Title: Clinical characteristics and longitudinal changes of patients with non-alcoholic fatty liver
disease in two decades: the NAGALA study
Version: 2 Date: 02 Jan 2021
Reviewer's report:
An interesting and well-detailed analysis of the prevalence of NAFLD in a Japanese population,
with associations to components of MetSyn and lifestyle (alcohol, physical activity and
smoking) in two cohorts, the first in the mid ’90, the second 20 years ahead. Data show
considerable differences in the prevalence of NAFLD and other variables, including physical
activity, and obesity as leading factors associated with NAFLD (although also lean NAFLD
increased systematically), with gender differences. There are several unexpected findings that
I found difficult to reconcile:
1. Apparently, the leading factor is the increase in obesity rates, despite a minimum, but highly
significant increase in BMI. This was accompanied by a dramatic increase in fasting glucose
(doubled in 20 years), that fits with increased obesity rates in males (not with decreased obesity
rates in females). How was that triglycerides were reduced in males and HDL cholesterol were
increased in the presence of diabetes? The increased prevalence of exercise seems too small to
justify these changes.
2. The authors argue that altered metabolic factors in females are driven by reduced physical
activity. If this is the case, why was BMI decreased? The lack of data on calorie intake is a
severe limit for the assessment of lifestyle. Any evidence from the literature that calorie intake
was reduced in the 20-year span of the two observations?
3. And in males, the prevalence of NAFLD in non-obese current cohort was higher, in spite of
increased exercise? How it comes? Any evidence frojm the literature that body shape (waist
circumference) in Japan population has changed during the past 20 years?
4. In the last sentence of “Study Population and Design” chapter the authors say that longitudinal
data of individuals who participated in health check-ups more than twice were analyzed. What
do they mean? Where are longitudinal data in paired samples?
5. Considering that data are continuously retrieved in the Gifu area, it would have been much
more solid a study analyzing trajectories on disease prevalence based un multiple cohorts instead
of two cohorts taken some 20 years apart.
6. Table 3 might be omitted. Data are already present in Table 2, and the P for comparison should
be added to Table 2.
Title: Clinical characteristics and longitudinal changes of patients with non-alcoholic fatty liver
disease in two decades: the NAGALA study
Version: 2 Date: 02 Jan 2021
Reviewer's report:
An interesting and well-detailed analysis of the prevalence of NAFLD in a Japanese population,
with associations to components of MetSyn and lifestyle (alcohol, physical activity and
smoking) in two cohorts, the first in the mid ’90, the second 20 years ahead. Data show
considerable differences in the prevalence of NAFLD and other variables, including physical
activity, and obesity as leading factors associated with NAFLD (although also lean NAFLD
increased systematically), with gender differences. There are several unexpected findings that
I found difficult to reconcile:
1. Apparently, the leading factor is the increase in obesity rates, despite a minimum, but highly
significant increase in BMI. This was accompanied by a dramatic increase in fasting glucose
(doubled in 20 years), that fits with increased obesity rates in males (not with decreased obesity
rates in females). How was that triglycerides were reduced in males and HDL cholesterol were
increased in the presence of diabetes? The increased prevalence of exercise seems too small to
justify these changes.
2. The authors argue that altered metabolic factors in females are driven by reduced physical
activity. If this is the case, why was BMI decreased? The lack of data on calorie intake is a
severe limit for the assessment of lifestyle. Any evidence from the literature that calorie intake
was reduced in the 20-year span of the two observations?
3. And in males, the prevalence of NAFLD in non-obese current cohort was higher, in spite of
increased exercise? How it comes? Any evidence frojm the literature that body shape (waist
circumference) in Japan population has changed during the past 20 years?
4. In the last sentence of “Study Population and Design” chapter the authors say that longitudinal
data of individuals who participated in health check-ups more than twice were analyzed. What
do they mean? Where are longitudinal data in paired samples?
5. Considering that data are continuously retrieved in the Gifu area, it would have been much
more solid a study analyzing trajectories on disease prevalence based un multiple cohorts instead
of two cohorts taken some 20 years apart.
6. Table 3 might be omitted. Data are already present in Table 2, and the P for comparison should
be added to Table 2.
Please review this paper.
user
Title: Clinical characteristics and longitudinal changes of patients with non-alcoholic fatty liver
disease in two decades: the NAGALA study
Version: 2 Date: 02 Jan 2021
Reviewer's report:
An interesting and well-detailed analysis of the prevalence of NAFLD in a Japanese population,
with associations to components of MetSyn and lifestyle (alcohol, physical activity and
smoking) in two cohorts, the first in the mid ’90, the second 20 years ahead. Data show
considerable differences in the prevalence of NAFLD and other variables, including physical
activity, and obesity as leading factors associated with NAFLD (although also lean NAFLD
increased systematically), with gender differences. There are several unexpected findings that
I found difficult to reconcile:
1. Apparently, the leading factor is the increase in obesity rates, despite a minimum, but highly
significant increase in BMI. This was accompanied by a dramatic increase in fasting glucose
(doubled in 20 years), that fits with increased obesity rates in males (not with decreased obesity
rates in females). How was that triglycerides were reduced in males and HDL cholesterol were
increased in the presence of diabetes? The increased prevalence of exercise seems too small to
justify these changes.
2. The authors argue that altered metabolic factors in females are driven by reduced physical
activity. If this is the case, why was BMI decreased? The lack of data on calorie intake is a
severe limit for the assessment of lifestyle. Any evidence from the literature that calorie intake
was reduced in the 20-year span of the two observations?
3. And in males, the prevalence of NAFLD in non-obese current cohort was higher, in spite of
increased exercise? How it comes? Any evidence frojm the literature that body shape (waist
circumference) in Japan population has changed during the past 20 years?
4. In the last sentence of “Study Population and Design” chapter the authors say that longitudinal
data of individuals who participated in health check-ups more than twice were analyzed. What
do they mean? Where are longitudinal data in paired samples?
5. Considering that data are continuously retrieved in the Gifu area, it would have been much
more solid a study analyzing trajectories on disease prevalence based un multiple cohorts instead
of two cohorts taken some 20 years apart.
6. Table 3 might be omitted. Data are already present in Table 2, and the P for comparison should
be added to Table 2.
assistant