Reviewer's report 
 Diagnostic Value of Biochemical Markers (FibroTest-FibroSURE) for the prediction of Liver Title: 
Fibrosis in patients with Non-Alcoholic Fatty Liver Disease 
 1  20 December 2005 Version: Date: 
 Hiroshi Sakugawa Reviewer: 
Reviewer's report: 
General 
This study written by Ratziu et al. is well designed, and has a sufficient sample size to draw conclusion. ------------------------------------------------------------------------------- 
Major Compulsory Revisions (that the author must respond to before a decision on publication can 
be reached) 
There are no Major Compulsory Revisions. ------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the 
author can be trusted to correct)Major Compulsory Revisions 
1. Among patients with NAFLD, discrimination between fatty liver alone and NASH is very important, 
because the former is non-progressive liver disease and the later is progressive liver disease. 
Information about NASH patients should be described: How many patients were diagnosed as 
NASH or fatty liver alone. The distribution of fibrosis stages in patients with NASH and those with 
fatty liver alone. 
2. The histological diagnosis of NAFLD should be defined: What was the extent of fatty change 
defined as diagnostic. 
3. There are differences in the amount of alcohol consumption described between in Page 7, in Page 12 and Page 17. The definition of non-alcoholic should be unified. 
4. (Line 2 on Page 3) non-alcoholic fatty liver Disease ? non-alcoholic fatty liver disease 
5. (Line 19 on Page 3) with Non-Alcoholic Fatty Liver Disease ? NAFLD or non-alcoholic fatty liver 
disease 6. (in Page 4) alpha-macroglobulin ? alpha2-macroglobulin, Non-Alcoholic Fatty Liver Disease ? 
non-alcoholic fatty liver disease 
7. (Line 2 on Page 6) with fibrosis in patients ? with advanced (or severe) fibrosis in patients 8. (Line 9 on Page 6) a2-microglobulin ? a2-microglobulin (A2M) (You used this abbreviation in the latter part of the manuscript.) 
9. (Line 8 on Page 7) central-obesity (body mass index of 27 or higher or ), body mass index of 27 or 
higher should be deleted because the index is not always associated with central-obesity. 
10. (Line 15 on Page 7) , alpha antitrypsine ? alpha1-antitrypsin 11. (Line 7 on Page 8) alpha antitrypsine ? alpha1-antitrypsin 
12. (Line 6 on Page 9) the abbreviation of NAS should be defined. 
13. (Line 2 on Page 13) was 0.085 (0.082-0.090) ? 0.085 (95% CI: 0.082-0.090) 14. (Line 4 on Page 9) a panel combining combining ? a panel combining 15. (Line 23 on Page 19) (3 cases out of 170 1.8%) ? (3 cases out of 170, 1.8%) 
16. (Line 16 on Page 21) FT is value is 0.70 ? FT value is 0.70 
17. (on Page 25, footnotes) in thi model ? in this model 18. (on Page 26, Table 3) Group 1 should be deleted. 19. (on Page 27, footnotes) No alcohol consumption is not correct. (<30g for men or <20g for 
women) 
20. (Line 6 on Page 29) the area under the ROC curves AUROCs the area under the ROC curves 
(AUROCs) 
21. (on Page 29, Figure 2) Spearman coefficient of correlation between the degree of fibrosis and 
FT value should be described in Figure 2 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
1. There are many abbreviation in the manuscript. ALD is not common abbreviation and I recommended not to be used. 2. (Line 12 on Page 17) by other community-based studies from France. Please cite these reports. 
 Accept after minor essential revisions What next?: 
 An article of importance in its field Level of interest: 
 Needs some language corrections before being published Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
I declare that I have no competing interensts. 
Reviewer's report 
 Diagnostic Value of Biochemical Markers (FibroTest-FibroSURE) for the prediction of Liver Title: 
Fibrosis in patients with Non-Alcoholic Fatty Liver Disease 
 1  20 December 2005 Version: Date: 
 Hiroshi Sakugawa Reviewer: 
Reviewer's report: 
General 
This study written by Ratziu et al. is well designed, and has a sufficient sample size to draw conclusion. ------------------------------------------------------------------------------- 
Major Compulsory Revisions (that the author must respond to before a decision on publication can 
be reached) 
There are no Major Compulsory Revisions. ------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the 
author can be trusted to correct)Major Compulsory Revisions 
1. Among patients with NAFLD, discrimination between fatty liver alone and NASH is very important, 
because the former is non-progressive liver disease and the later is progressive liver disease. 
Information about NASH patients should be described: How many patients were diagnosed as 
NASH or fatty liver alone. The distribution of fibrosis stages in patients with NASH and those with 
fatty liver alone. 
2. The histological diagnosis of NAFLD should be defined: What was the extent of fatty change 
defined as diagnostic. 
3. There are differences in the amount of alcohol consumption described between in Page 7, in Page 12 and Page 17. The definition of non-alcoholic should be unified. 
4. (Line 2 on Page 3) non-alcoholic fatty liver Disease ? non-alcoholic fatty liver disease 
5. (Line 19 on Page 3) with Non-Alcoholic Fatty Liver Disease ? NAFLD or non-alcoholic fatty liver 
disease 6. (in Page 4) alpha-macroglobulin ? alpha2-macroglobulin, Non-Alcoholic Fatty Liver Disease ? 
non-alcoholic fatty liver disease 
7. (Line 2 on Page 6) with fibrosis in patients ? with advanced (or severe) fibrosis in patients 8. (Line 9 on Page 6) a2-microglobulin ? a2-microglobulin (A2M) (You used this abbreviation in the latter part of the manuscript.) 
9. (Line 8 on Page 7) central-obesity (body mass index of 27 or higher or ), body mass index of 27 or 
higher should be deleted because the index is not always associated with central-obesity. 
10. (Line 15 on Page 7) , alpha antitrypsine ? alpha1-antitrypsin 11. (Line 7 on Page 8) alpha antitrypsine ? alpha1-antitrypsin 
12. (Line 6 on Page 9) the abbreviation of NAS should be defined. 
13. (Line 2 on Page 13) was 0.085 (0.082-0.090) ? 0.085 (95% CI: 0.082-0.090) 14. (Line 4 on Page 9) a panel combining combining ? a panel combining 15. (Line 23 on Page 19) (3 cases out of 170 1.8%) ? (3 cases out of 170, 1.8%) 
16. (Line 16 on Page 21) FT is value is 0.70 ? FT value is 0.70 
17. (on Page 25, footnotes) in thi model ? in this model 18. (on Page 26, Table 3) Group 1 should be deleted. 19. (on Page 27, footnotes) No alcohol consumption is not correct. (<30g for men or <20g for 
women) 
20. (Line 6 on Page 29) the area under the ROC curves AUROCs the area under the ROC curves 
(AUROCs) 
21. (on Page 29, Figure 2) Spearman coefficient of correlation between the degree of fibrosis and 
FT value should be described in Figure 2 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
1. There are many abbreviation in the manuscript. ALD is not common abbreviation and I recommended not to be used. 2. (Line 12 on Page 17) by other community-based studies from France. Please cite these reports. 
 Accept after minor essential revisions What next?: 
 An article of importance in its field Level of interest: 
 Needs some language corrections before being published Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
I declare that I have no competing interensts. 
Please review this paper.
user
Reviewer's report 
 Diagnostic Value of Biochemical Markers (FibroTest-FibroSURE) for the prediction of Liver Title: 
Fibrosis in patients with Non-Alcoholic Fatty Liver Disease 
 1  20 December 2005 Version: Date: 
 Hiroshi Sakugawa Reviewer: 
Reviewer's report: 
General 
This study written by Ratziu et al. is well designed, and has a sufficient sample size to draw conclusion. ------------------------------------------------------------------------------- 
Major Compulsory Revisions (that the author must respond to before a decision on publication can 
be reached) 
There are no Major Compulsory Revisions. ------------------------------------------------------------------------------- 
Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the 
author can be trusted to correct)Major Compulsory Revisions 
1. Among patients with NAFLD, discrimination between fatty liver alone and NASH is very important, 
because the former is non-progressive liver disease and the later is progressive liver disease. 
Information about NASH patients should be described: How many patients were diagnosed as 
NASH or fatty liver alone. The distribution of fibrosis stages in patients with NASH and those with 
fatty liver alone. 
2. The histological diagnosis of NAFLD should be defined: What was the extent of fatty change 
defined as diagnostic. 
3. There are differences in the amount of alcohol consumption described between in Page 7, in Page 12 and Page 17. The definition of non-alcoholic should be unified. 
4. (Line 2 on Page 3) non-alcoholic fatty liver Disease ? non-alcoholic fatty liver disease 
5. (Line 19 on Page 3) with Non-Alcoholic Fatty Liver Disease ? NAFLD or non-alcoholic fatty liver 
disease 6. (in Page 4) alpha-macroglobulin ? alpha2-macroglobulin, Non-Alcoholic Fatty Liver Disease ? 
non-alcoholic fatty liver disease 
7. (Line 2 on Page 6) with fibrosis in patients ? with advanced (or severe) fibrosis in patients 8. (Line 9 on Page 6) a2-microglobulin ? a2-microglobulin (A2M) (You used this abbreviation in the latter part of the manuscript.) 
9. (Line 8 on Page 7) central-obesity (body mass index of 27 or higher or ), body mass index of 27 or 
higher should be deleted because the index is not always associated with central-obesity. 
10. (Line 15 on Page 7) , alpha antitrypsine ? alpha1-antitrypsin 11. (Line 7 on Page 8) alpha antitrypsine ? alpha1-antitrypsin 
12. (Line 6 on Page 9) the abbreviation of NAS should be defined. 
13. (Line 2 on Page 13) was 0.085 (0.082-0.090) ? 0.085 (95% CI: 0.082-0.090) 14. (Line 4 on Page 9) a panel combining combining ? a panel combining 15. (Line 23 on Page 19) (3 cases out of 170 1.8%) ? (3 cases out of 170, 1.8%) 
16. (Line 16 on Page 21) FT is value is 0.70 ? FT value is 0.70 
17. (on Page 25, footnotes) in thi model ? in this model 18. (on Page 26, Table 3) Group 1 should be deleted. 19. (on Page 27, footnotes) No alcohol consumption is not correct. (<30g for men or <20g for 
women) 
20. (Line 6 on Page 29) the area under the ROC curves AUROCs the area under the ROC curves 
(AUROCs) 
21. (on Page 29, Figure 2) Spearman coefficient of correlation between the degree of fibrosis and 
FT value should be described in Figure 2 
------------------------------------------------------------------------------- 
Discretionary Revisions (which the author can choose to ignore) 
1. There are many abbreviation in the manuscript. ALD is not common abbreviation and I recommended not to be used. 2. (Line 12 on Page 17) by other community-based studies from France. Please cite these reports. 
 Accept after minor essential revisions What next?: 
 An article of importance in its field Level of interest: 
 Needs some language corrections before being published Quality of written English: 
 No Statistical review: 
Declaration of competing interests: 
I declare that I have no competing interensts. 
assistant