Title: The prevalence of obesity and underweight in celiac patients at the time of diagnosis: a
systematic review and meta-analysis
Version: 2 Date: 15 Aug 2024
Reviewer:  Stephanie Moleski
Reviewer's report:
I think this is an important topic and it is good to highlight how the classic presentation of
malabsorption in newly diagnosed CD patients is changing and that many patietns will not be
underweight at diagnosis. However it is not as novel as the authors claim.
The article falsely claims that “there is no comprehensive conclusion on the pooled prevalence
of obesity and overweight in celiac patients.”  Barone’s review article published in 2023 does
in fact look at pooled prevalence of patients in different BMI categories at CD diagnosis.  So
this is not as novel data as the authors suggest.
In the first paragraph the last sentence references a recent theory including the compensation
theory.  But the reference is from 1986.  They do mention it is a theory but with such an old
reference I do not think it is appropriate to include in a review.
In the discussion section, there is a paragraph describing the prevalence of underweight CD
patients (page 11). The authors claim that CD is not common in developing countries but also
discuss the presentation of CD patients in India.  The authors should note that the incidence of
CD in India, particularly North India is rising.
Furthermore, the authors discuss (also last paragraph on page 11) that these patients have more
severe intestinal damage due to the delay in diagnosis making it more common that they are
underweight.   However, in the conclusion paragraph the authors state that a delay in diagnosis
is more common in obese individuals.  While this is true, it seems conflicting to their prior
statement.
Title: The prevalence of obesity and underweight in celiac patients at the time of diagnosis: a
systematic review and meta-analysis
Version: 2 Date: 15 Aug 2024
Reviewer:  Stephanie Moleski
Reviewer's report:
I think this is an important topic and it is good to highlight how the classic presentation of
malabsorption in newly diagnosed CD patients is changing and that many patietns will not be
underweight at diagnosis. However it is not as novel as the authors claim.
The article falsely claims that “there is no comprehensive conclusion on the pooled prevalence
of obesity and overweight in celiac patients.”  Barone’s review article published in 2023 does
in fact look at pooled prevalence of patients in different BMI categories at CD diagnosis.  So
this is not as novel data as the authors suggest.
In the first paragraph the last sentence references a recent theory including the compensation
theory.  But the reference is from 1986.  They do mention it is a theory but with such an old
reference I do not think it is appropriate to include in a review.
In the discussion section, there is a paragraph describing the prevalence of underweight CD
patients (page 11). The authors claim that CD is not common in developing countries but also
discuss the presentation of CD patients in India.  The authors should note that the incidence of
CD in India, particularly North India is rising.
Furthermore, the authors discuss (also last paragraph on page 11) that these patients have more
severe intestinal damage due to the delay in diagnosis making it more common that they are
underweight.   However, in the conclusion paragraph the authors state that a delay in diagnosis
is more common in obese individuals.  While this is true, it seems conflicting to their prior
statement.
Please review this paper.
user
Title: The prevalence of obesity and underweight in celiac patients at the time of diagnosis: a
systematic review and meta-analysis
Version: 2 Date: 15 Aug 2024
Reviewer:  Stephanie Moleski
Reviewer's report:
I think this is an important topic and it is good to highlight how the classic presentation of
malabsorption in newly diagnosed CD patients is changing and that many patietns will not be
underweight at diagnosis. However it is not as novel as the authors claim.
The article falsely claims that “there is no comprehensive conclusion on the pooled prevalence
of obesity and overweight in celiac patients.”  Barone’s review article published in 2023 does
in fact look at pooled prevalence of patients in different BMI categories at CD diagnosis.  So
this is not as novel data as the authors suggest.
In the first paragraph the last sentence references a recent theory including the compensation
theory.  But the reference is from 1986.  They do mention it is a theory but with such an old
reference I do not think it is appropriate to include in a review.
In the discussion section, there is a paragraph describing the prevalence of underweight CD
patients (page 11). The authors claim that CD is not common in developing countries but also
discuss the presentation of CD patients in India.  The authors should note that the incidence of
CD in India, particularly North India is rising.
Furthermore, the authors discuss (also last paragraph on page 11) that these patients have more
severe intestinal damage due to the delay in diagnosis making it more common that they are
underweight.   However, in the conclusion paragraph the authors state that a delay in diagnosis
is more common in obese individuals.  While this is true, it seems conflicting to their prior
statement.
assistant