Title: Triglyceride Glucose-Waist Circumference: The Optimum Index to Screen Nonalcoholic
Fatty Liver Disease in Non-obese Adults
Version: 1 Date: 10 Dec 2022
Reviewer's report:
This is the study using indirect indicators to detect NAFLD from NHANES. There are some
major limitations here:
1. The definition of NAFLD:
(1)Since the spectrum of NAFLD is from simple steatosis (NAFL), NASH to fibrosis/cirrhosis,
using CAP >=249 db/m to define NAFLD can not provide sufficient information. Alternatively,
the outcome of NAFLD by CAP >=249 db/m can not include/exclude NASH or severe fibrosis,
which is the most vital indicator for current research and clinical follow-up.
(2)CAP refers the steatosis. However, the severity of steatosis is not any of the current parameters
of clinical survey/screening/or referral to a specialist.
2. The novelty of research: There are tons of published papers regarding indirect parameters
predicting NASH or severe fibrosis. Although the results of this manuscript support TyG, TyG-
BMI, TyG-WC, and TG/HDL-c can predict CAP >=249 (NAFLD), it can not provide the new
insights into the current knowledge of NAFLD. Moreover, from the viewpoint of MAFLD, these
metabolic factors are the risk factors and are highly related to NAFLD.
3. The definition of non-obese: The definitions of obesity by BMI should be various for different
ethnicities, especially for NHANES from the US.
Based on the significant limitation of above points 1 and 2, I will suggest the authors to re-
design the study.
Title: Triglyceride Glucose-Waist Circumference: The Optimum Index to Screen Nonalcoholic
Fatty Liver Disease in Non-obese Adults
Version: 1 Date: 10 Dec 2022
Reviewer's report:
This is the study using indirect indicators to detect NAFLD from NHANES. There are some
major limitations here:
1. The definition of NAFLD:
(1)Since the spectrum of NAFLD is from simple steatosis (NAFL), NASH to fibrosis/cirrhosis,
using CAP >=249 db/m to define NAFLD can not provide sufficient information. Alternatively,
the outcome of NAFLD by CAP >=249 db/m can not include/exclude NASH or severe fibrosis,
which is the most vital indicator for current research and clinical follow-up.
(2)CAP refers the steatosis. However, the severity of steatosis is not any of the current parameters
of clinical survey/screening/or referral to a specialist.
2. The novelty of research: There are tons of published papers regarding indirect parameters
predicting NASH or severe fibrosis. Although the results of this manuscript support TyG, TyG-
BMI, TyG-WC, and TG/HDL-c can predict CAP >=249 (NAFLD), it can not provide the new
insights into the current knowledge of NAFLD. Moreover, from the viewpoint of MAFLD, these
metabolic factors are the risk factors and are highly related to NAFLD.
3. The definition of non-obese: The definitions of obesity by BMI should be various for different
ethnicities, especially for NHANES from the US.
Based on the significant limitation of above points 1 and 2, I will suggest the authors to re-
design the study.
Please review this paper.
user
Title: Triglyceride Glucose-Waist Circumference: The Optimum Index to Screen Nonalcoholic
Fatty Liver Disease in Non-obese Adults
Version: 1 Date: 10 Dec 2022
Reviewer's report:
This is the study using indirect indicators to detect NAFLD from NHANES. There are some
major limitations here:
1. The definition of NAFLD:
(1)Since the spectrum of NAFLD is from simple steatosis (NAFL), NASH to fibrosis/cirrhosis,
using CAP >=249 db/m to define NAFLD can not provide sufficient information. Alternatively,
the outcome of NAFLD by CAP >=249 db/m can not include/exclude NASH or severe fibrosis,
which is the most vital indicator for current research and clinical follow-up.
(2)CAP refers the steatosis. However, the severity of steatosis is not any of the current parameters
of clinical survey/screening/or referral to a specialist.
2. The novelty of research: There are tons of published papers regarding indirect parameters
predicting NASH or severe fibrosis. Although the results of this manuscript support TyG, TyG-
BMI, TyG-WC, and TG/HDL-c can predict CAP >=249 (NAFLD), it can not provide the new
insights into the current knowledge of NAFLD. Moreover, from the viewpoint of MAFLD, these
metabolic factors are the risk factors and are highly related to NAFLD.
3. The definition of non-obese: The definitions of obesity by BMI should be various for different
ethnicities, especially for NHANES from the US.
Based on the significant limitation of above points 1 and 2, I will suggest the authors to re-
design the study.
assistant