Title: Fetuin-A: A Relevant Novel Serum Biomarker for Non-Invasive Diagnosis of Metabolic
Dysfunction-Associated Steatotic Liver Disease (MASLD): A Retrospective Case-control Study
Version: 2 Date: 12 Jun 2024
Reviewer's report:
The authors  present an interesting, though not novel, manuscript regarding the role of fetuin a
as a serum biomarker for NAFLD. Please find below my remarks:
1. In introduction section the change in nomenclature from NAFLD to MASLD should be
mentioned and later on the new definiton of MASLD should replace the definition of NAFLD
and NASH
2. In introduction section, a brief paragraph regarding structure, biosynthesis and role of fetuin a
should be added (ref: doi:10.3389/fcell.2022.945287; doi:10.1016/j.clinbiochem.2020.11.004)
3. In materials and methods section 'cases' should be defined through CAP, U/S, C/T or MRI.
Liver biochemistry and transient elastography are worthless for defining MASLD patients.
Moreover the sentence 'Patients with ascites, jaundice, enlarged spleen, exhaustion, and red
palms are among those included in the study' should be substituted with a sentence saying that
patients with cirrhosis were included in the study.
4. In same section, 'minor patients below 18 Y', should be substituted with 'patients under 18
years of age'
5. Diseases within quotation marks in materials and methods section (HBV, HCV, iron overload,
hepatolenticular degeneration) should be deleted, as they are only repeating the previous
diseases, while in medications, quotation marks should be deleted and t.ex. or like should be
before these medications
6.  FIB-4, a very commonly used score, should also be calculated for all patients and correlated
with fetuin a levels (ref: doi:10.3390/life11020143; doi:10.1111/liv.14669)
7.  In table 5, the authors show univariable results? If so, multivariable analysis regarding the
role of various parameters and/or diseases should be made
8. In discussion section, NAFLD should be substituted with MASLD and diagnosis etc
substituted with those of MASLD (ref: doi:10.1016/j.aohep.2023.101133)
9. In discussion section the results of non-invasive scores on various MASLD patients whould be
added (ref: doi:10.1111/liv.14669; doi:10.2174/1570162X17666190809153245; doi:10.3389/
fnut.2024.1284509)
10. Moreover, in discussion section the authors analyze already known results, like the role of
BMI in liver steatosis. I think they should instead focus on the results regarding fetuin a and
inform the readers on studies regarding BMI, transaminases etc and fetuin a.
11. Last, but not least, the advantages of the study should be highlighted
Title: Fetuin-A: A Relevant Novel Serum Biomarker for Non-Invasive Diagnosis of Metabolic
Dysfunction-Associated Steatotic Liver Disease (MASLD): A Retrospective Case-control Study
Version: 2 Date: 12 Jun 2024
Reviewer's report:
The authors  present an interesting, though not novel, manuscript regarding the role of fetuin a
as a serum biomarker for NAFLD. Please find below my remarks:
1. In introduction section the change in nomenclature from NAFLD to MASLD should be
mentioned and later on the new definiton of MASLD should replace the definition of NAFLD
and NASH
2. In introduction section, a brief paragraph regarding structure, biosynthesis and role of fetuin a
should be added (ref: doi:10.3389/fcell.2022.945287; doi:10.1016/j.clinbiochem.2020.11.004)
3. In materials and methods section 'cases' should be defined through CAP, U/S, C/T or MRI.
Liver biochemistry and transient elastography are worthless for defining MASLD patients.
Moreover the sentence 'Patients with ascites, jaundice, enlarged spleen, exhaustion, and red
palms are among those included in the study' should be substituted with a sentence saying that
patients with cirrhosis were included in the study.
4. In same section, 'minor patients below 18 Y', should be substituted with 'patients under 18
years of age'
5. Diseases within quotation marks in materials and methods section (HBV, HCV, iron overload,
hepatolenticular degeneration) should be deleted, as they are only repeating the previous
diseases, while in medications, quotation marks should be deleted and t.ex. or like should be
before these medications
6.  FIB-4, a very commonly used score, should also be calculated for all patients and correlated
with fetuin a levels (ref: doi:10.3390/life11020143; doi:10.1111/liv.14669)
7.  In table 5, the authors show univariable results? If so, multivariable analysis regarding the
role of various parameters and/or diseases should be made
8. In discussion section, NAFLD should be substituted with MASLD and diagnosis etc
substituted with those of MASLD (ref: doi:10.1016/j.aohep.2023.101133)
9. In discussion section the results of non-invasive scores on various MASLD patients whould be
added (ref: doi:10.1111/liv.14669; doi:10.2174/1570162X17666190809153245; doi:10.3389/
fnut.2024.1284509)
10. Moreover, in discussion section the authors analyze already known results, like the role of
BMI in liver steatosis. I think they should instead focus on the results regarding fetuin a and
inform the readers on studies regarding BMI, transaminases etc and fetuin a.
11. Last, but not least, the advantages of the study should be highlighted
Please review this paper.
user
Title: Fetuin-A: A Relevant Novel Serum Biomarker for Non-Invasive Diagnosis of Metabolic
Dysfunction-Associated Steatotic Liver Disease (MASLD): A Retrospective Case-control Study
Version: 2 Date: 12 Jun 2024
Reviewer's report:
The authors  present an interesting, though not novel, manuscript regarding the role of fetuin a
as a serum biomarker for NAFLD. Please find below my remarks:
1. In introduction section the change in nomenclature from NAFLD to MASLD should be
mentioned and later on the new definiton of MASLD should replace the definition of NAFLD
and NASH
2. In introduction section, a brief paragraph regarding structure, biosynthesis and role of fetuin a
should be added (ref: doi:10.3389/fcell.2022.945287; doi:10.1016/j.clinbiochem.2020.11.004)
3. In materials and methods section 'cases' should be defined through CAP, U/S, C/T or MRI.
Liver biochemistry and transient elastography are worthless for defining MASLD patients.
Moreover the sentence 'Patients with ascites, jaundice, enlarged spleen, exhaustion, and red
palms are among those included in the study' should be substituted with a sentence saying that
patients with cirrhosis were included in the study.
4. In same section, 'minor patients below 18 Y', should be substituted with 'patients under 18
years of age'
5. Diseases within quotation marks in materials and methods section (HBV, HCV, iron overload,
hepatolenticular degeneration) should be deleted, as they are only repeating the previous
diseases, while in medications, quotation marks should be deleted and t.ex. or like should be
before these medications
6.  FIB-4, a very commonly used score, should also be calculated for all patients and correlated
with fetuin a levels (ref: doi:10.3390/life11020143; doi:10.1111/liv.14669)
7.  In table 5, the authors show univariable results? If so, multivariable analysis regarding the
role of various parameters and/or diseases should be made
8. In discussion section, NAFLD should be substituted with MASLD and diagnosis etc
substituted with those of MASLD (ref: doi:10.1016/j.aohep.2023.101133)
9. In discussion section the results of non-invasive scores on various MASLD patients whould be
added (ref: doi:10.1111/liv.14669; doi:10.2174/1570162X17666190809153245; doi:10.3389/
fnut.2024.1284509)
10. Moreover, in discussion section the authors analyze already known results, like the role of
BMI in liver steatosis. I think they should instead focus on the results regarding fetuin a and
inform the readers on studies regarding BMI, transaminases etc and fetuin a.
11. Last, but not least, the advantages of the study should be highlighted
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