Title: Relationship between body composition and the histology of non-alcoholic fatty liver
disease: a cross-sectional study
Version: 3 Date: 09 Feb 2021
Reviewer's report:
In this manuscript, the authors examined the relationship between body composition and non-
alcoholic fatty liver disease progression as indicated by fibrosis and the non-alcoholic fatty liver
disease activity score. The authors found that fibrosis in non-alcoholic fatty liver disease, an
indicator of unfavorable long-term outcomes, is associated with more indices of fat mass than
of those of muscle mass. The manuscript does contain some interesting data, however, there are
several concerns should be addressed before it can be considered for publication.
1. The authors stated that no studies have compared the contributions of fat mass and muscle
mass to NAFLD histology. However, the effect of body composition on the liver function has
been determined (PMID: 29948305).  In general, this paper is too related to the published one
which greatly diminishes enthusiasm for the findings.
2. What is the muscle mass/ht2 to fat mass /ht2 ratio according to the stage of fibrosis?
3. The number of the patients should be increased.
4. In Additional file 1, the authors showed that muscle mass/ ht2 was increased with steatosis
grade. This data should be confirmed with more cases.
5. In Additional file 2, the authors showed that there were no significant differences of body
composition in lobular inflammation grade. However, there were significant differences of body
composition in the stage of fibrosis. The data should be confirmed with high number cases, since
inflammation is key to drive NAFLD to NASH (with fibrosis). Did the author investigate the
correlation between fibrosis and lobular inflammation, fibrosis and body composition, lobular
inflammation and body composition?
6. What is normal muscle mass/ht2 median? Compared to normal, the muscle mass/ht2 in
NAFLD was increased or decreased?
7. It will be better also show normal human body composition to better distinguish body
composition changes in NAFLD.
8. Some statements are not accuracy. For example, the author stated that “There were no
significant differences in the lobular inflammation grade or ballooning grade between these
groups (Additional files 2 and 3)”. It should be “in different lobular inflammation grade, there
were no significant differences in body composition”.
Title: Relationship between body composition and the histology of non-alcoholic fatty liver
disease: a cross-sectional study
Version: 3 Date: 09 Feb 2021
Reviewer's report:
In this manuscript, the authors examined the relationship between body composition and non-
alcoholic fatty liver disease progression as indicated by fibrosis and the non-alcoholic fatty liver
disease activity score. The authors found that fibrosis in non-alcoholic fatty liver disease, an
indicator of unfavorable long-term outcomes, is associated with more indices of fat mass than
of those of muscle mass. The manuscript does contain some interesting data, however, there are
several concerns should be addressed before it can be considered for publication.
1. The authors stated that no studies have compared the contributions of fat mass and muscle
mass to NAFLD histology. However, the effect of body composition on the liver function has
been determined (PMID: 29948305).  In general, this paper is too related to the published one
which greatly diminishes enthusiasm for the findings.
2. What is the muscle mass/ht2 to fat mass /ht2 ratio according to the stage of fibrosis?
3. The number of the patients should be increased.
4. In Additional file 1, the authors showed that muscle mass/ ht2 was increased with steatosis
grade. This data should be confirmed with more cases.
5. In Additional file 2, the authors showed that there were no significant differences of body
composition in lobular inflammation grade. However, there were significant differences of body
composition in the stage of fibrosis. The data should be confirmed with high number cases, since
inflammation is key to drive NAFLD to NASH (with fibrosis). Did the author investigate the
correlation between fibrosis and lobular inflammation, fibrosis and body composition, lobular
inflammation and body composition?
6. What is normal muscle mass/ht2 median? Compared to normal, the muscle mass/ht2 in
NAFLD was increased or decreased?
7. It will be better also show normal human body composition to better distinguish body
composition changes in NAFLD.
8. Some statements are not accuracy. For example, the author stated that “There were no
significant differences in the lobular inflammation grade or ballooning grade between these
groups (Additional files 2 and 3)”. It should be “in different lobular inflammation grade, there
were no significant differences in body composition”.
Please review this paper.
user
Title: Relationship between body composition and the histology of non-alcoholic fatty liver
disease: a cross-sectional study
Version: 3 Date: 09 Feb 2021
Reviewer's report:
In this manuscript, the authors examined the relationship between body composition and non-
alcoholic fatty liver disease progression as indicated by fibrosis and the non-alcoholic fatty liver
disease activity score. The authors found that fibrosis in non-alcoholic fatty liver disease, an
indicator of unfavorable long-term outcomes, is associated with more indices of fat mass than
of those of muscle mass. The manuscript does contain some interesting data, however, there are
several concerns should be addressed before it can be considered for publication.
1. The authors stated that no studies have compared the contributions of fat mass and muscle
mass to NAFLD histology. However, the effect of body composition on the liver function has
been determined (PMID: 29948305).  In general, this paper is too related to the published one
which greatly diminishes enthusiasm for the findings.
2. What is the muscle mass/ht2 to fat mass /ht2 ratio according to the stage of fibrosis?
3. The number of the patients should be increased.
4. In Additional file 1, the authors showed that muscle mass/ ht2 was increased with steatosis
grade. This data should be confirmed with more cases.
5. In Additional file 2, the authors showed that there were no significant differences of body
composition in lobular inflammation grade. However, there were significant differences of body
composition in the stage of fibrosis. The data should be confirmed with high number cases, since
inflammation is key to drive NAFLD to NASH (with fibrosis). Did the author investigate the
correlation between fibrosis and lobular inflammation, fibrosis and body composition, lobular
inflammation and body composition?
6. What is normal muscle mass/ht2 median? Compared to normal, the muscle mass/ht2 in
NAFLD was increased or decreased?
7. It will be better also show normal human body composition to better distinguish body
composition changes in NAFLD.
8. Some statements are not accuracy. For example, the author stated that “There were no
significant differences in the lobular inflammation grade or ballooning grade between these
groups (Additional files 2 and 3)”. It should be “in different lobular inflammation grade, there
were no significant differences in body composition”.
assistant