Reviewer ’s report  
 
Title:  Strong As sociation between Metabolically -Abnormal Obesity and Gallstone Disease in 
Adults under 50 Years  
 
Version: 0 Date: 19 Nov 2018 
 
Reviewer:  Sikarin  Upala  
 
Reviewer’s report:  
 
The manuscript contained an i mportant research question about the role of age, obesity and 
metabolic syndrome on the risk of gallstone. However, there are limitations and areas that the 
authors need to improve the manuscript to be accepted.  
 
 
Introduction  
 
- There should be a descriptio n of how the four groups of metabolic syndrome and obesity 
profile are used clinically and in research. What evidence has shown the importance of dividing 
the two conditions in to these four categories.  
 
 
Methods  
 
- the authors should provide a detail descri ption of the sensitivity and specificity of abdominal 
sonograpthy on the detection of gallstone, who interpreted the results, and whether there is a 
verification of radiographic assessment.  
 
- provide reference on why obesity is defined as BMI >= 24 kg/m2  
 
- describe reason why the analysis needs to be separated among those age below and above 50. 
Will the results be different if the analysis was done in the whole sample?  Give reason why the 
definition of being elderly is above the age 50 and not 60 or 65?  
 
 
Results  
 
- provide both the results for univariate and multivariate regression analysis. What variables are 
used in the stepwise regression analysis.  
 
- should show whether there is difference of baseline characteristics and prevalence of four 
categories of obesity, metabolic syndrome among those age< and >=50  
 
- In table 3, the category heading should be Variables, not Valuable  
 
- please explain the variable "Four groups" in Table 3. Is this a categorical variable and what was 
the reference and comparison for this variable.   
 
 
Discussion  
 
- It was concluded that the combination of metabolic syndrome and obesity posted the highest 
risk of gallstone formation. However, this is a cross -sectional study and usually only association 
can be estimated, not "risk" per se .  
 
- There should be a discussion on whether the difference in baseline characteristics among the 
four groups had any impact on the regression results  
 
- explain why association of obesity and metabolic syndrome and gallstone was different among 
young and e lder individuals  
 
Are the methods appropriate and well described?  
If not, please specify wha t is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects req uire further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interest s? 
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I u pload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/lice nses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be included as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title:  Strong As sociation between Metabolically -Abnormal Obesity and Gallstone Disease in 
Adults under 50 Years  
 
Version: 0 Date: 19 Nov 2018 
 
Reviewer:  Sikarin  Upala  
 
Reviewer’s report:  
 
The manuscript contained an i mportant research question about the role of age, obesity and 
metabolic syndrome on the risk of gallstone. However, there are limitations and areas that the 
authors need to improve the manuscript to be accepted.  
 
 
Introduction  
 
- There should be a descriptio n of how the four groups of metabolic syndrome and obesity 
profile are used clinically and in research. What evidence has shown the importance of dividing 
the two conditions in to these four categories.  
 
 
Methods  
 
- the authors should provide a detail descri ption of the sensitivity and specificity of abdominal 
sonograpthy on the detection of gallstone, who interpreted the results, and whether there is a 
verification of radiographic assessment.  
 
- provide reference on why obesity is defined as BMI >= 24 kg/m2  
 
- describe reason why the analysis needs to be separated among those age below and above 50. 
Will the results be different if the analysis was done in the whole sample?  Give reason why the 
definition of being elderly is above the age 50 and not 60 or 65?  
 
 
Results  
 
- provide both the results for univariate and multivariate regression analysis. What variables are 
used in the stepwise regression analysis.  
 
- should show whether there is difference of baseline characteristics and prevalence of four 
categories of obesity, metabolic syndrome among those age< and >=50  
 
- In table 3, the category heading should be Variables, not Valuable  
 
- please explain the variable "Four groups" in Table 3. Is this a categorical variable and what was 
the reference and comparison for this variable.   
 
 
Discussion  
 
- It was concluded that the combination of metabolic syndrome and obesity posted the highest 
risk of gallstone formation. However, this is a cross -sectional study and usually only association 
can be estimated, not "risk" per se .  
 
- There should be a discussion on whether the difference in baseline characteristics among the 
four groups had any impact on the regression results  
 
- explain why association of obesity and metabolic syndrome and gallstone was different among 
young and e lder individuals  
 
Are the methods appropriate and well described?  
If not, please specify wha t is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects req uire further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interest s? 
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I u pload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/lice nses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be included as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title:  Strong As sociation between Metabolically -Abnormal Obesity and Gallstone Disease in 
Adults under 50 Years  
 
Version: 0 Date: 19 Nov 2018 
 
Reviewer:  Sikarin  Upala  
 
Reviewer’s report:  
 
The manuscript contained an i mportant research question about the role of age, obesity and 
metabolic syndrome on the risk of gallstone. However, there are limitations and areas that the 
authors need to improve the manuscript to be accepted.  
 
 
Introduction  
 
- There should be a descriptio n of how the four groups of metabolic syndrome and obesity 
profile are used clinically and in research. What evidence has shown the importance of dividing 
the two conditions in to these four categories.  
 
 
Methods  
 
- the authors should provide a detail descri ption of the sensitivity and specificity of abdominal 
sonograpthy on the detection of gallstone, who interpreted the results, and whether there is a 
verification of radiographic assessment.  
 
- provide reference on why obesity is defined as BMI >= 24 kg/m2  
 
- describe reason why the analysis needs to be separated among those age below and above 50. 
Will the results be different if the analysis was done in the whole sample?  Give reason why the 
definition of being elderly is above the age 50 and not 60 or 65?  
 
 
Results  
 
- provide both the results for univariate and multivariate regression analysis. What variables are 
used in the stepwise regression analysis.  
 
- should show whether there is difference of baseline characteristics and prevalence of four 
categories of obesity, metabolic syndrome among those age< and >=50  
 
- In table 3, the category heading should be Variables, not Valuable  
 
- please explain the variable "Four groups" in Table 3. Is this a categorical variable and what was 
the reference and comparison for this variable.   
 
 
Discussion  
 
- It was concluded that the combination of metabolic syndrome and obesity posted the highest 
risk of gallstone formation. However, this is a cross -sectional study and usually only association 
can be estimated, not "risk" per se .  
 
- There should be a discussion on whether the difference in baseline characteristics among the 
four groups had any impact on the regression results  
 
- explain why association of obesity and metabolic syndrome and gallstone was different among 
young and e lder individuals  
 
Are the methods appropriate and well described?  
If not, please specify wha t is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects req uire further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interest s? 
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I u pload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/lice nses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be included as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant