Title: Visceral adiposity index as a predictor of metabolic dysfunction–associated steatotic liver
disease: a cross-sectional study
Version: 0 Date: 01 Apr 2025
Reviewer's report:
In the present manuscript the Authors evaluate the use of VAI to predict the MASLD onset in
a population of enrolled subject. The paper is attractive for its clinical applications, but showed
several criticisms:
1. While the study includes multivariate adjustments, it remains unclear whether all relevant
confounding factors (e.g., dietary intake, physical activity, genetic predispositions) were
adequately accounted for.
2. The study reports a strong association between VAI and MASLD but does not establish
causality, given the cross-sectional nature of the study.
3. The developed nomogram includes VAI alongside other predictors, but its clinical
applicability is questionable.  Indeed, the model's discriminatory power (AUC = 0.713) is only
moderate, which limits its utility for individualized risk prediction.
4. The study cohort’s demographics and baseline characteristics are not described in enough
detail to assess external validity.  It is unclear whether findings can be generalized across
different populations, particularly given potential ethnic and geographical variations in
metabolic risk factors.
Title: Visceral adiposity index as a predictor of metabolic dysfunction–associated steatotic liver
disease: a cross-sectional study
Version: 0 Date: 01 Apr 2025
Reviewer's report:
In the present manuscript the Authors evaluate the use of VAI to predict the MASLD onset in
a population of enrolled subject. The paper is attractive for its clinical applications, but showed
several criticisms:
1. While the study includes multivariate adjustments, it remains unclear whether all relevant
confounding factors (e.g., dietary intake, physical activity, genetic predispositions) were
adequately accounted for.
2. The study reports a strong association between VAI and MASLD but does not establish
causality, given the cross-sectional nature of the study.
3. The developed nomogram includes VAI alongside other predictors, but its clinical
applicability is questionable.  Indeed, the model's discriminatory power (AUC = 0.713) is only
moderate, which limits its utility for individualized risk prediction.
4. The study cohort’s demographics and baseline characteristics are not described in enough
detail to assess external validity.  It is unclear whether findings can be generalized across
different populations, particularly given potential ethnic and geographical variations in
metabolic risk factors.
Please review this paper.
user
Title: Visceral adiposity index as a predictor of metabolic dysfunction–associated steatotic liver
disease: a cross-sectional study
Version: 0 Date: 01 Apr 2025
Reviewer's report:
In the present manuscript the Authors evaluate the use of VAI to predict the MASLD onset in
a population of enrolled subject. The paper is attractive for its clinical applications, but showed
several criticisms:
1. While the study includes multivariate adjustments, it remains unclear whether all relevant
confounding factors (e.g., dietary intake, physical activity, genetic predispositions) were
adequately accounted for.
2. The study reports a strong association between VAI and MASLD but does not establish
causality, given the cross-sectional nature of the study.
3. The developed nomogram includes VAI alongside other predictors, but its clinical
applicability is questionable.  Indeed, the model's discriminatory power (AUC = 0.713) is only
moderate, which limits its utility for individualized risk prediction.
4. The study cohort’s demographics and baseline characteristics are not described in enough
detail to assess external validity.  It is unclear whether findings can be generalized across
different populations, particularly given potential ethnic and geographical variations in
metabolic risk factors.
assistant