Title: Evaluating the Role of Circadian Syndrome in Predicting MASLD Risk: Evidence from
a Large Cross-Sectional Study
Version: 0 Date: 21 Apr 2025
Reviewer's report:
Thank you for the opportunity to review this manuscript. I sincerely thank the authors for their
contribution.
Jihan Sun et al. investigates the association between Circadian Syndrome (CircS) and Metabolic
Dysfunction-Associated Steatotic Liver Disease (MASLD) using data from the 2017-2018
NHANES cycle. They found that CircS is significantly associated with increased MASLD risk
and has good "predictive" value for MASLD (AUC = 0.732). The manuscript is well-written,
with clear methodology and comprehensive statistical analyses. The findings are interesting and
provide valuable insights into the relationship between circadian health and MASLD risk.
Here are my comments which I think may help the authors to improve:
Major:
1. Usually, cross-sectional design cannot reveal causality. As the authors mention in their
"Limitations", "as a cross-sectional analysis, it cannot confirm a causal relationship between
CircS and MASLD, only an association". The use of "predicting" is not proper. Please constrain
the use of "predict" in the paper. And please remove the ROC analysis.
Other:
2. In Abstract, "Weighted logistic regression, subgroup, and restricted cubic spline analyses
were performed to examine the CircS-MASLD association" is not clear for me what they can
examine. I would suggest making it clearer like "Weighted logistic regression was used to
assess the overall relationship. Restricted cubic spline models were applied to evaluate the dose–
response relationship. Subgroup analyses were conducted to explore potential effect modifiers
underlying ..."
3. In Abstract, "... had increased odds of MASLD (Model 3: OR = 4.068, 95% CI: 2.726–6.070,
p < 0.001)" is not clear. The reader does not know what Model 3 is when reading the Abstract.
I would suggest: "Application of weighted logistic regression revealed ... had increased odds of
MASLD after adjusting ..."
3. As you mentioned, ~3000 out of ~9000 individuals were excluded due to missing CircS data.
This means CircS is not a common measurement because it contains uncommon assessment. Is
the diagnosis of MASLD more inconvenient than that of CircS? If it is not, a complex variable
like CircS limits its use in clinical practice. This should be considered at least in the discussion.
4. How is the CircS score determined? I saw the Assessment of Circadian Syndrome but have
not seen the calculation of the CircS score.
Title: Evaluating the Role of Circadian Syndrome in Predicting MASLD Risk: Evidence from
a Large Cross-Sectional Study
Version: 0 Date: 21 Apr 2025
Reviewer's report:
Thank you for the opportunity to review this manuscript. I sincerely thank the authors for their
contribution.
Jihan Sun et al. investigates the association between Circadian Syndrome (CircS) and Metabolic
Dysfunction-Associated Steatotic Liver Disease (MASLD) using data from the 2017-2018
NHANES cycle. They found that CircS is significantly associated with increased MASLD risk
and has good "predictive" value for MASLD (AUC = 0.732). The manuscript is well-written,
with clear methodology and comprehensive statistical analyses. The findings are interesting and
provide valuable insights into the relationship between circadian health and MASLD risk.
Here are my comments which I think may help the authors to improve:
Major:
1. Usually, cross-sectional design cannot reveal causality. As the authors mention in their
"Limitations", "as a cross-sectional analysis, it cannot confirm a causal relationship between
CircS and MASLD, only an association". The use of "predicting" is not proper. Please constrain
the use of "predict" in the paper. And please remove the ROC analysis.
Other:
2. In Abstract, "Weighted logistic regression, subgroup, and restricted cubic spline analyses
were performed to examine the CircS-MASLD association" is not clear for me what they can
examine. I would suggest making it clearer like "Weighted logistic regression was used to
assess the overall relationship. Restricted cubic spline models were applied to evaluate the dose–
response relationship. Subgroup analyses were conducted to explore potential effect modifiers
underlying ..."
3. In Abstract, "... had increased odds of MASLD (Model 3: OR = 4.068, 95% CI: 2.726–6.070,
p < 0.001)" is not clear. The reader does not know what Model 3 is when reading the Abstract.
I would suggest: "Application of weighted logistic regression revealed ... had increased odds of
MASLD after adjusting ..."
3. As you mentioned, ~3000 out of ~9000 individuals were excluded due to missing CircS data.
This means CircS is not a common measurement because it contains uncommon assessment. Is
the diagnosis of MASLD more inconvenient than that of CircS? If it is not, a complex variable
like CircS limits its use in clinical practice. This should be considered at least in the discussion.
4. How is the CircS score determined? I saw the Assessment of Circadian Syndrome but have
not seen the calculation of the CircS score.
Please review this paper.
user
Title: Evaluating the Role of Circadian Syndrome in Predicting MASLD Risk: Evidence from
a Large Cross-Sectional Study
Version: 0 Date: 21 Apr 2025
Reviewer's report:
Thank you for the opportunity to review this manuscript. I sincerely thank the authors for their
contribution.
Jihan Sun et al. investigates the association between Circadian Syndrome (CircS) and Metabolic
Dysfunction-Associated Steatotic Liver Disease (MASLD) using data from the 2017-2018
NHANES cycle. They found that CircS is significantly associated with increased MASLD risk
and has good "predictive" value for MASLD (AUC = 0.732). The manuscript is well-written,
with clear methodology and comprehensive statistical analyses. The findings are interesting and
provide valuable insights into the relationship between circadian health and MASLD risk.
Here are my comments which I think may help the authors to improve:
Major:
1. Usually, cross-sectional design cannot reveal causality. As the authors mention in their
"Limitations", "as a cross-sectional analysis, it cannot confirm a causal relationship between
CircS and MASLD, only an association". The use of "predicting" is not proper. Please constrain
the use of "predict" in the paper. And please remove the ROC analysis.
Other:
2. In Abstract, "Weighted logistic regression, subgroup, and restricted cubic spline analyses
were performed to examine the CircS-MASLD association" is not clear for me what they can
examine. I would suggest making it clearer like "Weighted logistic regression was used to
assess the overall relationship. Restricted cubic spline models were applied to evaluate the dose–
response relationship. Subgroup analyses were conducted to explore potential effect modifiers
underlying ..."
3. In Abstract, "... had increased odds of MASLD (Model 3: OR = 4.068, 95% CI: 2.726–6.070,
p < 0.001)" is not clear. The reader does not know what Model 3 is when reading the Abstract.
I would suggest: "Application of weighted logistic regression revealed ... had increased odds of
MASLD after adjusting ..."
3. As you mentioned, ~3000 out of ~9000 individuals were excluded due to missing CircS data.
This means CircS is not a common measurement because it contains uncommon assessment. Is
the diagnosis of MASLD more inconvenient than that of CircS? If it is not, a complex variable
like CircS limits its use in clinical practice. This should be considered at least in the discussion.
4. How is the CircS score determined? I saw the Assessment of Circadian Syndrome but have
not seen the calculation of the CircS score.
assistant