Reviewer ’s report  
 
Title: Non-alcoholic fatty liver disease and its associations among adolescents in an urban, Sri 
Lankan community  
 
Version: 0 Date: 23 Jul 2017  
 
Reviewer: Giuseppina Umano  
 
Reviewer's report:  
 
This paper aims to evaluate the prevalence of NAFLD and its association in a population of Sri 
Lankan adolescents. The authors  found that NAFLD was significantly associated with short 
duration of breast feeding, obesity, increased waist circumference, and higher prevalence of 
metabolic derangement. The work approaches an interesting field of research in a low income 
country. Howe ver I have some comments:  
1. The authors use BMI adults' cut -offs for weight group categories. I suggest to use the BMI 
z-score as cut -off for weight group categories.  
2. The authors report a significant association between NAFLD and higher prevalence of  
metabolic derangement. I suggest to evaluate if the association herein mentioned is 
independent of BMI. The authors should add this analysis in the results section.  
3. The Figure 1 show the differences in body fat composition. The authors should mention t he 
technique used to assess body fat percentage in the methods section.  
4. The gold standard for NAFLD diagnosis is the Magnetic Resonance Imaging. The authors 
should mention this limitation in the text.  
5. Please see line 42 for a typing error: "prevalenc e risk ration".  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the  authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation t hat may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, e ither now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents rel ating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no compet ing interests' 
below.  If your reply is yes to any, please give details below.  
 
I have no conflict of interest to disclose  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors  and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer revie w policy of the journal  
Reviewer ’s report  
 
Title: Non-alcoholic fatty liver disease and its associations among adolescents in an urban, Sri 
Lankan community  
 
Version: 0 Date: 23 Jul 2017  
 
Reviewer: Giuseppina Umano  
 
Reviewer's report:  
 
This paper aims to evaluate the prevalence of NAFLD and its association in a population of Sri 
Lankan adolescents. The authors  found that NAFLD was significantly associated with short 
duration of breast feeding, obesity, increased waist circumference, and higher prevalence of 
metabolic derangement. The work approaches an interesting field of research in a low income 
country. Howe ver I have some comments:  
1. The authors use BMI adults' cut -offs for weight group categories. I suggest to use the BMI 
z-score as cut -off for weight group categories.  
2. The authors report a significant association between NAFLD and higher prevalence of  
metabolic derangement. I suggest to evaluate if the association herein mentioned is 
independent of BMI. The authors should add this analysis in the results section.  
3. The Figure 1 show the differences in body fat composition. The authors should mention t he 
technique used to assess body fat percentage in the methods section.  
4. The gold standard for NAFLD diagnosis is the Magnetic Resonance Imaging. The authors 
should mention this limitation in the text.  
5. Please see line 42 for a typing error: "prevalenc e risk ration".  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the  authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation t hat may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, e ither now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents rel ating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no compet ing interests' 
below.  If your reply is yes to any, please give details below.  
 
I have no conflict of interest to disclose  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors  and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer revie w policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Non-alcoholic fatty liver disease and its associations among adolescents in an urban, Sri 
Lankan community  
 
Version: 0 Date: 23 Jul 2017  
 
Reviewer: Giuseppina Umano  
 
Reviewer's report:  
 
This paper aims to evaluate the prevalence of NAFLD and its association in a population of Sri 
Lankan adolescents. The authors  found that NAFLD was significantly associated with short 
duration of breast feeding, obesity, increased waist circumference, and higher prevalence of 
metabolic derangement. The work approaches an interesting field of research in a low income 
country. Howe ver I have some comments:  
1. The authors use BMI adults' cut -offs for weight group categories. I suggest to use the BMI 
z-score as cut -off for weight group categories.  
2. The authors report a significant association between NAFLD and higher prevalence of  
metabolic derangement. I suggest to evaluate if the association herein mentioned is 
independent of BMI. The authors should add this analysis in the results section.  
3. The Figure 1 show the differences in body fat composition. The authors should mention t he 
technique used to assess body fat percentage in the methods section.  
4. The gold standard for NAFLD diagnosis is the Magnetic Resonance Imaging. The authors 
should mention this limitation in the text.  
5. Please see line 42 for a typing error: "prevalenc e risk ration".  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the  authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation t hat may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, e ither now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents rel ating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no compet ing interests' 
below.  If your reply is yes to any, please give details below.  
 
I have no conflict of interest to disclose  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors  and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer revie w policy of the journal  
assistant