Title: Association Between Non-Skimmed Milk Consumption and Metabolic Dysfunction-
Associated Fatty Liver Disease in US Adults: Insights from NHANES Data
Version: 1 Date: 09 Mar 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-As a cross-sectional study, it cannot establish causality. While associations can be identified,
the direction of the relationship between non-skimmed milk consumption and NAFLD cannot be
definitively concluded. Longitudinal studies or randomized controlled trials would be required
to determine causality.
-The study relies on self-reported dietary data, inherently subject to recall bias or misreporting.
Although NHANES uses validated questionnaires, dietary recall is still an imperfect method,
especially for estimating portion sizes and frequency of consumption. This may affect the
accuracy of milk consumption data.
-The study classifies milk products into broad categories (whole milk vs. non-skimmed milk) but
does not consider more detailed variations in milk consumption, such as different fat percentages
(e.g., 2%, 1%, or reduced-fat milk). These distinctions could be important in determining
whether the type of milk consumed plays a significant role in the development of NAFLD.
-While the study identifies an association between milk consumption and NAFLD, it does not
explore potential biological mechanisms that could explain this relationship. For example, dairy
products contain bioactive compounds that might influence liver fat accumulation, but these
mechanisms are not explored in detail.
-Although NHANES provides a representative sample of the U.S. population, the findings may
not be generalizable to other populations, particularly those outside the U.S. or those with
different dietary patterns.
-The study does not differentiate between milk products based on their quality (e.g., organic
vs. conventional milk), which could influence their impact on health outcomes. Higher-quality
products might have different effects than lower-quality ones.
-While the study adjusts for a comprehensive set of covariates, there may still be unmeasured
confounding factors influencing the relationship between milk consumption and NAFLD. For
example, genetic predispositions to NAFLD or other dietary habits (such as total caloric intake
or other nutrient-rich foods) were not included.
-The discussion acknowledges conflicting findings in existing literature, but it would be helpful
to explore these contradictions in more detail. For example, the authors could discuss the specific
reasons why studies such as the Chinese cohort study found an association between dairy
and liver cancer. In contrast, others suggest a protective effect of milk against hepatocellular
carcinoma. Delving deeper into the potential discrepancies in study design or populations would
add nuance to the discussion.
Title: Association Between Non-Skimmed Milk Consumption and Metabolic Dysfunction-
Associated Fatty Liver Disease in US Adults: Insights from NHANES Data
Version: 1 Date: 09 Mar 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-As a cross-sectional study, it cannot establish causality. While associations can be identified,
the direction of the relationship between non-skimmed milk consumption and NAFLD cannot be
definitively concluded. Longitudinal studies or randomized controlled trials would be required
to determine causality.
-The study relies on self-reported dietary data, inherently subject to recall bias or misreporting.
Although NHANES uses validated questionnaires, dietary recall is still an imperfect method,
especially for estimating portion sizes and frequency of consumption. This may affect the
accuracy of milk consumption data.
-The study classifies milk products into broad categories (whole milk vs. non-skimmed milk) but
does not consider more detailed variations in milk consumption, such as different fat percentages
(e.g., 2%, 1%, or reduced-fat milk). These distinctions could be important in determining
whether the type of milk consumed plays a significant role in the development of NAFLD.
-While the study identifies an association between milk consumption and NAFLD, it does not
explore potential biological mechanisms that could explain this relationship. For example, dairy
products contain bioactive compounds that might influence liver fat accumulation, but these
mechanisms are not explored in detail.
-Although NHANES provides a representative sample of the U.S. population, the findings may
not be generalizable to other populations, particularly those outside the U.S. or those with
different dietary patterns.
-The study does not differentiate between milk products based on their quality (e.g., organic
vs. conventional milk), which could influence their impact on health outcomes. Higher-quality
products might have different effects than lower-quality ones.
-While the study adjusts for a comprehensive set of covariates, there may still be unmeasured
confounding factors influencing the relationship between milk consumption and NAFLD. For
example, genetic predispositions to NAFLD or other dietary habits (such as total caloric intake
or other nutrient-rich foods) were not included.
-The discussion acknowledges conflicting findings in existing literature, but it would be helpful
to explore these contradictions in more detail. For example, the authors could discuss the specific
reasons why studies such as the Chinese cohort study found an association between dairy
and liver cancer. In contrast, others suggest a protective effect of milk against hepatocellular
carcinoma. Delving deeper into the potential discrepancies in study design or populations would
add nuance to the discussion.
Please review this paper.
user
Title: Association Between Non-Skimmed Milk Consumption and Metabolic Dysfunction-
Associated Fatty Liver Disease in US Adults: Insights from NHANES Data
Version: 1 Date: 09 Mar 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-As a cross-sectional study, it cannot establish causality. While associations can be identified,
the direction of the relationship between non-skimmed milk consumption and NAFLD cannot be
definitively concluded. Longitudinal studies or randomized controlled trials would be required
to determine causality.
-The study relies on self-reported dietary data, inherently subject to recall bias or misreporting.
Although NHANES uses validated questionnaires, dietary recall is still an imperfect method,
especially for estimating portion sizes and frequency of consumption. This may affect the
accuracy of milk consumption data.
-The study classifies milk products into broad categories (whole milk vs. non-skimmed milk) but
does not consider more detailed variations in milk consumption, such as different fat percentages
(e.g., 2%, 1%, or reduced-fat milk). These distinctions could be important in determining
whether the type of milk consumed plays a significant role in the development of NAFLD.
-While the study identifies an association between milk consumption and NAFLD, it does not
explore potential biological mechanisms that could explain this relationship. For example, dairy
products contain bioactive compounds that might influence liver fat accumulation, but these
mechanisms are not explored in detail.
-Although NHANES provides a representative sample of the U.S. population, the findings may
not be generalizable to other populations, particularly those outside the U.S. or those with
different dietary patterns.
-The study does not differentiate between milk products based on their quality (e.g., organic
vs. conventional milk), which could influence their impact on health outcomes. Higher-quality
products might have different effects than lower-quality ones.
-While the study adjusts for a comprehensive set of covariates, there may still be unmeasured
confounding factors influencing the relationship between milk consumption and NAFLD. For
example, genetic predispositions to NAFLD or other dietary habits (such as total caloric intake
or other nutrient-rich foods) were not included.
-The discussion acknowledges conflicting findings in existing literature, but it would be helpful
to explore these contradictions in more detail. For example, the authors could discuss the specific
reasons why studies such as the Chinese cohort study found an association between dairy
and liver cancer. In contrast, others suggest a protective effect of milk against hepatocellular
carcinoma. Delving deeper into the potential discrepancies in study design or populations would
add nuance to the discussion.
assistant