Title: Non-alcoholic Fatty Liver Disease and Cognitive Function in Middle-aged Adults: The
CARDIA Study
Version: 1 Date: 22 Jan 2021
Reviewer's report:
- Introduction section: i suggest to report epidemiology data on NAFLD worldwide. In the US
and globally, NAFLD is the most common cause of chronic liver disease. By definition, NAFLD
occurs in the absence of excessive alcohol consumption,3 and is associated with CVD and
its risk factors including type 2 diabetes, obesity, hyperlipidemia, and hypertension. Such risk
factors are known to contribute to cognitive impairment with or without the mediation of CVD.
Furthermore, considering findings from previous studies suggesting that NAFLD could be an
independent CVD risk factor, it appears reasonable to hypothesize that NAFLD is independently
associated with cognitive impairment.
- Methods section: i suggest to divide the Measurements in two sub-sections "Clinical" and
"Biochemical" measurements. Also i suggest to inlcude trygliceride values in the dataset.  No
data on dietetic profiles are reeported in the text. Please improve this part.
- Discussion section: it is possible that the association between NAFLD and cognitive
impairment is an epiphenomenon, because CV risk factors and diseases are related to both
NAFLD and cognition. The key point can be represented by insulin resistance, that explain the
association between NAFLD and cognitive impairment, because insulin resistance plays critical
roles in the pathogenesis of NAFLD and Alzheimer disease.
Title: Non-alcoholic Fatty Liver Disease and Cognitive Function in Middle-aged Adults: The
CARDIA Study
Version: 1 Date: 22 Jan 2021
Reviewer's report:
- Introduction section: i suggest to report epidemiology data on NAFLD worldwide. In the US
and globally, NAFLD is the most common cause of chronic liver disease. By definition, NAFLD
occurs in the absence of excessive alcohol consumption,3 and is associated with CVD and
its risk factors including type 2 diabetes, obesity, hyperlipidemia, and hypertension. Such risk
factors are known to contribute to cognitive impairment with or without the mediation of CVD.
Furthermore, considering findings from previous studies suggesting that NAFLD could be an
independent CVD risk factor, it appears reasonable to hypothesize that NAFLD is independently
associated with cognitive impairment.
- Methods section: i suggest to divide the Measurements in two sub-sections "Clinical" and
"Biochemical" measurements. Also i suggest to inlcude trygliceride values in the dataset.  No
data on dietetic profiles are reeported in the text. Please improve this part.
- Discussion section: it is possible that the association between NAFLD and cognitive
impairment is an epiphenomenon, because CV risk factors and diseases are related to both
NAFLD and cognition. The key point can be represented by insulin resistance, that explain the
association between NAFLD and cognitive impairment, because insulin resistance plays critical
roles in the pathogenesis of NAFLD and Alzheimer disease.
Please review this paper.
user
Title: Non-alcoholic Fatty Liver Disease and Cognitive Function in Middle-aged Adults: The
CARDIA Study
Version: 1 Date: 22 Jan 2021
Reviewer's report:
- Introduction section: i suggest to report epidemiology data on NAFLD worldwide. In the US
and globally, NAFLD is the most common cause of chronic liver disease. By definition, NAFLD
occurs in the absence of excessive alcohol consumption,3 and is associated with CVD and
its risk factors including type 2 diabetes, obesity, hyperlipidemia, and hypertension. Such risk
factors are known to contribute to cognitive impairment with or without the mediation of CVD.
Furthermore, considering findings from previous studies suggesting that NAFLD could be an
independent CVD risk factor, it appears reasonable to hypothesize that NAFLD is independently
associated with cognitive impairment.
- Methods section: i suggest to divide the Measurements in two sub-sections "Clinical" and
"Biochemical" measurements. Also i suggest to inlcude trygliceride values in the dataset.  No
data on dietetic profiles are reeported in the text. Please improve this part.
- Discussion section: it is possible that the association between NAFLD and cognitive
impairment is an epiphenomenon, because CV risk factors and diseases are related to both
NAFLD and cognition. The key point can be represented by insulin resistance, that explain the
association between NAFLD and cognitive impairment, because insulin resistance plays critical
roles in the pathogenesis of NAFLD and Alzheimer disease.
assistant