Title: The Association Between Oxidative Balance Score with Constipation and Diarrhea in US
Adults: A Cross-sectional Analysis of NHANES 2007–2010
Version: 4 Date: 26 Dec 2024
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-While oxidative stress is suggested to contribute to gastrointestinal dysfunction, the study
does not establish the temporal sequence of these events, which is crucial for drawing causal
conclusions.
-The reliance on self-reported bowel health data from the Bowel Health Questionnaire, while
standard in epidemiological studies, could introduce recall bias or misclassification. It may be
beneficial to mention how this limitation compares to other studies or clinical assessments, as
stool frequency and type can vary based on factors such as stress, diet, or medication use.
-The definitions of constipation and diarrhea based on stool frequency and type are clearly
outlined, but the threshold for defining these conditions could be better justified. For example,
why were individuals with fewer than two bowel movements per week classified as constipated,
rather than using more widely accepted criteria, such as the Rome criteria for functional
constipation?
-The authors propose that oxidative stress leads to gastrointestinal dysfunction, yet the
manuscript lacks an in-depth exploration of the biological mechanisms linking oxidative stress to
constipation and diarrhea. Adding more detailed mechanistic insights, such as how antioxidants
or pro-oxidants might specifically affect gut motility, epithelial function, or the gut microbiota,
would strengthen the paper’s contribution to understanding the pathophysiology of these
disorders.
-Although the study stratifies the analyses by sex, a more detailed discussion of the biological,
hormonal, or behavioral factors that might explain the observed differences in the OBS-
gastrointestinal health relationship would be helpful. For example, could estrogen or other sex
hormones modulate the antioxidant defense system, influencing oxidative stress and gut function
differently in men and women?
-More context around the specific cut-off values for OBS quartiles would be helpful for
replicability and understanding.
-The discussion could benefit from a deeper exploration of the biological mechanisms,
particularly regarding the interaction between oxidative stress, gut microbiota, and sex
differences.
-The subgroup analyses are insightful, but further detail on how these factors (e.g., PIR,
depression) influence the relationship between OBS and bowel health could provide more
nuanced insights.
Title: The Association Between Oxidative Balance Score with Constipation and Diarrhea in US
Adults: A Cross-sectional Analysis of NHANES 2007–2010
Version: 4 Date: 26 Dec 2024
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-While oxidative stress is suggested to contribute to gastrointestinal dysfunction, the study
does not establish the temporal sequence of these events, which is crucial for drawing causal
conclusions.
-The reliance on self-reported bowel health data from the Bowel Health Questionnaire, while
standard in epidemiological studies, could introduce recall bias or misclassification. It may be
beneficial to mention how this limitation compares to other studies or clinical assessments, as
stool frequency and type can vary based on factors such as stress, diet, or medication use.
-The definitions of constipation and diarrhea based on stool frequency and type are clearly
outlined, but the threshold for defining these conditions could be better justified. For example,
why were individuals with fewer than two bowel movements per week classified as constipated,
rather than using more widely accepted criteria, such as the Rome criteria for functional
constipation?
-The authors propose that oxidative stress leads to gastrointestinal dysfunction, yet the
manuscript lacks an in-depth exploration of the biological mechanisms linking oxidative stress to
constipation and diarrhea. Adding more detailed mechanistic insights, such as how antioxidants
or pro-oxidants might specifically affect gut motility, epithelial function, or the gut microbiota,
would strengthen the paper’s contribution to understanding the pathophysiology of these
disorders.
-Although the study stratifies the analyses by sex, a more detailed discussion of the biological,
hormonal, or behavioral factors that might explain the observed differences in the OBS-
gastrointestinal health relationship would be helpful. For example, could estrogen or other sex
hormones modulate the antioxidant defense system, influencing oxidative stress and gut function
differently in men and women?
-More context around the specific cut-off values for OBS quartiles would be helpful for
replicability and understanding.
-The discussion could benefit from a deeper exploration of the biological mechanisms,
particularly regarding the interaction between oxidative stress, gut microbiota, and sex
differences.
-The subgroup analyses are insightful, but further detail on how these factors (e.g., PIR,
depression) influence the relationship between OBS and bowel health could provide more
nuanced insights.
Please review this paper.
user
Title: The Association Between Oxidative Balance Score with Constipation and Diarrhea in US
Adults: A Cross-sectional Analysis of NHANES 2007–2010
Version: 4 Date: 26 Dec 2024
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-While oxidative stress is suggested to contribute to gastrointestinal dysfunction, the study
does not establish the temporal sequence of these events, which is crucial for drawing causal
conclusions.
-The reliance on self-reported bowel health data from the Bowel Health Questionnaire, while
standard in epidemiological studies, could introduce recall bias or misclassification. It may be
beneficial to mention how this limitation compares to other studies or clinical assessments, as
stool frequency and type can vary based on factors such as stress, diet, or medication use.
-The definitions of constipation and diarrhea based on stool frequency and type are clearly
outlined, but the threshold for defining these conditions could be better justified. For example,
why were individuals with fewer than two bowel movements per week classified as constipated,
rather than using more widely accepted criteria, such as the Rome criteria for functional
constipation?
-The authors propose that oxidative stress leads to gastrointestinal dysfunction, yet the
manuscript lacks an in-depth exploration of the biological mechanisms linking oxidative stress to
constipation and diarrhea. Adding more detailed mechanistic insights, such as how antioxidants
or pro-oxidants might specifically affect gut motility, epithelial function, or the gut microbiota,
would strengthen the paper’s contribution to understanding the pathophysiology of these
disorders.
-Although the study stratifies the analyses by sex, a more detailed discussion of the biological,
hormonal, or behavioral factors that might explain the observed differences in the OBS-
gastrointestinal health relationship would be helpful. For example, could estrogen or other sex
hormones modulate the antioxidant defense system, influencing oxidative stress and gut function
differently in men and women?
-More context around the specific cut-off values for OBS quartiles would be helpful for
replicability and understanding.
-The discussion could benefit from a deeper exploration of the biological mechanisms,
particularly regarding the interaction between oxidative stress, gut microbiota, and sex
differences.
-The subgroup analyses are insightful, but further detail on how these factors (e.g., PIR,
depression) influence the relationship between OBS and bowel health could provide more
nuanced insights.
assistant