Reviewer’s report
Title: 
Association of meat consumption with NAFLD risk and liver-related
biochemical indexes in older Chinese: a cross-sectional study
Version: 
0 
Date: 
13 Sep 2020
Reviewer's report:
In this study the authors aimed to explore the association between specific meet
subtypes consumption and the risk of NAFLD. They showed an increased risk of
NAFLD development derived from the overconsumption of red meat as well as
identified a positive correlation with serum levels of GGT, ALT, AST, TG and
negative correlation with HDL-C.
In this study it is possible to identify strength points like the sample size and the
detailed statistical analysis. However, some other concerns regarding the
scientific background surrounding the rationale of the study and the
methodologic approach exist.
Minor revisions
1. Abstract: "High meats intake contributes to unhealthy status" please describe
better considering your topic.
2. Abstract: "liver related biomarkers", please define.
3. Abstract-Methods: in this section it was not inserted a methods description.
Please change it.
4. Abstract: please insert the p values for all the mentioned evaluations
5. Keywords: meat consumption
6. Introduction: "Furthermore, liver-related clinical parameters such as 
γ
-
glutamyl transferase (GGT), aspartate aminotransferase (AST) and alanine
transaminase (ALT) were closely associated with NAFLD [21]. Elevated GGT,
AST ALT and were the markers underlying liver diseases such as NAFLD [22]."
Please modify the sentences. Even if there were indicated the sources of this
knowledge by specific references, nowadays it is largely accepted that the
indicated parameters don't represent useful markers for the disease, in particular
considering NAFLD in general and not NASH. Moreover AST, ALT and GGT
are not "clinical" but biochemical parameters.
7. Methods: "(D) Individuals who did not answer more than 25 food-related
items on the questionnaire." You excluded them from the analysis, not from the
enrollment, right? Please clarify. 
8. Results: please indicate the evaluated variables (where it is possible) in mg/dl,
not mmol/L
Major revision
1. What is the reason why the authors decided to enroll patients older than 45? It
would have been interesting to analyze the data of younger people also in order
to stratify the risk of meat overconsumption-NAFLD development among
different age ranges. This assumption is sustained by the analysis of the scientific
literature on this topic that identified in the young population an increasing
prevalence of NAFLD.
2. A study design flowchart is needed
3. In the inclusion/exclusion criteria: it was not mentioned the use of medication
that could potentially interfere with the showed results, as well as patients with
thyroids disturbances.
4. So, in order to evaluate the presence of NAFLD it was performed only an
abdominal ultrasonography examination. As not so sensible technique the
authors certainly considered the possibility of "some false negative patients".
Moreover, they didn't classify the patients in accordance to the severity of the
steatosis (CAP, MRI, FLI, etc). I think it is necessary to discuss these points in
the discussion section-study limitations.
5. Methods: the nutritional assessment was based on Semi-quantitative food
frequency questionnaire. The authors didn't assess completely dietary behavior
in terms of macro and micronutrients intake with a dedicate software
(WinFood® or something similar). That certainly could affect severely the
results of the study, due to the influence of some other dietary components on
the specified main endpoint.
6. Statistical analysis: 
- "Nonparametric Kruskal-Wallis test and Chi-Square test were performed for
comparisons between groups" what groups? Until this paragraph the authors
didn't mention a group stratification
- What is the reason for the application of non-parametric test? Did the authors
perform any assessment for normality (Kolgoromov-Smirnov or similar)?
- Confounding variables: medication
7. It is not clear the reason why the authors decided to assess some biochemical
variables and didn't use any strategy for the steatosis severity assessment.
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Yes
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 that 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, either 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 relating 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 competing
interests' below. If your reply is yes to any, please give details below.
none
Reviewer Publication Consent.
 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
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. If you change your decision later, we
will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
No
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Reviewer’s report
Title: 
Association of meat consumption with NAFLD risk and liver-related
biochemical indexes in older Chinese: a cross-sectional study
Version: 
0 
Date: 
13 Sep 2020
Reviewer's report:
In this study the authors aimed to explore the association between specific meet
subtypes consumption and the risk of NAFLD. They showed an increased risk of
NAFLD development derived from the overconsumption of red meat as well as
identified a positive correlation with serum levels of GGT, ALT, AST, TG and
negative correlation with HDL-C.
In this study it is possible to identify strength points like the sample size and the
detailed statistical analysis. However, some other concerns regarding the
scientific background surrounding the rationale of the study and the
methodologic approach exist.
Minor revisions
1. Abstract: "High meats intake contributes to unhealthy status" please describe
better considering your topic.
2. Abstract: "liver related biomarkers", please define.
3. Abstract-Methods: in this section it was not inserted a methods description.
Please change it.
4. Abstract: please insert the p values for all the mentioned evaluations
5. Keywords: meat consumption
6. Introduction: "Furthermore, liver-related clinical parameters such as 
γ
-
glutamyl transferase (GGT), aspartate aminotransferase (AST) and alanine
transaminase (ALT) were closely associated with NAFLD [21]. Elevated GGT,
AST ALT and were the markers underlying liver diseases such as NAFLD [22]."
Please modify the sentences. Even if there were indicated the sources of this
knowledge by specific references, nowadays it is largely accepted that the
indicated parameters don't represent useful markers for the disease, in particular
considering NAFLD in general and not NASH. Moreover AST, ALT and GGT
are not "clinical" but biochemical parameters.
7. Methods: "(D) Individuals who did not answer more than 25 food-related
items on the questionnaire." You excluded them from the analysis, not from the
enrollment, right? Please clarify. 
8. Results: please indicate the evaluated variables (where it is possible) in mg/dl,
not mmol/L
Major revision
1. What is the reason why the authors decided to enroll patients older than 45? It
would have been interesting to analyze the data of younger people also in order
to stratify the risk of meat overconsumption-NAFLD development among
different age ranges. This assumption is sustained by the analysis of the scientific
literature on this topic that identified in the young population an increasing
prevalence of NAFLD.
2. A study design flowchart is needed
3. In the inclusion/exclusion criteria: it was not mentioned the use of medication
that could potentially interfere with the showed results, as well as patients with
thyroids disturbances.
4. So, in order to evaluate the presence of NAFLD it was performed only an
abdominal ultrasonography examination. As not so sensible technique the
authors certainly considered the possibility of "some false negative patients".
Moreover, they didn't classify the patients in accordance to the severity of the
steatosis (CAP, MRI, FLI, etc). I think it is necessary to discuss these points in
the discussion section-study limitations.
5. Methods: the nutritional assessment was based on Semi-quantitative food
frequency questionnaire. The authors didn't assess completely dietary behavior
in terms of macro and micronutrients intake with a dedicate software
(WinFood® or something similar). That certainly could affect severely the
results of the study, due to the influence of some other dietary components on
the specified main endpoint.
6. Statistical analysis: 
- "Nonparametric Kruskal-Wallis test and Chi-Square test were performed for
comparisons between groups" what groups? Until this paragraph the authors
didn't mention a group stratification
- What is the reason for the application of non-parametric test? Did the authors
perform any assessment for normality (Kolgoromov-Smirnov or similar)?
- Confounding variables: medication
7. It is not clear the reason why the authors decided to assess some biochemical
variables and didn't use any strategy for the steatosis severity assessment.
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons after the final decision on the manuscript has been made. If you have
already registered at Publons, they will notify you of the receipt of this review
and update your profile 
as per your settings and their policy. If you are not
registered with Publons, you will receive an email from them asking you to
register in order for them to be able to recognize your review on your new
profile page. Publons may use the Review Data to generate derivative metadata
for the benefit of Publons and you as a reviewer, carefully considering the
sensitivity of such information. For example, Publons may verify your record as
a reviewer by updating your profile published on its webservice if you have
registered for such service or help editors to identify candidate reviewers. Please
find the details of processing in Publons’ privacy policy
https://publons.com/about/terms
Yes
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 that 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, either 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 relating 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 competing
interests' below. If your reply is yes to any, please give details below.
none
Reviewer Publication Consent.
 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
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. If you change your decision later, we
will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
No
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Please review this paper.
user
Reviewer’s report
Title: 
Association of meat consumption with NAFLD risk and liver-related
biochemical indexes in older Chinese: a cross-sectional study
Version: 
0 
Date: 
13 Sep 2020
Reviewer's report:
In this study the authors aimed to explore the association between specific meet
subtypes consumption and the risk of NAFLD. They showed an increased risk of
NAFLD development derived from the overconsumption of red meat as well as
identified a positive correlation with serum levels of GGT, ALT, AST, TG and
negative correlation with HDL-C.
In this study it is possible to identify strength points like the sample size and the
detailed statistical analysis. However, some other concerns regarding the
scientific background surrounding the rationale of the study and the
methodologic approach exist.
Minor revisions
1. Abstract: "High meats intake contributes to unhealthy status" please describe
better considering your topic.
2. Abstract: "liver related biomarkers", please define.
3. Abstract-Methods: in this section it was not inserted a methods description.
Please change it.
4. Abstract: please insert the p values for all the mentioned evaluations
5. Keywords: meat consumption
6. Introduction: "Furthermore, liver-related clinical parameters such as 
γ
-
glutamyl transferase (GGT), aspartate aminotransferase (AST) and alanine
transaminase (ALT) were closely associated with NAFLD [21]. Elevated GGT,
AST ALT and were the markers underlying liver diseases such as NAFLD [22]."
Please modify the sentences. Even if there were indicated the sources of this
knowledge by specific references, nowadays it is largely accepted that the
indicated parameters don't represent useful markers for the disease, in particular
considering NAFLD in general and not NASH. Moreover AST, ALT and GGT
are not "clinical" but biochemical parameters.
7. Methods: "(D) Individuals who did not answer more than 25 food-related
items on the questionnaire." You excluded them from the analysis, not from the
enrollment, right? Please clarify. 
8. Results: please indicate the evaluated variables (where it is possible) in mg/dl,
not mmol/L
Major revision
1. What is the reason why the authors decided to enroll patients older than 45? It
would have been interesting to analyze the data of younger people also in order
to stratify the risk of meat overconsumption-NAFLD development among
different age ranges. This assumption is sustained by the analysis of the scientific
literature on this topic that identified in the young population an increasing
prevalence of NAFLD.
2. A study design flowchart is needed
3. In the inclusion/exclusion criteria: it was not mentioned the use of medication
that could potentially interfere with the showed results, as well as patients with
thyroids disturbances.
4. So, in order to evaluate the presence of NAFLD it was performed only an
abdominal ultrasonography examination. As not so sensible technique the
authors certainly considered the possibility of "some false negative patients".
Moreover, they didn't classify the patients in accordance to the severity of the
steatosis (CAP, MRI, FLI, etc). I think it is necessary to discuss these points in
the discussion section-study limitations.
5. Methods: the nutritional assessment was based on Semi-quantitative food
frequency questionnaire. The authors didn't assess completely dietary behavior
in terms of macro and micronutrients intake with a dedicate software
(WinFood® or something similar). That certainly could affect severely the
results of the study, due to the influence of some other dietary components on
the specified main endpoint.
6. Statistical analysis: 
- "Nonparametric Kruskal-Wallis test and Chi-Square test were performed for
comparisons between groups" what groups? Until this paragraph the authors
didn't mention a group stratification
- What is the reason for the application of non-parametric test? Did the authors
perform any assessment for normality (Kolgoromov-Smirnov or similar)?
- Confounding variables: medication
7. It is not clear the reason why the authors decided to assess some biochemical
variables and didn't use any strategy for the steatosis severity assessment.
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons after the final decision on the manuscript has been made. If you have
already registered at Publons, they will notify you of the receipt of this review
and update your profile 
as per your settings and their policy. If you are not
registered with Publons, you will receive an email from them asking you to
register in order for them to be able to recognize your review on your new
profile page. Publons may use the Review Data to generate derivative metadata
for the benefit of Publons and you as a reviewer, carefully considering the
sensitivity of such information. For example, Publons may verify your record as
a reviewer by updating your profile published on its webservice if you have
registered for such service or help editors to identify candidate reviewers. Please
find the details of processing in Publons’ privacy policy
https://publons.com/about/terms
Yes
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 that 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, either 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 relating 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 competing
interests' below. If your reply is yes to any, please give details below.
none
Reviewer Publication Consent.
 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
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. If you change your decision later, we
will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
No
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
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