Title: Association between glycated hemoglobin/high-density lipoprotein ratio and
nonalcoholic fatty liver disease in a U.S. nondiabetic population: a cross-sectional study based
on NHANES 2017-2020 data
Version: 0 Date: 10 May 2025
Reviewer's report:
Major Comment
• In the discussion section (pages 240–253), the explanation of the nonlinear association between
the HbA1c/HDL-C ratio and NAFLD—particularly for values below the inflection point of 1.43
—lacks clarity and may present a logical contradiction. The authors should clarify why NAFLD
risk appears to increase when the ratio is below 1.43, and ensure that the mechanistic explanation
aligns with the observed data.
Minor Comments
1. A brief overview of the NHANES dataset would improve accessibility for a broader
readership. Please clarify:
o What population the dataset represents
o How participants were selected
o Whether this was a cross-sectional or longitudinal dataset and how follow-up was conducted
if it’s a longitudinal dataset
2. For comorbid conditions such as hypertension (HTN), hepatitis B virus infection (HBV),
etc., please indicate whether diagnoses were determined by ICD-9/ICD-10 codes or survey
responses. If applicable, a supplemental table listing the specific diagnostic codes would enhance
transparency.
3. In Figure 1, please clarify the rationale for excluding patients with a history of chronic
hepatitis.
4. Address typographical and labeling issues—for example, should it be “ALL” or “All” in
Figure 1.
5. Please define the abbreviation of “RIP” as it appears in Line 125.
6. The rationale for dividing participants into tertiles based on the HbA1c/HDL-C ratio should
be explained. Why were tertiles chosen over quartiles or quintiles
7. A reference should be provided for the statement:“Data were weighted according to the
recommendations of guidelines published by the Centers for Disease Control and Prevention
(CDC).” (lines 117–178).
8. The presentation of data could be made more formal. For example, the sentence: “There
were 5,485 individuals in all, 44.67% of them being male and their mean age was 45.86 (18.32)
years” (lines 133–134) should clarify that (18.32) refers to the standard deviation (SD); In
line 85, the sentence: “We ignored minors under the age of 18 years (5867)”would be more
appropriately presented as:
“We excluded minors under the age of 18 years (n = 5,867).”
Title: Association between glycated hemoglobin/high-density lipoprotein ratio and
nonalcoholic fatty liver disease in a U.S. nondiabetic population: a cross-sectional study based
on NHANES 2017-2020 data
Version: 0 Date: 10 May 2025
Reviewer's report:
Major Comment
• In the discussion section (pages 240–253), the explanation of the nonlinear association between
the HbA1c/HDL-C ratio and NAFLD—particularly for values below the inflection point of 1.43
—lacks clarity and may present a logical contradiction. The authors should clarify why NAFLD
risk appears to increase when the ratio is below 1.43, and ensure that the mechanistic explanation
aligns with the observed data.
Minor Comments
1. A brief overview of the NHANES dataset would improve accessibility for a broader
readership. Please clarify:
o What population the dataset represents
o How participants were selected
o Whether this was a cross-sectional or longitudinal dataset and how follow-up was conducted
if it’s a longitudinal dataset
2. For comorbid conditions such as hypertension (HTN), hepatitis B virus infection (HBV),
etc., please indicate whether diagnoses were determined by ICD-9/ICD-10 codes or survey
responses. If applicable, a supplemental table listing the specific diagnostic codes would enhance
transparency.
3. In Figure 1, please clarify the rationale for excluding patients with a history of chronic
hepatitis.
4. Address typographical and labeling issues—for example, should it be “ALL” or “All” in
Figure 1.
5. Please define the abbreviation of “RIP” as it appears in Line 125.
6. The rationale for dividing participants into tertiles based on the HbA1c/HDL-C ratio should
be explained. Why were tertiles chosen over quartiles or quintiles
7. A reference should be provided for the statement:“Data were weighted according to the
recommendations of guidelines published by the Centers for Disease Control and Prevention
(CDC).” (lines 117–178).
8. The presentation of data could be made more formal. For example, the sentence: “There
were 5,485 individuals in all, 44.67% of them being male and their mean age was 45.86 (18.32)
years” (lines 133–134) should clarify that (18.32) refers to the standard deviation (SD); In
line 85, the sentence: “We ignored minors under the age of 18 years (5867)”would be more
appropriately presented as:
“We excluded minors under the age of 18 years (n = 5,867).”
Please review this paper.
user
Title: Association between glycated hemoglobin/high-density lipoprotein ratio and
nonalcoholic fatty liver disease in a U.S. nondiabetic population: a cross-sectional study based
on NHANES 2017-2020 data
Version: 0 Date: 10 May 2025
Reviewer's report:
Major Comment
• In the discussion section (pages 240–253), the explanation of the nonlinear association between
the HbA1c/HDL-C ratio and NAFLD—particularly for values below the inflection point of 1.43
—lacks clarity and may present a logical contradiction. The authors should clarify why NAFLD
risk appears to increase when the ratio is below 1.43, and ensure that the mechanistic explanation
aligns with the observed data.
Minor Comments
1. A brief overview of the NHANES dataset would improve accessibility for a broader
readership. Please clarify:
o What population the dataset represents
o How participants were selected
o Whether this was a cross-sectional or longitudinal dataset and how follow-up was conducted
if it’s a longitudinal dataset
2. For comorbid conditions such as hypertension (HTN), hepatitis B virus infection (HBV),
etc., please indicate whether diagnoses were determined by ICD-9/ICD-10 codes or survey
responses. If applicable, a supplemental table listing the specific diagnostic codes would enhance
transparency.
3. In Figure 1, please clarify the rationale for excluding patients with a history of chronic
hepatitis.
4. Address typographical and labeling issues—for example, should it be “ALL” or “All” in
Figure 1.
5. Please define the abbreviation of “RIP” as it appears in Line 125.
6. The rationale for dividing participants into tertiles based on the HbA1c/HDL-C ratio should
be explained. Why were tertiles chosen over quartiles or quintiles
7. A reference should be provided for the statement:“Data were weighted according to the
recommendations of guidelines published by the Centers for Disease Control and Prevention
(CDC).” (lines 117–178).
8. The presentation of data could be made more formal. For example, the sentence: “There
were 5,485 individuals in all, 44.67% of them being male and their mean age was 45.86 (18.32)
years” (lines 133–134) should clarify that (18.32) refers to the standard deviation (SD); In
line 85, the sentence: “We ignored minors under the age of 18 years (5867)”would be more
appropriately presented as:
“We excluded minors under the age of 18 years (n = 5,867).”
assistant