Title: Reduced muscle mass is an important part of Global Leadership Initiative on Malnutrition
criteria in nutritional diagnosis of hepatocellular carcinoma
Version: 2 Date: 16 Jul 2024
Reviewer's report:
The authors have addressed a contemporary topic with high relevance for patients and the health
care system. So far, there are only limited studies about GLIM malnutrition diagnosis in HCC
patients and the descriptive data of the manuscript are of interest for clinicians and researchers.
The GLIM consensus criteria are the currently available diagnostic criteria for the assessment
of malnutrition combining phenotypic and etiologic aspects. One central phenotypic criterion
is the reduction of muscle mass. One main aim of the present study was to assess the clinical
application of the GLIM criteria with and without muscle mass in HCC patients.
The reason for excluding one central criterion from malnutrition diagnosis is not clear to
me. Especially in patients suffering from severe liver disease, overhydration is a common
complication,  masking the other phenotypic criteria (reduced BMI, weight loss). Therefore,
the muscle mass which was assessed by the gold standard CT in this study, needs to be of
particularly high importance. As a consequence of excluding the criterion reduced muscle mass,
numerous malnourished patients were not recognized by this approach leading to altered results
of the comparison of malnourished and non-malnourished patients. This seems logical and is
not helpful in terms of validation of the GLIM criteria or improving the diagnostic procedure
in HCC patients. In conclusion, despite the interesting topic, the orientation and argumentation
of the paper is not convincing.
Moreover, the manuscript and the attached files are in part poorly prepared. The cited literature
is not always reflecting what was stated in the text. A response letter for Frontiers in Nutrition
was attached which I am suprised about.
Title: Reduced muscle mass is an important part of Global Leadership Initiative on Malnutrition
criteria in nutritional diagnosis of hepatocellular carcinoma
Version: 2 Date: 16 Jul 2024
Reviewer's report:
The authors have addressed a contemporary topic with high relevance for patients and the health
care system. So far, there are only limited studies about GLIM malnutrition diagnosis in HCC
patients and the descriptive data of the manuscript are of interest for clinicians and researchers.
The GLIM consensus criteria are the currently available diagnostic criteria for the assessment
of malnutrition combining phenotypic and etiologic aspects. One central phenotypic criterion
is the reduction of muscle mass. One main aim of the present study was to assess the clinical
application of the GLIM criteria with and without muscle mass in HCC patients.
The reason for excluding one central criterion from malnutrition diagnosis is not clear to
me. Especially in patients suffering from severe liver disease, overhydration is a common
complication,  masking the other phenotypic criteria (reduced BMI, weight loss). Therefore,
the muscle mass which was assessed by the gold standard CT in this study, needs to be of
particularly high importance. As a consequence of excluding the criterion reduced muscle mass,
numerous malnourished patients were not recognized by this approach leading to altered results
of the comparison of malnourished and non-malnourished patients. This seems logical and is
not helpful in terms of validation of the GLIM criteria or improving the diagnostic procedure
in HCC patients. In conclusion, despite the interesting topic, the orientation and argumentation
of the paper is not convincing.
Moreover, the manuscript and the attached files are in part poorly prepared. The cited literature
is not always reflecting what was stated in the text. A response letter for Frontiers in Nutrition
was attached which I am suprised about.
Please review this paper.
user
Title: Reduced muscle mass is an important part of Global Leadership Initiative on Malnutrition
criteria in nutritional diagnosis of hepatocellular carcinoma
Version: 2 Date: 16 Jul 2024
Reviewer's report:
The authors have addressed a contemporary topic with high relevance for patients and the health
care system. So far, there are only limited studies about GLIM malnutrition diagnosis in HCC
patients and the descriptive data of the manuscript are of interest for clinicians and researchers.
The GLIM consensus criteria are the currently available diagnostic criteria for the assessment
of malnutrition combining phenotypic and etiologic aspects. One central phenotypic criterion
is the reduction of muscle mass. One main aim of the present study was to assess the clinical
application of the GLIM criteria with and without muscle mass in HCC patients.
The reason for excluding one central criterion from malnutrition diagnosis is not clear to
me. Especially in patients suffering from severe liver disease, overhydration is a common
complication,  masking the other phenotypic criteria (reduced BMI, weight loss). Therefore,
the muscle mass which was assessed by the gold standard CT in this study, needs to be of
particularly high importance. As a consequence of excluding the criterion reduced muscle mass,
numerous malnourished patients were not recognized by this approach leading to altered results
of the comparison of malnourished and non-malnourished patients. This seems logical and is
not helpful in terms of validation of the GLIM criteria or improving the diagnostic procedure
in HCC patients. In conclusion, despite the interesting topic, the orientation and argumentation
of the paper is not convincing.
Moreover, the manuscript and the attached files are in part poorly prepared. The cited literature
is not always reflecting what was stated in the text. A response letter for Frontiers in Nutrition
was attached which I am suprised about.
assistant