Title: Correlation between nonalcoholic fatty liver disease and left ventricular diastolic
dysfunction in non-obese adults: a cross-sectional study
Version: 4 Date: 16 Nov 2022
Reviewer's report:
1. Authors of the revised manuscript of Cong et al. “Correlation between nonalcoholic fatty liver
disease and early left ventricular diastolic dysfunction in non-obese adults: a cross-sectional
study”, have tried to implement more complex approach to identify left ventricular diastolic
dysfunction (LVDD).  However, author’s attempt CANNOT be considered adequate. Authors
still use only 2 metrics (E/A ratio and E value), which is insufficient for differentiating normal
from the pseudoformal LV filling. In addition, authors mistakenly call LV diastolic function
normal when 0.850 cm/s (again, more metrics are needed). Reviewer’s opinion here is based on
American and European recommendations (e.g., mentioned in author’s ref 28 ).
2. Authors found NO DIFFERENCE in the prevalence of LVDD in non-obese NAFLD and
control groups (58% vs 54%, P=0.487). In multivariate logistic regression analysis, NAFLD was
not statistically significant factor (P=0.628, Table 7). BUT authors boldly state in the text and
in the conclusion (both abstract and discussion) that “the non-obese NAFLD group had a higher
prevalence of LV diastolic dysfunction” and “non-obese NAFLD is associated with increased
risk of LV diastolic dysfunction”. This is just not right.
3. At best, authors can discuss here only the changes in transmitral flow and its possible
worsening in NAFLD (based on E/A values and prevalence of E/A<1). Suggested conclusion
could be as follows: “Non-obese NAFLD was associated with decrease of E/A, however more
research is necessary to evaluate risk of non-obese NAFLD for LV diastolic dysfunction”. The
title should be also changed.
Title: Correlation between nonalcoholic fatty liver disease and left ventricular diastolic
dysfunction in non-obese adults: a cross-sectional study
Version: 4 Date: 16 Nov 2022
Reviewer's report:
1. Authors of the revised manuscript of Cong et al. “Correlation between nonalcoholic fatty liver
disease and early left ventricular diastolic dysfunction in non-obese adults: a cross-sectional
study”, have tried to implement more complex approach to identify left ventricular diastolic
dysfunction (LVDD).  However, author’s attempt CANNOT be considered adequate. Authors
still use only 2 metrics (E/A ratio and E value), which is insufficient for differentiating normal
from the pseudoformal LV filling. In addition, authors mistakenly call LV diastolic function
normal when 0.850 cm/s (again, more metrics are needed). Reviewer’s opinion here is based on
American and European recommendations (e.g., mentioned in author’s ref 28 ).
2. Authors found NO DIFFERENCE in the prevalence of LVDD in non-obese NAFLD and
control groups (58% vs 54%, P=0.487). In multivariate logistic regression analysis, NAFLD was
not statistically significant factor (P=0.628, Table 7). BUT authors boldly state in the text and
in the conclusion (both abstract and discussion) that “the non-obese NAFLD group had a higher
prevalence of LV diastolic dysfunction” and “non-obese NAFLD is associated with increased
risk of LV diastolic dysfunction”. This is just not right.
3. At best, authors can discuss here only the changes in transmitral flow and its possible
worsening in NAFLD (based on E/A values and prevalence of E/A<1). Suggested conclusion
could be as follows: “Non-obese NAFLD was associated with decrease of E/A, however more
research is necessary to evaluate risk of non-obese NAFLD for LV diastolic dysfunction”. The
title should be also changed.
Please review this paper.
user
Title: Correlation between nonalcoholic fatty liver disease and left ventricular diastolic
dysfunction in non-obese adults: a cross-sectional study
Version: 4 Date: 16 Nov 2022
Reviewer's report:
1. Authors of the revised manuscript of Cong et al. “Correlation between nonalcoholic fatty liver
disease and early left ventricular diastolic dysfunction in non-obese adults: a cross-sectional
study”, have tried to implement more complex approach to identify left ventricular diastolic
dysfunction (LVDD).  However, author’s attempt CANNOT be considered adequate. Authors
still use only 2 metrics (E/A ratio and E value), which is insufficient for differentiating normal
from the pseudoformal LV filling. In addition, authors mistakenly call LV diastolic function
normal when 0.850 cm/s (again, more metrics are needed). Reviewer’s opinion here is based on
American and European recommendations (e.g., mentioned in author’s ref 28 ).
2. Authors found NO DIFFERENCE in the prevalence of LVDD in non-obese NAFLD and
control groups (58% vs 54%, P=0.487). In multivariate logistic regression analysis, NAFLD was
not statistically significant factor (P=0.628, Table 7). BUT authors boldly state in the text and
in the conclusion (both abstract and discussion) that “the non-obese NAFLD group had a higher
prevalence of LV diastolic dysfunction” and “non-obese NAFLD is associated with increased
risk of LV diastolic dysfunction”. This is just not right.
3. At best, authors can discuss here only the changes in transmitral flow and its possible
worsening in NAFLD (based on E/A values and prevalence of E/A<1). Suggested conclusion
could be as follows: “Non-obese NAFLD was associated with decrease of E/A, however more
research is necessary to evaluate risk of non-obese NAFLD for LV diastolic dysfunction”. The
title should be also changed.
assistant