Title: Waist-to-height ratio and non-alcoholic fatty liver disease in adults
Version: 1 Date: 05 Mar 2021
Reviewer's report:
I read with interest the manuscript of Sheng et al. regarding the relationship between Waist-to-
height ratio and NAFLD on ultrasonography in 14,125 participants from a health examination
programme. In this cross-sectional study the authors found that WHtR is associated with an
increased prevalence of NAFLD.
The topic is not so novel indeed, as convincing evidence indicates that waist-to-height
ratio (WHtR) is associated with central obesity, diabetes, hypertension, metabolic syndrome
and,consequently, NAFLD. This study adds new data on this topic. I have however some
concerns:
- through the manuscript the authors used the terms “incidence”, however it is a cross-sectional
study in which the time variable is not present. Importantly, they have to use “prevalence”.
- Table 3, I have not understood the part regarding WHtR ratio (Quintile, per SD increase).
Since WHtR ratio is treated as categorical variable, what does  “per SD increase” mean in
this case? In addition, I think that there are an over adjustment in the models, as authors have
included WHtR ratio as independent variable but also height, BMI, AST, ALT, GGT. Odds
ratio as markedly higher, especially in model 1 and 2. I did not understand the reason. Are there
important collinearity in the models? Are there non-normally distribuited variables that need
to be logarithmically transformed? Since figure 1 shows a non-linear association between the
WHtR and NAFLD, I am not sure that a logistic regression model is the best way. Probably,
other regression models are more appropriate.
Title: Waist-to-height ratio and non-alcoholic fatty liver disease in adults
Version: 1 Date: 05 Mar 2021
Reviewer's report:
I read with interest the manuscript of Sheng et al. regarding the relationship between Waist-to-
height ratio and NAFLD on ultrasonography in 14,125 participants from a health examination
programme. In this cross-sectional study the authors found that WHtR is associated with an
increased prevalence of NAFLD.
The topic is not so novel indeed, as convincing evidence indicates that waist-to-height
ratio (WHtR) is associated with central obesity, diabetes, hypertension, metabolic syndrome
and,consequently, NAFLD. This study adds new data on this topic. I have however some
concerns:
- through the manuscript the authors used the terms “incidence”, however it is a cross-sectional
study in which the time variable is not present. Importantly, they have to use “prevalence”.
- Table 3, I have not understood the part regarding WHtR ratio (Quintile, per SD increase).
Since WHtR ratio is treated as categorical variable, what does  “per SD increase” mean in
this case? In addition, I think that there are an over adjustment in the models, as authors have
included WHtR ratio as independent variable but also height, BMI, AST, ALT, GGT. Odds
ratio as markedly higher, especially in model 1 and 2. I did not understand the reason. Are there
important collinearity in the models? Are there non-normally distribuited variables that need
to be logarithmically transformed? Since figure 1 shows a non-linear association between the
WHtR and NAFLD, I am not sure that a logistic regression model is the best way. Probably,
other regression models are more appropriate.
Please review this paper.
user
Title: Waist-to-height ratio and non-alcoholic fatty liver disease in adults
Version: 1 Date: 05 Mar 2021
Reviewer's report:
I read with interest the manuscript of Sheng et al. regarding the relationship between Waist-to-
height ratio and NAFLD on ultrasonography in 14,125 participants from a health examination
programme. In this cross-sectional study the authors found that WHtR is associated with an
increased prevalence of NAFLD.
The topic is not so novel indeed, as convincing evidence indicates that waist-to-height
ratio (WHtR) is associated with central obesity, diabetes, hypertension, metabolic syndrome
and,consequently, NAFLD. This study adds new data on this topic. I have however some
concerns:
- through the manuscript the authors used the terms “incidence”, however it is a cross-sectional
study in which the time variable is not present. Importantly, they have to use “prevalence”.
- Table 3, I have not understood the part regarding WHtR ratio (Quintile, per SD increase).
Since WHtR ratio is treated as categorical variable, what does  “per SD increase” mean in
this case? In addition, I think that there are an over adjustment in the models, as authors have
included WHtR ratio as independent variable but also height, BMI, AST, ALT, GGT. Odds
ratio as markedly higher, especially in model 1 and 2. I did not understand the reason. Are there
important collinearity in the models? Are there non-normally distribuited variables that need
to be logarithmically transformed? Since figure 1 shows a non-linear association between the
WHtR and NAFLD, I am not sure that a logistic regression model is the best way. Probably,
other regression models are more appropriate.
assistant