Title: Frequency of Insulin Resistance among Non-Diabetic Patients with Non-Alcoholic Fatty
Liver Disease Using HOMA-IR: An Experience of a Tertiary Care Hospital in Karachi, Pakistan
Version: 3 Date: 21 Jan 2025
Reviewer's report:
Positive notes:
Relevance: The study addresses a critical topic—insulin resistance in non-diabetic NAFLD
patients—a relevant issue considering the global prevalence of NAFLD and its link to metabolic
syndrome.
Design and Sample Size: A prospective cross-sectional study with a sample size of 362
participants is appropriate to provide meaningful data.
Comprehensive Analysis: The study uses robust diagnostic criteria such as HOMA-IR, CAP
scores, and metabolic syndrome definitions, which are well-recognized in clinical research.
Findings: The study identifies a high prevalence of insulin resistance and highlights significant
differences in biochemical markers, which are useful for clinical understanding.
Improvement areas & Suggestions:
1. The objective could be more detailed, specifying how identifying associated factors
contributes to clinical or research advancements. Example: Include why focusing on non-
diabetic NAFLD patients is crucial compared to diabetic populations.
2. Clarify whether patients with prediabetes (elevated fasting glucose or impaired glucose
tolerance) were included, as they might influence insulin resistance outcomes.
3. While SPSS was used, there is no mention of statistical tests applied (e.g., chi-square, t-tests,
regression analysis). Include details on the statistical methods and their justification.
4. The discussion could delve deeper into potential mechanisms linking IR with NAFLD and
metabolic syndrome.
5. Examine the longitudinal impact of IR on NAFLD progression in non-diabetic populations.
6. Explore potential interventions (e.g., lifestyle modifications, pharmacotherapy) tailored to
individuals with NAFLD and IR in local contexts.
Title: Frequency of Insulin Resistance among Non-Diabetic Patients with Non-Alcoholic Fatty
Liver Disease Using HOMA-IR: An Experience of a Tertiary Care Hospital in Karachi, Pakistan
Version: 3 Date: 21 Jan 2025
Reviewer's report:
Positive notes:
Relevance: The study addresses a critical topic—insulin resistance in non-diabetic NAFLD
patients—a relevant issue considering the global prevalence of NAFLD and its link to metabolic
syndrome.
Design and Sample Size: A prospective cross-sectional study with a sample size of 362
participants is appropriate to provide meaningful data.
Comprehensive Analysis: The study uses robust diagnostic criteria such as HOMA-IR, CAP
scores, and metabolic syndrome definitions, which are well-recognized in clinical research.
Findings: The study identifies a high prevalence of insulin resistance and highlights significant
differences in biochemical markers, which are useful for clinical understanding.
Improvement areas & Suggestions:
1. The objective could be more detailed, specifying how identifying associated factors
contributes to clinical or research advancements. Example: Include why focusing on non-
diabetic NAFLD patients is crucial compared to diabetic populations.
2. Clarify whether patients with prediabetes (elevated fasting glucose or impaired glucose
tolerance) were included, as they might influence insulin resistance outcomes.
3. While SPSS was used, there is no mention of statistical tests applied (e.g., chi-square, t-tests,
regression analysis). Include details on the statistical methods and their justification.
4. The discussion could delve deeper into potential mechanisms linking IR with NAFLD and
metabolic syndrome.
5. Examine the longitudinal impact of IR on NAFLD progression in non-diabetic populations.
6. Explore potential interventions (e.g., lifestyle modifications, pharmacotherapy) tailored to
individuals with NAFLD and IR in local contexts.
Please review this paper.
user
Title: Frequency of Insulin Resistance among Non-Diabetic Patients with Non-Alcoholic Fatty
Liver Disease Using HOMA-IR: An Experience of a Tertiary Care Hospital in Karachi, Pakistan
Version: 3 Date: 21 Jan 2025
Reviewer's report:
Positive notes:
Relevance: The study addresses a critical topic—insulin resistance in non-diabetic NAFLD
patients—a relevant issue considering the global prevalence of NAFLD and its link to metabolic
syndrome.
Design and Sample Size: A prospective cross-sectional study with a sample size of 362
participants is appropriate to provide meaningful data.
Comprehensive Analysis: The study uses robust diagnostic criteria such as HOMA-IR, CAP
scores, and metabolic syndrome definitions, which are well-recognized in clinical research.
Findings: The study identifies a high prevalence of insulin resistance and highlights significant
differences in biochemical markers, which are useful for clinical understanding.
Improvement areas & Suggestions:
1. The objective could be more detailed, specifying how identifying associated factors
contributes to clinical or research advancements. Example: Include why focusing on non-
diabetic NAFLD patients is crucial compared to diabetic populations.
2. Clarify whether patients with prediabetes (elevated fasting glucose or impaired glucose
tolerance) were included, as they might influence insulin resistance outcomes.
3. While SPSS was used, there is no mention of statistical tests applied (e.g., chi-square, t-tests,
regression analysis). Include details on the statistical methods and their justification.
4. The discussion could delve deeper into potential mechanisms linking IR with NAFLD and
metabolic syndrome.
5. Examine the longitudinal impact of IR on NAFLD progression in non-diabetic populations.
6. Explore potential interventions (e.g., lifestyle modifications, pharmacotherapy) tailored to
individuals with NAFLD and IR in local contexts.
assistant