Title: Metabolic Score for Visceral Fat is Correlated with All-Cause and Cardiovascular
Mortality among Individuals with Non-Alcoholic Fatty Liver Disease
Version: 0 Date: 03 Feb 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-While METS-VF is introduced and its components are explained, there could be more emphasis
on how METS-VF compares to other similar indices, like the visceral adiposity index (VAI)
and the TyG index. How does METS-VF outperform or complement these other markers in
predicting mortality outcomes in NAFLD? Providing a brief comparison could strengthen the
argument for using METS-VF in this population.
-The study mentions that METS-VF is related to visceral fat but doesn’t fully explain what
visceral fat is or why it is particularly relevant in the context of NAFLD. A bit more on the
biology of visceral fat and why its accumulation is dangerous for those with NAFLD (e.g.,
through insulin resistance, and inflammation) could enhance the reader’s understanding of the
significance of the findings.
-The exclusion criteria are well-defined, but there is no explanation for why some groups (e.g.,
pregnant women, and heavy alcohol users) were excluded. While it's understandable that these
factors could confound results, it would be beneficial to explicitly address how their inclusion
or exclusion may influence the study's generalizability.
-The exclusion of subjects with missing METS-VF or FLI data (34,913 and 78, respectively)
might seem high. A brief mention of how the excluded subjects differed from those included in
terms of baseline characteristics would be useful in assessing the risk of selection bias.
-The definitions of CVD and all-cause mortality are well-established through ICD-10 codes,
but it would be helpful to discuss any potential misclassification biases, especially when
relying on administrative coding data. For example, could there be a risk of underreporting or
misclassifying some deaths as "all-cause" rather than "CVD-related"?
-Although the authors advocate for METS-VF as a superior predictor of mortality, further
discussion of how METS-VF could be practically integrated into clinical practice would be
valuable. For example, can METS-VF be routinely measured in primary care settings or liver
clinics? How might it be incorporated alongside other diagnostic tools for assessing metabolic
risk in individuals with NAFLD?
-The non-linear correlation with an inflection point at 7.436 is intriguing but would benefit from
more clarification. The authors might consider elaborating on the significance of this threshold
and how it could be used clinically. Does this inflection point indicate a critical level of visceral
fat, beyond which the risk of mortality sharply increases?
Title: Metabolic Score for Visceral Fat is Correlated with All-Cause and Cardiovascular
Mortality among Individuals with Non-Alcoholic Fatty Liver Disease
Version: 0 Date: 03 Feb 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-While METS-VF is introduced and its components are explained, there could be more emphasis
on how METS-VF compares to other similar indices, like the visceral adiposity index (VAI)
and the TyG index. How does METS-VF outperform or complement these other markers in
predicting mortality outcomes in NAFLD? Providing a brief comparison could strengthen the
argument for using METS-VF in this population.
-The study mentions that METS-VF is related to visceral fat but doesn’t fully explain what
visceral fat is or why it is particularly relevant in the context of NAFLD. A bit more on the
biology of visceral fat and why its accumulation is dangerous for those with NAFLD (e.g.,
through insulin resistance, and inflammation) could enhance the reader’s understanding of the
significance of the findings.
-The exclusion criteria are well-defined, but there is no explanation for why some groups (e.g.,
pregnant women, and heavy alcohol users) were excluded. While it's understandable that these
factors could confound results, it would be beneficial to explicitly address how their inclusion
or exclusion may influence the study's generalizability.
-The exclusion of subjects with missing METS-VF or FLI data (34,913 and 78, respectively)
might seem high. A brief mention of how the excluded subjects differed from those included in
terms of baseline characteristics would be useful in assessing the risk of selection bias.
-The definitions of CVD and all-cause mortality are well-established through ICD-10 codes,
but it would be helpful to discuss any potential misclassification biases, especially when
relying on administrative coding data. For example, could there be a risk of underreporting or
misclassifying some deaths as "all-cause" rather than "CVD-related"?
-Although the authors advocate for METS-VF as a superior predictor of mortality, further
discussion of how METS-VF could be practically integrated into clinical practice would be
valuable. For example, can METS-VF be routinely measured in primary care settings or liver
clinics? How might it be incorporated alongside other diagnostic tools for assessing metabolic
risk in individuals with NAFLD?
-The non-linear correlation with an inflection point at 7.436 is intriguing but would benefit from
more clarification. The authors might consider elaborating on the significance of this threshold
and how it could be used clinically. Does this inflection point indicate a critical level of visceral
fat, beyond which the risk of mortality sharply increases?
Please review this paper.
user
Title: Metabolic Score for Visceral Fat is Correlated with All-Cause and Cardiovascular
Mortality among Individuals with Non-Alcoholic Fatty Liver Disease
Version: 0 Date: 03 Feb 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-While METS-VF is introduced and its components are explained, there could be more emphasis
on how METS-VF compares to other similar indices, like the visceral adiposity index (VAI)
and the TyG index. How does METS-VF outperform or complement these other markers in
predicting mortality outcomes in NAFLD? Providing a brief comparison could strengthen the
argument for using METS-VF in this population.
-The study mentions that METS-VF is related to visceral fat but doesn’t fully explain what
visceral fat is or why it is particularly relevant in the context of NAFLD. A bit more on the
biology of visceral fat and why its accumulation is dangerous for those with NAFLD (e.g.,
through insulin resistance, and inflammation) could enhance the reader’s understanding of the
significance of the findings.
-The exclusion criteria are well-defined, but there is no explanation for why some groups (e.g.,
pregnant women, and heavy alcohol users) were excluded. While it's understandable that these
factors could confound results, it would be beneficial to explicitly address how their inclusion
or exclusion may influence the study's generalizability.
-The exclusion of subjects with missing METS-VF or FLI data (34,913 and 78, respectively)
might seem high. A brief mention of how the excluded subjects differed from those included in
terms of baseline characteristics would be useful in assessing the risk of selection bias.
-The definitions of CVD and all-cause mortality are well-established through ICD-10 codes,
but it would be helpful to discuss any potential misclassification biases, especially when
relying on administrative coding data. For example, could there be a risk of underreporting or
misclassifying some deaths as "all-cause" rather than "CVD-related"?
-Although the authors advocate for METS-VF as a superior predictor of mortality, further
discussion of how METS-VF could be practically integrated into clinical practice would be
valuable. For example, can METS-VF be routinely measured in primary care settings or liver
clinics? How might it be incorporated alongside other diagnostic tools for assessing metabolic
risk in individuals with NAFLD?
-The non-linear correlation with an inflection point at 7.436 is intriguing but would benefit from
more clarification. The authors might consider elaborating on the significance of this threshold
and how it could be used clinically. Does this inflection point indicate a critical level of visceral
fat, beyond which the risk of mortality sharply increases?
assistant