comments online under a Creative Commons Attribution License 
attributed to Research Square and was paid a small honorarium for completing the review within 
a specified t imeframe. Honoraria for reviews such as this are paid regardless of the reviewer 
recommendation.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I u pload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/lice nses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be included as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title:  Strong As sociation between Metabolically -Abnormal Obesity and Gallstone Disease in 
Adults under 50 Years  
 
Version: 1 Date: 17 Apr 2019 
 
Reviewer:  Reviewer  2 
 
Reviewer’s report:  
 
PEER REVIEWER ASSESSMENTS:  
 
OBJECTIVE - Full research articles: is there a clear objective that addresses one or several 
testable re search questions? (Brief or other article types: is there a clear objective?)  
 
Yes - there is a clear objective  
 
 
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for the 
objective?  
 
Yes - the approach is appropriate  
 
 
EXECUTION - Are the experiments and analyses performed with sufficient technical rigor to 
allow confidence in the results?  
 
Yes - experiments and analyses were performed appropriately  
 
 
STATISTICS - Is the use of statistics in the manuscript appropriate?  
 
Yes - appropriate statistical analyses have been used in the study  
 
 
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not 
overstated?  
 
Yes - the author's interpretation is reasonable  
 
 
OVERALL MANUSCRIPT POTENTIAL - Has the  author addressed your concerns sufficiently 
for you to now recommend the work as a technically sound contribution? If not, can further 
revisions be made to make the work technically sound?  
 
Yes - current version is technically sound  
 
 
PEER REVIEWER COMMENTS :  
 
GENERAL COMMENTS: The authors have responded to all the questions raised by myself and 
the excellent review by the other reviewer.  
 
They have made the appropriate changes in the text of the manuscript as well.  
 
My overall impression is that they have con vincingly shown that their findings are appropriate 
for their specific population i.e. The Chinese population that they take care of. However, these 
findings  may very well NOT be applicable to non Asian populations not only because of the 
differences in B MI but also the predilection for diabetes in less obese subjects. Also the risk 
factor of HCV as the primary risk factor for gallstones in the elderly ill may not hold true in 
other countries where HCV is not endemic.  
 
 
ADDITIONAL REQUESTS/SUGGESTIONS:  
 
1. Page 4 line 74 change gender to sex  
 
2. Line 79 would the word "profiles" be better than statuses?  
 
3. Line 95 here I would strongly suggest that you add where in the world the study was done  
 
4 line 109 change "spot" to "area" or " mass"  
 
5. Line 148. Renal  function ( go back to line 146) is not "higher".    I would suggest that on line 
146 you change the sentence to say "had higher blood pressure and more abnormal levels of "  
 
6. Line 184 -186 specify again that this study is in an Asian population  
 
7. Line 2 03. Change to "In addition to age, the levels of serum uric acid, liver function tests, and 
renal function significantly differed amongst the four groups, being more abnormal in"  
 
8. Line 214. When you say surgical complications, specify " after cholecystectomy"  
 
9. Table 1. Though there are statistically different mean values, many of these are are statistically 
different due to a house n value but otherwise they are clinically unim portant like Bun, Cr, LDL, 
GOT, GPT,  
 
10. How can you explain the incidence in table 2 and table 4 that the MANO has a higher 
incidence than the MAO Group is this a typo or did the MANO group have a higher HCV 
incidence?  
 
I think you should discuss it in a separate paragraph or if explain it  if you can.  
 
Are the methods appropriate and well described?  
If not, please specify wha t is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects req uire further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interest s? 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
This reviewer has been recruited by a partner organization, Research Square. Reviewers with 
declared or apparent competing interest s are not utilized for these reviews. This reviewer has 
agreed to publication of their comments online under a Creative Commons Attribution License 
attributed to Research Square and was paid a small honorarium for completing the review within 
a specified t imeframe. Honoraria for reviews such as this are paid regardless of the reviewer 
recommendation.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I u pload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/lice nses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be included as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title:  Strong As sociation between Metabolically -Abnormal Obesity and Gallstone Disease in 
Adults under 50 Years  
 
Version: 1 Date: 17 Apr 2019 
 
Reviewer:  Reviewer  2 
 
Reviewer’s report:  
 
PEER REVIEWER ASSESSMENTS:  
 
OBJECTIVE - Full research articles: is there a clear objective that addresses one or several 
testable re search questions? (Brief or other article types: is there a clear objective?)  
 
Yes - there is a clear objective  
 
 
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for the 
objective?  
 
Yes - the approach is appropriate  
 
 
EXECUTION - Are the experiments and analyses performed with sufficient technical rigor to 
allow confidence in the results?  
 
Yes - experiments and analyses were performed appropriately  
 
 
STATISTICS - Is the use of statistics in the manuscript appropriate?  
 
Yes - appropriate statistical analyses have been used in the study  
 
 
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not 
overstated?  
 
Yes - the author's interpretation is reasonable  
 
 
OVERALL MANUSCRIPT POTENTIAL - Has the  author addressed your concerns sufficiently 
for you to now recommend the work as a technically sound contribution? If not, can further 
revisions be made to make the work technically sound?  
 
Yes - current version is technically sound  
 
 
PEER REVIEWER COMMENTS :  
 
GENERAL COMMENTS: The authors have responded to all the questions raised by myself and 
the excellent review by the other reviewer.  
 
They have made the appropriate changes in the text of the manuscript as well.  
 
My overall impression is that they have con vincingly shown that their findings are appropriate 
for their specific population i.e. The Chinese population that they take care of. However, these 
findings  may very well NOT be applicable to non Asian populations not only because of the 
differences in B MI but also the predilection for diabetes in less obese subjects. Also the risk 
factor of HCV as the primary risk factor for gallstones in the elderly ill may not hold true in 
other countries where HCV is not endemic.  
 
 
ADDITIONAL REQUESTS/SUGGESTIONS:  
 
1. Page 4 line 74 change gender to sex  
 
2. Line 79 would the word "profiles" be better than statuses?  
 
3. Line 95 here I would strongly suggest that you add where in the world the study was done  
 
4 line 109 change "spot" to "area" or " mass"  
 
5. Line 148. Renal  function ( go back to line 146) is not "higher".    I would suggest that on line 
146 you change the sentence to say "had higher blood pressure and more abnormal levels of "  
 
6. Line 184 -186 specify again that this study is in an Asian population  
 
7. Line 2 03. Change to "In addition to age, the levels of serum uric acid, liver function tests, and 
renal function significantly differed amongst the four groups, being more abnormal in"  
 
8. Line 214. When you say surgical complications, specify " after cholecystectomy"  
 
9. Table 1. Though there are statistically different mean values, many of these are are statistically 
different due to a house n value but otherwise they are clinically unim portant like Bun, Cr, LDL, 
GOT, GPT,  
 
10. How can you explain the incidence in table 2 and table 4 that the MANO has a higher 
incidence than the MAO Group is this a typo or did the MANO group have a higher HCV 
incidence?  
 
I think you should discuss it in a separate paragraph or if explain it  if you can.  
 
Are the methods appropriate and well described?  
If not, please specify wha t is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects req uire further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interest s? 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
This reviewer has been recruited by a partner organization, Research Square. Reviewers with 
declared or apparent competing interest s are not utilized for these reviews. This reviewer has 
agreed to publication of their comments online under a Creative Commons Attribution License 
attributed to Research Square and was paid a small honorarium for completing the review within 
a specified t imeframe. Honoraria for reviews such as this are paid regardless of the reviewer 
recommendation.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I u pload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/lice nses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be included as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant