Title: Association of Circulating Adipsin with Nonalcoholic Fatty Liver Disease in Obese
Adults: A Cross-Sectional Study
Version: 1 Date: 08 Jan 2021
Reviewer's report:
Here, the authors mainly concluded that circulating adipsin concentrations were inversely
associated with NAFLD in their study group, which may be interpreted as a protective factor for
NAFLD development. In my opinion, this is a well written study and contributes to the current
knowledge about this issue greatly. The authors can improve their work taking my suggestions
into account.
1. The authors referred to the 18. reference for further information about the study design.
However, in this reference another reference was cited for further information. In my opinion,
this confuses the reader. I recommend explaining the study design separately for this research.
2. This study was conducted with obese Chines individuals. Therefore, the results could not be
generalized to the world population. Please mention this in limitations.
3. Here, ultrasonography was chosen as diagnostic method for the diagnosis of NAFLD.
However, it is well known that hepatic steatosis defined by ultrasonography is not as accurate
as other diagnostic methods such as controlled attenuation parameter by Fibroscan, MRI-PDFF
or liver biopsy. A significant amount of patients with hepatic steatosis less than 20% may
be underdiagnosed as non-NAFLD in their study group. Please discuss and mention this in
limitation in the light of the references I recommend here (World J Gastroenterol. 2019 Mar
21; 25(11): 1307–1326.; Eur J Gastroenterol Hepatol. 2013 Nov;25(11):1330-4.; J Pediatr
Endocrinol Metab. 2020 Apr 28;33(4):473-479).
4. Could the authors also analyse the association between liver fibrosis grade and adipsin levels?
The authors did not perform liver biopsy. However, I recommend calculation of FIB-4 or NFS for
the estimation of advanced fibrosis as recommended in the major guidelines (Hepatol Int. 2020
Oct 1. doi: 10.1007/s12072-020-10094-2. Online ahead of print.; Hepatology. 2018;67:328–
357.; J Hepatol. 2016;64:1388–1402.). Those tests have been shown to be clinically useful for
ruling out advanced fibrosis owing to their negative predictive values (Gut Liver. 2020 Jul 15;
14(4): 486–491.) and can also be used the patients with normal transaminases (Hepatology
Forum 2020; 1(1): 8-13 DOI: 10.14744/hf.2020.0006). However, recently it has been shown
that those tests could not perform adequately among lean and morbidly obese individuals (Eur
J Gastroenterol Hepatol. 2020 Sep 23. doi: 10.1097/MEG.0000000000001946. Online ahead of
print.). How many patients are categorized as morbidly obese in your population? Please also
add this information. All in all, in my opinion calculating those scores for estimation of liver
fibrosis would enrich their analysis greatly. Please also discuss the use of those scores citing the
references I recommended here.
Title: Association of Circulating Adipsin with Nonalcoholic Fatty Liver Disease in Obese
Adults: A Cross-Sectional Study
Version: 1 Date: 08 Jan 2021
Reviewer's report:
Here, the authors mainly concluded that circulating adipsin concentrations were inversely
associated with NAFLD in their study group, which may be interpreted as a protective factor for
NAFLD development. In my opinion, this is a well written study and contributes to the current
knowledge about this issue greatly. The authors can improve their work taking my suggestions
into account.
1. The authors referred to the 18. reference for further information about the study design.
However, in this reference another reference was cited for further information. In my opinion,
this confuses the reader. I recommend explaining the study design separately for this research.
2. This study was conducted with obese Chines individuals. Therefore, the results could not be
generalized to the world population. Please mention this in limitations.
3. Here, ultrasonography was chosen as diagnostic method for the diagnosis of NAFLD.
However, it is well known that hepatic steatosis defined by ultrasonography is not as accurate
as other diagnostic methods such as controlled attenuation parameter by Fibroscan, MRI-PDFF
or liver biopsy. A significant amount of patients with hepatic steatosis less than 20% may
be underdiagnosed as non-NAFLD in their study group. Please discuss and mention this in
limitation in the light of the references I recommend here (World J Gastroenterol. 2019 Mar
21; 25(11): 1307–1326.; Eur J Gastroenterol Hepatol. 2013 Nov;25(11):1330-4.; J Pediatr
Endocrinol Metab. 2020 Apr 28;33(4):473-479).
4. Could the authors also analyse the association between liver fibrosis grade and adipsin levels?
The authors did not perform liver biopsy. However, I recommend calculation of FIB-4 or NFS for
the estimation of advanced fibrosis as recommended in the major guidelines (Hepatol Int. 2020
Oct 1. doi: 10.1007/s12072-020-10094-2. Online ahead of print.; Hepatology. 2018;67:328–
357.; J Hepatol. 2016;64:1388–1402.). Those tests have been shown to be clinically useful for
ruling out advanced fibrosis owing to their negative predictive values (Gut Liver. 2020 Jul 15;
14(4): 486–491.) and can also be used the patients with normal transaminases (Hepatology
Forum 2020; 1(1): 8-13 DOI: 10.14744/hf.2020.0006). However, recently it has been shown
that those tests could not perform adequately among lean and morbidly obese individuals (Eur
J Gastroenterol Hepatol. 2020 Sep 23. doi: 10.1097/MEG.0000000000001946. Online ahead of
print.). How many patients are categorized as morbidly obese in your population? Please also
add this information. All in all, in my opinion calculating those scores for estimation of liver
fibrosis would enrich their analysis greatly. Please also discuss the use of those scores citing the
references I recommended here.
Please review this paper.
user
Title: Association of Circulating Adipsin with Nonalcoholic Fatty Liver Disease in Obese
Adults: A Cross-Sectional Study
Version: 1 Date: 08 Jan 2021
Reviewer's report:
Here, the authors mainly concluded that circulating adipsin concentrations were inversely
associated with NAFLD in their study group, which may be interpreted as a protective factor for
NAFLD development. In my opinion, this is a well written study and contributes to the current
knowledge about this issue greatly. The authors can improve their work taking my suggestions
into account.
1. The authors referred to the 18. reference for further information about the study design.
However, in this reference another reference was cited for further information. In my opinion,
this confuses the reader. I recommend explaining the study design separately for this research.
2. This study was conducted with obese Chines individuals. Therefore, the results could not be
generalized to the world population. Please mention this in limitations.
3. Here, ultrasonography was chosen as diagnostic method for the diagnosis of NAFLD.
However, it is well known that hepatic steatosis defined by ultrasonography is not as accurate
as other diagnostic methods such as controlled attenuation parameter by Fibroscan, MRI-PDFF
or liver biopsy. A significant amount of patients with hepatic steatosis less than 20% may
be underdiagnosed as non-NAFLD in their study group. Please discuss and mention this in
limitation in the light of the references I recommend here (World J Gastroenterol. 2019 Mar
21; 25(11): 1307–1326.; Eur J Gastroenterol Hepatol. 2013 Nov;25(11):1330-4.; J Pediatr
Endocrinol Metab. 2020 Apr 28;33(4):473-479).
4. Could the authors also analyse the association between liver fibrosis grade and adipsin levels?
The authors did not perform liver biopsy. However, I recommend calculation of FIB-4 or NFS for
the estimation of advanced fibrosis as recommended in the major guidelines (Hepatol Int. 2020
Oct 1. doi: 10.1007/s12072-020-10094-2. Online ahead of print.; Hepatology. 2018;67:328–
357.; J Hepatol. 2016;64:1388–1402.). Those tests have been shown to be clinically useful for
ruling out advanced fibrosis owing to their negative predictive values (Gut Liver. 2020 Jul 15;
14(4): 486–491.) and can also be used the patients with normal transaminases (Hepatology
Forum 2020; 1(1): 8-13 DOI: 10.14744/hf.2020.0006). However, recently it has been shown
that those tests could not perform adequately among lean and morbidly obese individuals (Eur
J Gastroenterol Hepatol. 2020 Sep 23. doi: 10.1097/MEG.0000000000001946. Online ahead of
print.). How many patients are categorized as morbidly obese in your population? Please also
add this information. All in all, in my opinion calculating those scores for estimation of liver
fibrosis would enrich their analysis greatly. Please also discuss the use of those scores citing the
references I recommended here.
assistant