Title: The role of Triglyceride Glucose-Waist Circumference (TyG_WC) in predicting
metabolic dysfunction-associated steatotic liver disease among individuals with hyperuricemia
Version: 2 Date: 01 Feb 2025
Reviewer:  Salam Bennouar
Reviewer's report:
Manuscript ID: 974563b4-aaae-4f87-913b-140a84b06686
Title: The role of Triglyceride Glucose-Waist Circumference (TyG_WC) in predicting
metabolic dysfunction-associated steatotic liver disease among individuals with hyperuricemia
Journal: BMC Gastroenterology
I have read attentively the manuscript. My comments are as follows:
The article is well drafted, and the statistical analyses are original and fairly robust. However,
major limitations were noted, particularly in relation to the MASLD definition, the TYG-WC
index retained as a predictor, and certain variables included in the multivariate adjustment:
details are presented below:
Major comments:
1- The study findings indicate that the OR of the TYG-WC index in predicting the risk of
MASLD was 118. Regrettably, this unusually high OR does not attest the highly predictive
capacity of this index, but rather reflects the major issue of this study, which lies in the choice
of the index. Indeed, this index represents a key component of the MASLD definition, which
explains the strong and not surprising relationship between this disease and this index. In this
study, the most recent consensus definition of MASLD was used, combining the presence of
hepatic steatosis with at least two of the metabolic syndrome components. Indeed, the TYG-
WC index formula combines three of the metabolic syndrome components (glucose, triglyceride
and waist circumference), making obvious the strong association highlighted. If it were the
association with NAFLD, defined solely by the presence of hepatic steatosis, the problem would
not arise.
Another concern relates to the choice of confounding variables, in particular diabetes, which is
strongly auto-correlated with glycaemia; a component of the TYG-WC Index, thus potentially
clouding the found results.
2- Given the close link between hyper-uricemia and impaired renal function, patients with severe
and end-stage renal failure, as well as dialysis patients, should be excluded.
3- Anti-hypertensive treatments, such as diuretics, are known to have a hyper-uricemic effect.
This treatment should be documented, and used in multiple adjustments of multivariate analyses.
Minor comments:
1- The method section should begin with the design of the study and the included population,
before presenting the studied variables.
2- Abbreviations should be detailed when first used in the text.
3- Assay methods for biochemical parameters should be cited.
4- The values defining hyperuricemia are consensual and should be indicated in the methods
section: 70mg/l for men and 60mg/l for women.
Title: The role of Triglyceride Glucose-Waist Circumference (TyG_WC) in predicting
metabolic dysfunction-associated steatotic liver disease among individuals with hyperuricemia
Version: 2 Date: 01 Feb 2025
Reviewer:  Salam Bennouar
Reviewer's report:
Manuscript ID: 974563b4-aaae-4f87-913b-140a84b06686
Title: The role of Triglyceride Glucose-Waist Circumference (TyG_WC) in predicting
metabolic dysfunction-associated steatotic liver disease among individuals with hyperuricemia
Journal: BMC Gastroenterology
I have read attentively the manuscript. My comments are as follows:
The article is well drafted, and the statistical analyses are original and fairly robust. However,
major limitations were noted, particularly in relation to the MASLD definition, the TYG-WC
index retained as a predictor, and certain variables included in the multivariate adjustment:
details are presented below:
Major comments:
1- The study findings indicate that the OR of the TYG-WC index in predicting the risk of
MASLD was 118. Regrettably, this unusually high OR does not attest the highly predictive
capacity of this index, but rather reflects the major issue of this study, which lies in the choice
of the index. Indeed, this index represents a key component of the MASLD definition, which
explains the strong and not surprising relationship between this disease and this index. In this
study, the most recent consensus definition of MASLD was used, combining the presence of
hepatic steatosis with at least two of the metabolic syndrome components. Indeed, the TYG-
WC index formula combines three of the metabolic syndrome components (glucose, triglyceride
and waist circumference), making obvious the strong association highlighted. If it were the
association with NAFLD, defined solely by the presence of hepatic steatosis, the problem would
not arise.
Another concern relates to the choice of confounding variables, in particular diabetes, which is
strongly auto-correlated with glycaemia; a component of the TYG-WC Index, thus potentially
clouding the found results.
2- Given the close link between hyper-uricemia and impaired renal function, patients with severe
and end-stage renal failure, as well as dialysis patients, should be excluded.
3- Anti-hypertensive treatments, such as diuretics, are known to have a hyper-uricemic effect.
This treatment should be documented, and used in multiple adjustments of multivariate analyses.
Minor comments:
1- The method section should begin with the design of the study and the included population,
before presenting the studied variables.
2- Abbreviations should be detailed when first used in the text.
3- Assay methods for biochemical parameters should be cited.
4- The values defining hyperuricemia are consensual and should be indicated in the methods
section: 70mg/l for men and 60mg/l for women.
Please review this paper.
user
Title: The role of Triglyceride Glucose-Waist Circumference (TyG_WC) in predicting
metabolic dysfunction-associated steatotic liver disease among individuals with hyperuricemia
Version: 2 Date: 01 Feb 2025
Reviewer:  Salam Bennouar
Reviewer's report:
Manuscript ID: 974563b4-aaae-4f87-913b-140a84b06686
Title: The role of Triglyceride Glucose-Waist Circumference (TyG_WC) in predicting
metabolic dysfunction-associated steatotic liver disease among individuals with hyperuricemia
Journal: BMC Gastroenterology
I have read attentively the manuscript. My comments are as follows:
The article is well drafted, and the statistical analyses are original and fairly robust. However,
major limitations were noted, particularly in relation to the MASLD definition, the TYG-WC
index retained as a predictor, and certain variables included in the multivariate adjustment:
details are presented below:
Major comments:
1- The study findings indicate that the OR of the TYG-WC index in predicting the risk of
MASLD was 118. Regrettably, this unusually high OR does not attest the highly predictive
capacity of this index, but rather reflects the major issue of this study, which lies in the choice
of the index. Indeed, this index represents a key component of the MASLD definition, which
explains the strong and not surprising relationship between this disease and this index. In this
study, the most recent consensus definition of MASLD was used, combining the presence of
hepatic steatosis with at least two of the metabolic syndrome components. Indeed, the TYG-
WC index formula combines three of the metabolic syndrome components (glucose, triglyceride
and waist circumference), making obvious the strong association highlighted. If it were the
association with NAFLD, defined solely by the presence of hepatic steatosis, the problem would
not arise.
Another concern relates to the choice of confounding variables, in particular diabetes, which is
strongly auto-correlated with glycaemia; a component of the TYG-WC Index, thus potentially
clouding the found results.
2- Given the close link between hyper-uricemia and impaired renal function, patients with severe
and end-stage renal failure, as well as dialysis patients, should be excluded.
3- Anti-hypertensive treatments, such as diuretics, are known to have a hyper-uricemic effect.
This treatment should be documented, and used in multiple adjustments of multivariate analyses.
Minor comments:
1- The method section should begin with the design of the study and the included population,
before presenting the studied variables.
2- Abbreviations should be detailed when first used in the text.
3- Assay methods for biochemical parameters should be cited.
4- The values defining hyperuricemia are consensual and should be indicated in the methods
section: 70mg/l for men and 60mg/l for women.
assistant