Title: Liver cancer risk  and changes in lifestyle habits after successful hepatitis C virus therapy
                                                                               Post-DAA HCV therapy: lifestyle
changes and liver cancer risk
Version: 3 Date: 23 Nov 2024
Reviewer's report:
The authors present the results of a prospective study in patients with advanced liver disease
having achieved SVR in HCV infection analysing a change in life style habits after cure.
They included 182 patients and followed them until development of liver cirrhosis, death or loss
to follow-up with ultrasound, laboratory work-up, anthropometric measurements, and lifestyle
habit questionnaires. At 48 months, where were statistically significant increases in BMI and
alcohol consumption.
The study addresses a relevant clinical question and is well designed. Statistical methods are
appropriate and applied correctly. Discussed literature is relevant and up-to-date. The authors
also correctly discuss limitations of the study.
Major remarks:
In the abstract the authors state to follow-up until development of LC, death or loss to follow-
up, in the methods part of the paper it is until 4th year of follow-up, HCC occurrence or death.
The ethics section even mentions data collection until completion of 10 years after SVR. Could
you please specify the length of follow-up and correct the abstract consistently?
The authors give data on development of hepatic steatosis. How was that assessed? Ultrasound
or CAP measurement? The method section reports ultrasound for HCC surveillance but does
not mention fat assessment.
The AUDIT-test is designed to assess risk of alcohol addiction as well. Could you also report
on the points achieved in that screening test?
In the methods section the authors point to additional file 1 after introducing the methods to
assess alcohol consumption, but file 1 gives information on definition of obesity and hip-waist-
ratio.
Additional File 2 (survey questions) is not related to in the main file. Which document contains
S3 table mentioned in figure legend 3?
In figure 3 below the x-axis is “enol consumption” – probably alcohol consumption?
The audit questionnaire categorizes alcohol consumption to never, once per month, 2-4 times
per month, 2-3 times per week and almost daily. How were these categories accumulated in the
analysis?
The audit questionnaire also asks for the amount of alcohol consumed. Can you give data on the
amount of alcohol that patients consume in g/week or month?
Title: Liver cancer risk  and changes in lifestyle habits after successful hepatitis C virus therapy
                                                                               Post-DAA HCV therapy: lifestyle
changes and liver cancer risk
Version: 3 Date: 23 Nov 2024
Reviewer's report:
The authors present the results of a prospective study in patients with advanced liver disease
having achieved SVR in HCV infection analysing a change in life style habits after cure.
They included 182 patients and followed them until development of liver cirrhosis, death or loss
to follow-up with ultrasound, laboratory work-up, anthropometric measurements, and lifestyle
habit questionnaires. At 48 months, where were statistically significant increases in BMI and
alcohol consumption.
The study addresses a relevant clinical question and is well designed. Statistical methods are
appropriate and applied correctly. Discussed literature is relevant and up-to-date. The authors
also correctly discuss limitations of the study.
Major remarks:
In the abstract the authors state to follow-up until development of LC, death or loss to follow-
up, in the methods part of the paper it is until 4th year of follow-up, HCC occurrence or death.
The ethics section even mentions data collection until completion of 10 years after SVR. Could
you please specify the length of follow-up and correct the abstract consistently?
The authors give data on development of hepatic steatosis. How was that assessed? Ultrasound
or CAP measurement? The method section reports ultrasound for HCC surveillance but does
not mention fat assessment.
The AUDIT-test is designed to assess risk of alcohol addiction as well. Could you also report
on the points achieved in that screening test?
In the methods section the authors point to additional file 1 after introducing the methods to
assess alcohol consumption, but file 1 gives information on definition of obesity and hip-waist-
ratio.
Additional File 2 (survey questions) is not related to in the main file. Which document contains
S3 table mentioned in figure legend 3?
In figure 3 below the x-axis is “enol consumption” – probably alcohol consumption?
The audit questionnaire categorizes alcohol consumption to never, once per month, 2-4 times
per month, 2-3 times per week and almost daily. How were these categories accumulated in the
analysis?
The audit questionnaire also asks for the amount of alcohol consumed. Can you give data on the
amount of alcohol that patients consume in g/week or month?
Please review this paper.
user
Title: Liver cancer risk  and changes in lifestyle habits after successful hepatitis C virus therapy
                                                                               Post-DAA HCV therapy: lifestyle
changes and liver cancer risk
Version: 3 Date: 23 Nov 2024
Reviewer's report:
The authors present the results of a prospective study in patients with advanced liver disease
having achieved SVR in HCV infection analysing a change in life style habits after cure.
They included 182 patients and followed them until development of liver cirrhosis, death or loss
to follow-up with ultrasound, laboratory work-up, anthropometric measurements, and lifestyle
habit questionnaires. At 48 months, where were statistically significant increases in BMI and
alcohol consumption.
The study addresses a relevant clinical question and is well designed. Statistical methods are
appropriate and applied correctly. Discussed literature is relevant and up-to-date. The authors
also correctly discuss limitations of the study.
Major remarks:
In the abstract the authors state to follow-up until development of LC, death or loss to follow-
up, in the methods part of the paper it is until 4th year of follow-up, HCC occurrence or death.
The ethics section even mentions data collection until completion of 10 years after SVR. Could
you please specify the length of follow-up and correct the abstract consistently?
The authors give data on development of hepatic steatosis. How was that assessed? Ultrasound
or CAP measurement? The method section reports ultrasound for HCC surveillance but does
not mention fat assessment.
The AUDIT-test is designed to assess risk of alcohol addiction as well. Could you also report
on the points achieved in that screening test?
In the methods section the authors point to additional file 1 after introducing the methods to
assess alcohol consumption, but file 1 gives information on definition of obesity and hip-waist-
ratio.
Additional File 2 (survey questions) is not related to in the main file. Which document contains
S3 table mentioned in figure legend 3?
In figure 3 below the x-axis is “enol consumption” – probably alcohol consumption?
The audit questionnaire categorizes alcohol consumption to never, once per month, 2-4 times
per month, 2-3 times per week and almost daily. How were these categories accumulated in the
analysis?
The audit questionnaire also asks for the amount of alcohol consumed. Can you give data on the
amount of alcohol that patients consume in g/week or month?
assistant