Title: Impact and usefulness of the transition to the new MAFLD classification for non-B, non-
C HCC: A retrospective cohort study
Version: 0 Date: 01 Apr 2023
Reviewer's report:
Although the topic is of interest, there are fatal methodological drawbacks that hamper the study
conclusions:
1. MAFLD diagnosis is not mutually exclusive with other liver diseases, including chronic
hepatitis C a B (especially during the last year in the era of HCV viral eradication by DAAs
and HBV replication control)
2.  absence of evidence of hepatic steatosis does not rule out MAFLD diagnosis in patients with
cirrhosis (likely the majority of patients with HCC), if there's a previous evidence of excess
hepatic fat
3. the reason why i the study design the other ethological factors for liver disease was excluded
is unclear
4. as there was no systematic assessment of HCC incidence in the area, Authors cannot draw
reliable epidemiological conclusions
5. the main outcome should have been the prevalence and trends of MAFLD-only/MAFLD-
NAFLD and NAFLD-only as compared to other causes of liver disease in the general cohort,
and the comparisons between these different groups
6. the study is mono centric, retrospective, and the sample size is limited; results may not be
generalisable to other settings
Title: Impact and usefulness of the transition to the new MAFLD classification for non-B, non-
C HCC: A retrospective cohort study
Version: 0 Date: 01 Apr 2023
Reviewer's report:
Although the topic is of interest, there are fatal methodological drawbacks that hamper the study
conclusions:
1. MAFLD diagnosis is not mutually exclusive with other liver diseases, including chronic
hepatitis C a B (especially during the last year in the era of HCV viral eradication by DAAs
and HBV replication control)
2.  absence of evidence of hepatic steatosis does not rule out MAFLD diagnosis in patients with
cirrhosis (likely the majority of patients with HCC), if there's a previous evidence of excess
hepatic fat
3. the reason why i the study design the other ethological factors for liver disease was excluded
is unclear
4. as there was no systematic assessment of HCC incidence in the area, Authors cannot draw
reliable epidemiological conclusions
5. the main outcome should have been the prevalence and trends of MAFLD-only/MAFLD-
NAFLD and NAFLD-only as compared to other causes of liver disease in the general cohort,
and the comparisons between these different groups
6. the study is mono centric, retrospective, and the sample size is limited; results may not be
generalisable to other settings
Please review this paper.
user
Title: Impact and usefulness of the transition to the new MAFLD classification for non-B, non-
C HCC: A retrospective cohort study
Version: 0 Date: 01 Apr 2023
Reviewer's report:
Although the topic is of interest, there are fatal methodological drawbacks that hamper the study
conclusions:
1. MAFLD diagnosis is not mutually exclusive with other liver diseases, including chronic
hepatitis C a B (especially during the last year in the era of HCV viral eradication by DAAs
and HBV replication control)
2.  absence of evidence of hepatic steatosis does not rule out MAFLD diagnosis in patients with
cirrhosis (likely the majority of patients with HCC), if there's a previous evidence of excess
hepatic fat
3. the reason why i the study design the other ethological factors for liver disease was excluded
is unclear
4. as there was no systematic assessment of HCC incidence in the area, Authors cannot draw
reliable epidemiological conclusions
5. the main outcome should have been the prevalence and trends of MAFLD-only/MAFLD-
NAFLD and NAFLD-only as compared to other causes of liver disease in the general cohort,
and the comparisons between these different groups
6. the study is mono centric, retrospective, and the sample size is limited; results may not be
generalisable to other settings
assistant