Title: Osteoporosis and sarcopenia are common and insufficiently diagnosed among chronic
pancreatitis patients
Version: 3 Date: 23 Jan 2023
Reviewer:  Serena Stigliano
Reviewer's report:
In the present study Parhiala M and colleagues aim at assess the prevalence of osteoporosis,
sarcopenia and vitamin deficiency among patients with chronic pancreatitis.
The topic is interesting but is not new since a lot of previous studies had investigated this field
and current guidelines already recommend its  evaluation in CP patients.
However the study is well written and designed and it could strengthen previous data.
Some comments:
- Please check the definition of chronic pancreatitis : moderate or marked ductal pancreatic
ductal lesions according to the Cambridge classification. Is not clear.
- pancreatic exocrine insufficiency (pancreatic steatorrhea markedly reduced by pancreatic
enzyme replacement therapy). Please check this part because PEI is not a synonymous of
steatorrhea.
- author say that blood examinations and data collection was performed in 2019 so almost 5
years after the diagnosis. Can they explain why?
- When the DEXA was performed?
- Why the CT/RM for the sarcopenia evaluation was performed 1 year after the DEXA?
- about the vitamin deficiency , authors didn't mentioned the vitamin K level, an important fat-
soluble vitamin that is frequently reduced in patients with EPI and that is linked with bone
metabolism.  I suggest to analyzed this  vitamin or at list mention it in the discussion.
- about the vitamin D level, what is the prevalence of deficiency in the general population in
Finland?
Title: Osteoporosis and sarcopenia are common and insufficiently diagnosed among chronic
pancreatitis patients
Version: 3 Date: 23 Jan 2023
Reviewer:  Serena Stigliano
Reviewer's report:
In the present study Parhiala M and colleagues aim at assess the prevalence of osteoporosis,
sarcopenia and vitamin deficiency among patients with chronic pancreatitis.
The topic is interesting but is not new since a lot of previous studies had investigated this field
and current guidelines already recommend its  evaluation in CP patients.
However the study is well written and designed and it could strengthen previous data.
Some comments:
- Please check the definition of chronic pancreatitis : moderate or marked ductal pancreatic
ductal lesions according to the Cambridge classification. Is not clear.
- pancreatic exocrine insufficiency (pancreatic steatorrhea markedly reduced by pancreatic
enzyme replacement therapy). Please check this part because PEI is not a synonymous of
steatorrhea.
- author say that blood examinations and data collection was performed in 2019 so almost 5
years after the diagnosis. Can they explain why?
- When the DEXA was performed?
- Why the CT/RM for the sarcopenia evaluation was performed 1 year after the DEXA?
- about the vitamin deficiency , authors didn't mentioned the vitamin K level, an important fat-
soluble vitamin that is frequently reduced in patients with EPI and that is linked with bone
metabolism.  I suggest to analyzed this  vitamin or at list mention it in the discussion.
- about the vitamin D level, what is the prevalence of deficiency in the general population in
Finland?
Please review this paper.
user
Title: Osteoporosis and sarcopenia are common and insufficiently diagnosed among chronic
pancreatitis patients
Version: 3 Date: 23 Jan 2023
Reviewer:  Serena Stigliano
Reviewer's report:
In the present study Parhiala M and colleagues aim at assess the prevalence of osteoporosis,
sarcopenia and vitamin deficiency among patients with chronic pancreatitis.
The topic is interesting but is not new since a lot of previous studies had investigated this field
and current guidelines already recommend its  evaluation in CP patients.
However the study is well written and designed and it could strengthen previous data.
Some comments:
- Please check the definition of chronic pancreatitis : moderate or marked ductal pancreatic
ductal lesions according to the Cambridge classification. Is not clear.
- pancreatic exocrine insufficiency (pancreatic steatorrhea markedly reduced by pancreatic
enzyme replacement therapy). Please check this part because PEI is not a synonymous of
steatorrhea.
- author say that blood examinations and data collection was performed in 2019 so almost 5
years after the diagnosis. Can they explain why?
- When the DEXA was performed?
- Why the CT/RM for the sarcopenia evaluation was performed 1 year after the DEXA?
- about the vitamin deficiency , authors didn't mentioned the vitamin K level, an important fat-
soluble vitamin that is frequently reduced in patients with EPI and that is linked with bone
metabolism.  I suggest to analyzed this  vitamin or at list mention it in the discussion.
- about the vitamin D level, what is the prevalence of deficiency in the general population in
Finland?
assistant