Reviewer ’s report  
 
Title: Anthropometric, Biochemical and Clinical Assessment of Ma lnutrition among Egyptian 
Children with Chronic Liver Diseases: A Single Institutional Cross -sectional Study  
 
Version: 0 Date: 19 Feb 2019  
 
Reviewer: Alfredo Larrosa -Haro  
 
Reviewer's report:  
 
Please include all comments for the authors in this box rather than uploading your report as an 
attachment. Please only upload as attachments annotated versions of manuscripts, graphs, 
supporting materials or other aspects of your report which canno t be included in a text format.  
 
Please overwrite this text when adding your comments to the authors.  
 
-This work proposes to evaluate the nutritional status of children with CLD and make 
anthropometric associations and with some biochemical indicators; the number of cases studied 
is one of the relevant aspects. Regarding the design, an analytical cross -sectional study is 
proposed and a control group is included,which does not seem correct since the group with CLD 
seemed to correspond to its universe and the control group is selected. The evaluation of the 
nutritional status with z -score was already made against a parameter, so the use of a control 
group is debatable. The z values of the control group are on the positive side of the distrubution 
curve and in a lmost all cases when observing the SD they exceed + 2SD which makes it 
questionable if it can be considered as a nutritionally "healthy" group. Another aspect related to 
the control group are ethical aspects in particular with blood samples which would at least 
require a particular mention.  
 
-There is no justification for the evaluation of 2 biomarkers and it seems that the authors taken 
them because they had availability more than for being part of the research question.  
 
-A table of correlation of anthropom etric indices with a number of significant correlations is 
presented. It is not clear what is the reason for including this large number of anthropometric 
indicators, which makes it difficult to explain what these significant relationships mean and 
makes t his large amount of data on one hand difficult to interpret and on the other does not 
establish which of them responds to the objective raised. It is a known fact that when studying 
sample of healthy or malnourished pediatric subjects these significant cor relations are observed 
in what it has been called "anthropometric harmony".  
 
-It is known that the presence of edema associated with hypoalbuminemia - which frequently 
occurs in this type of patients - introduces an important bias in the interpretation of in dicators that 
include weight as a variable as it suebestimates deficit. The authors do not report the presence of 
edema or the albumin values; only correlation coefficients and value of p are presented. Albumin 
is a difficult marker to interpret since on t he one hand it can express liver failure in the synthesis 
of proteins and on the other hand malnutrition.  
-In summary, this is a valuable series due to the number of patients and the large amount of 
related data that, although it is proposed as an analytic al study, does not propose a hypothesis 
and stays in the descriptive field despite carrying out statistical tests of the relational level.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls ? 
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any s tatistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following qu estions:  
 
1.  Have you in the past five years received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares in an organisation t hat may in any way gain or 
lose financially from the publication of this manuscript, either now or in the 
future?  
 
3.  Do you hold or are you currently applying for any patents  relating to the content 
of the manuscript?  
 
4.  Have you received reimbursements, fees, funding, or salary from an organization 
that holds or has applied for patents relating to the content of the manuscript?  
 
5.  Do you have any other financial competing interests?  
 
6.  Do you have any non -financial competing i nterests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have  no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the op en peer review policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website along with the  authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be i ncluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Anthropometric, Biochemical and Clinical Assessment of Ma lnutrition among Egyptian 
Children with Chronic Liver Diseases: A Single Institutional Cross -sectional Study  
 
Version: 0 Date: 19 Feb 2019  
 
Reviewer: Alfredo Larrosa -Haro  
 
Reviewer's report:  
 
Please include all comments for the authors in this box rather than uploading your report as an 
attachment. Please only upload as attachments annotated versions of manuscripts, graphs, 
supporting materials or other aspects of your report which canno t be included in a text format.  
 
Please overwrite this text when adding your comments to the authors.  
 
-This work proposes to evaluate the nutritional status of children with CLD and make 
anthropometric associations and with some biochemical indicators; the number of cases studied 
is one of the relevant aspects. Regarding the design, an analytical cross -sectional study is 
proposed and a control group is included,which does not seem correct since the group with CLD 
seemed to correspond to its universe and the control group is selected. The evaluation of the 
nutritional status with z -score was already made against a parameter, so the use of a control 
group is debatable. The z values of the control group are on the positive side of the distrubution 
curve and in a lmost all cases when observing the SD they exceed + 2SD which makes it 
questionable if it can be considered as a nutritionally "healthy" group. Another aspect related to 
the control group are ethical aspects in particular with blood samples which would at least 
require a particular mention.  
 
-There is no justification for the evaluation of 2 biomarkers and it seems that the authors taken 
them because they had availability more than for being part of the research question.  
 
-A table of correlation of anthropom etric indices with a number of significant correlations is 
presented. It is not clear what is the reason for including this large number of anthropometric 
indicators, which makes it difficult to explain what these significant relationships mean and 
makes t his large amount of data on one hand difficult to interpret and on the other does not 
establish which of them responds to the objective raised. It is a known fact that when studying 
sample of healthy or malnourished pediatric subjects these significant cor relations are observed 
in what it has been called "anthropometric harmony".  
 
-It is known that the presence of edema associated with hypoalbuminemia - which frequently 
occurs in this type of patients - introduces an important bias in the interpretation of in dicators that 
include weight as a variable as it suebestimates deficit. The authors do not report the presence of 
edema or the albumin values; only correlation coefficients and value of p are presented. Albumin 
is a difficult marker to interpret since on t he one hand it can express liver failure in the synthesis 
of proteins and on the other hand malnutrition.  
-In summary, this is a valuable series due to the number of patients and the large amount of 
related data that, although it is proposed as an analytic al study, does not propose a hypothesis 
and stays in the descriptive field despite carrying out statistical tests of the relational level.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls ? 
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any s tatistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following qu estions:  
 
1.  Have you in the past five years received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares in an organisation t hat may in any way gain or 
lose financially from the publication of this manuscript, either now or in the 
future?  
 
3.  Do you hold or are you currently applying for any patents  relating to the content 
of the manuscript?  
 
4.  Have you received reimbursements, fees, funding, or salary from an organization 
that holds or has applied for patents relating to the content of the manuscript?  
 
5.  Do you have any other financial competing interests?  
 
6.  Do you have any non -financial competing i nterests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have  no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the op en peer review policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website along with the  authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be i ncluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Anthropometric, Biochemical and Clinical Assessment of Ma lnutrition among Egyptian 
Children with Chronic Liver Diseases: A Single Institutional Cross -sectional Study  
 
Version: 0 Date: 19 Feb 2019  
 
Reviewer: Alfredo Larrosa -Haro  
 
Reviewer's report:  
 
Please include all comments for the authors in this box rather than uploading your report as an 
attachment. Please only upload as attachments annotated versions of manuscripts, graphs, 
supporting materials or other aspects of your report which canno t be included in a text format.  
 
Please overwrite this text when adding your comments to the authors.  
 
-This work proposes to evaluate the nutritional status of children with CLD and make 
anthropometric associations and with some biochemical indicators; the number of cases studied 
is one of the relevant aspects. Regarding the design, an analytical cross -sectional study is 
proposed and a control group is included,which does not seem correct since the group with CLD 
seemed to correspond to its universe and the control group is selected. The evaluation of the 
nutritional status with z -score was already made against a parameter, so the use of a control 
group is debatable. The z values of the control group are on the positive side of the distrubution 
curve and in a lmost all cases when observing the SD they exceed + 2SD which makes it 
questionable if it can be considered as a nutritionally "healthy" group. Another aspect related to 
the control group are ethical aspects in particular with blood samples which would at least 
require a particular mention.  
 
-There is no justification for the evaluation of 2 biomarkers and it seems that the authors taken 
them because they had availability more than for being part of the research question.  
 
-A table of correlation of anthropom etric indices with a number of significant correlations is 
presented. It is not clear what is the reason for including this large number of anthropometric 
indicators, which makes it difficult to explain what these significant relationships mean and 
makes t his large amount of data on one hand difficult to interpret and on the other does not 
establish which of them responds to the objective raised. It is a known fact that when studying 
sample of healthy or malnourished pediatric subjects these significant cor relations are observed 
in what it has been called "anthropometric harmony".  
 
-It is known that the presence of edema associated with hypoalbuminemia - which frequently 
occurs in this type of patients - introduces an important bias in the interpretation of in dicators that 
include weight as a variable as it suebestimates deficit. The authors do not report the presence of 
edema or the albumin values; only correlation coefficients and value of p are presented. Albumin 
is a difficult marker to interpret since on t he one hand it can express liver failure in the synthesis 
of proteins and on the other hand malnutrition.  
-In summary, this is a valuable series due to the number of patients and the large amount of 
related data that, although it is proposed as an analytic al study, does not propose a hypothesis 
and stays in the descriptive field despite carrying out statistical tests of the relational level.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls ? 
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any s tatistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following qu estions:  
 
1.  Have you in the past five years received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares in an organisation t hat may in any way gain or 
lose financially from the publication of this manuscript, either now or in the 
future?  
 
3.  Do you hold or are you currently applying for any patents  relating to the content 
of the manuscript?  
 
4.  Have you received reimbursements, fees, funding, or salary from an organization 
that holds or has applied for patents relating to the content of the manuscript?  
 
5.  Do you have any other financial competing interests?  
 
6.  Do you have any non -financial competing i nterests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have  no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the op en peer review policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website along with the  authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be i ncluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant