Title: Association of serum creatinine with hepatic steatosis and fibrosis: a cross-sectional study
Version: 2 Date: 17 May 2022
Reviewer's report:
In the present manuscript the authors report the results of a large cross-sectional study
investigating the association between hepatic steatosis, hepatic fibrosis and serum creatinine
levels in a sample of Chinese individuals referred to a single center for routine check-up. The
manuscript is well-written and easy to follow.
I have the following comments:
1. The Authors use the term hepatic steatosis. I believe that more efforts should be put into
identifying whether this is nonalcoholic fatty liver disease, alcoholic liver disease or some other
form of liver disease. Do you have information on alcohol intake? Did you exclude participants
with known viral hepatitis or known advanced chronic liver disease?
2. Since creatinine is also dependent on muscle mass, do you have any data on physical activity
in these subjects?
3. It would be important to also adjust for diabetes or hba1c in the multivariable models as
diabetes is a major risk factor for increased creatinine levels
4. I found it peculiar that no differences in triglycerides and HDL cholesterol were present
between participants with and withoud steatosis. Could you also report the prevalence of
metabolic syndrome and diabetes in table 1?
5. Please replace the paragraph “Relevant factors for the incidence of HS” with “Relevant factors
for the prevalence of HS”, as incidence and prevalence are two very different things (these are
very basic epidemiologic concepts) and incidence rates cannot be derived from cross-sectional
studies. Please also remove the word incidence in lines 182,184 and 187.
6. In the discussion section I would also mention the association between steatosis and fibrosis
with albuminuria, which is a predictor of future development of CKD and is associated with
higher creatinine levels (see doi: 10.1016/j.dld.2021.02.010). Similarly, more recent studies on
the prevalence of liver steatosis and fibrosis in the general population might be recalled (e.g.
doi: 10.1111/liv.14828)
Title: Association of serum creatinine with hepatic steatosis and fibrosis: a cross-sectional study
Version: 2 Date: 17 May 2022
Reviewer's report:
In the present manuscript the authors report the results of a large cross-sectional study
investigating the association between hepatic steatosis, hepatic fibrosis and serum creatinine
levels in a sample of Chinese individuals referred to a single center for routine check-up. The
manuscript is well-written and easy to follow.
I have the following comments:
1. The Authors use the term hepatic steatosis. I believe that more efforts should be put into
identifying whether this is nonalcoholic fatty liver disease, alcoholic liver disease or some other
form of liver disease. Do you have information on alcohol intake? Did you exclude participants
with known viral hepatitis or known advanced chronic liver disease?
2. Since creatinine is also dependent on muscle mass, do you have any data on physical activity
in these subjects?
3. It would be important to also adjust for diabetes or hba1c in the multivariable models as
diabetes is a major risk factor for increased creatinine levels
4. I found it peculiar that no differences in triglycerides and HDL cholesterol were present
between participants with and withoud steatosis. Could you also report the prevalence of
metabolic syndrome and diabetes in table 1?
5. Please replace the paragraph “Relevant factors for the incidence of HS” with “Relevant factors
for the prevalence of HS”, as incidence and prevalence are two very different things (these are
very basic epidemiologic concepts) and incidence rates cannot be derived from cross-sectional
studies. Please also remove the word incidence in lines 182,184 and 187.
6. In the discussion section I would also mention the association between steatosis and fibrosis
with albuminuria, which is a predictor of future development of CKD and is associated with
higher creatinine levels (see doi: 10.1016/j.dld.2021.02.010). Similarly, more recent studies on
the prevalence of liver steatosis and fibrosis in the general population might be recalled (e.g.
doi: 10.1111/liv.14828)
Please review this paper.
user
Title: Association of serum creatinine with hepatic steatosis and fibrosis: a cross-sectional study
Version: 2 Date: 17 May 2022
Reviewer's report:
In the present manuscript the authors report the results of a large cross-sectional study
investigating the association between hepatic steatosis, hepatic fibrosis and serum creatinine
levels in a sample of Chinese individuals referred to a single center for routine check-up. The
manuscript is well-written and easy to follow.
I have the following comments:
1. The Authors use the term hepatic steatosis. I believe that more efforts should be put into
identifying whether this is nonalcoholic fatty liver disease, alcoholic liver disease or some other
form of liver disease. Do you have information on alcohol intake? Did you exclude participants
with known viral hepatitis or known advanced chronic liver disease?
2. Since creatinine is also dependent on muscle mass, do you have any data on physical activity
in these subjects?
3. It would be important to also adjust for diabetes or hba1c in the multivariable models as
diabetes is a major risk factor for increased creatinine levels
4. I found it peculiar that no differences in triglycerides and HDL cholesterol were present
between participants with and withoud steatosis. Could you also report the prevalence of
metabolic syndrome and diabetes in table 1?
5. Please replace the paragraph “Relevant factors for the incidence of HS” with “Relevant factors
for the prevalence of HS”, as incidence and prevalence are two very different things (these are
very basic epidemiologic concepts) and incidence rates cannot be derived from cross-sectional
studies. Please also remove the word incidence in lines 182,184 and 187.
6. In the discussion section I would also mention the association between steatosis and fibrosis
with albuminuria, which is a predictor of future development of CKD and is associated with
higher creatinine levels (see doi: 10.1016/j.dld.2021.02.010). Similarly, more recent studies on
the prevalence of liver steatosis and fibrosis in the general population might be recalled (e.g.
doi: 10.1111/liv.14828)
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