Title: The association between modified cardiometabolic index with non-alcoholic fatty liver
disease and liver fibrosis: A cross-sectional study
Version: 0 Date: 03 Mar 2025
Reviewer:  Sang Yi Moon
Reviewer's report:
This study utilizes the 2017–2018 National Health and Nutrition Examination Survey
(NHANES) database to diagnose NAFLD/MASLD and proposes a newly modified CMI as a
formula for distinguishing significant/advanced fibrosis, the most critical prognostic factor.
Given the increasing prevalence of MASLD and the importance of its diagnosis and the
identification of significant/advanced fibrosis in primary care settings, this issue is of significant
clinical relevance.
While the study's content and statistical approach are well-reasoned and appropriate, two
important questions remain.
#1
The study lacks a detailed explanation of the development process of the modified CMI. When
proposing a new formula, it is essential not only to demonstrate its superiority over existing
models but also to clearly describe the rationale and process behind its creation.
#2
The authors assessed the AUROC of MCMI for diagnosing NAFLD and detecting significant/
advanced fibrosis, comparing it with CMI, USFLI, and TyG. However, widely used and well-
validated biomarkers for NAFLD diagnosis include the Fatty Liver Index (FLI), NAFLD Liver
Fat Score (NLFS), and Hepatic Steatosis Index (HSI). Similarly, extensively studied indices
such as the NAFLD Fibrosis Score (NFS) and Fibrosis-4 Index (FIB-4) are commonly used for
identifying significant/advanced fibrosis in NAFLD. A rationale for selecting CMI, USFLI, and
TyG as comparators instead of these well-established biomarkers should be provided.
(Reference: PMID: 34154309, PMID: 39159947)
Title: The association between modified cardiometabolic index with non-alcoholic fatty liver
disease and liver fibrosis: A cross-sectional study
Version: 0 Date: 03 Mar 2025
Reviewer:  Sang Yi Moon
Reviewer's report:
This study utilizes the 2017–2018 National Health and Nutrition Examination Survey
(NHANES) database to diagnose NAFLD/MASLD and proposes a newly modified CMI as a
formula for distinguishing significant/advanced fibrosis, the most critical prognostic factor.
Given the increasing prevalence of MASLD and the importance of its diagnosis and the
identification of significant/advanced fibrosis in primary care settings, this issue is of significant
clinical relevance.
While the study's content and statistical approach are well-reasoned and appropriate, two
important questions remain.
#1
The study lacks a detailed explanation of the development process of the modified CMI. When
proposing a new formula, it is essential not only to demonstrate its superiority over existing
models but also to clearly describe the rationale and process behind its creation.
#2
The authors assessed the AUROC of MCMI for diagnosing NAFLD and detecting significant/
advanced fibrosis, comparing it with CMI, USFLI, and TyG. However, widely used and well-
validated biomarkers for NAFLD diagnosis include the Fatty Liver Index (FLI), NAFLD Liver
Fat Score (NLFS), and Hepatic Steatosis Index (HSI). Similarly, extensively studied indices
such as the NAFLD Fibrosis Score (NFS) and Fibrosis-4 Index (FIB-4) are commonly used for
identifying significant/advanced fibrosis in NAFLD. A rationale for selecting CMI, USFLI, and
TyG as comparators instead of these well-established biomarkers should be provided.
(Reference: PMID: 34154309, PMID: 39159947)
Please review this paper.
user
Title: The association between modified cardiometabolic index with non-alcoholic fatty liver
disease and liver fibrosis: A cross-sectional study
Version: 0 Date: 03 Mar 2025
Reviewer:  Sang Yi Moon
Reviewer's report:
This study utilizes the 2017–2018 National Health and Nutrition Examination Survey
(NHANES) database to diagnose NAFLD/MASLD and proposes a newly modified CMI as a
formula for distinguishing significant/advanced fibrosis, the most critical prognostic factor.
Given the increasing prevalence of MASLD and the importance of its diagnosis and the
identification of significant/advanced fibrosis in primary care settings, this issue is of significant
clinical relevance.
While the study's content and statistical approach are well-reasoned and appropriate, two
important questions remain.
#1
The study lacks a detailed explanation of the development process of the modified CMI. When
proposing a new formula, it is essential not only to demonstrate its superiority over existing
models but also to clearly describe the rationale and process behind its creation.
#2
The authors assessed the AUROC of MCMI for diagnosing NAFLD and detecting significant/
advanced fibrosis, comparing it with CMI, USFLI, and TyG. However, widely used and well-
validated biomarkers for NAFLD diagnosis include the Fatty Liver Index (FLI), NAFLD Liver
Fat Score (NLFS), and Hepatic Steatosis Index (HSI). Similarly, extensively studied indices
such as the NAFLD Fibrosis Score (NFS) and Fibrosis-4 Index (FIB-4) are commonly used for
identifying significant/advanced fibrosis in NAFLD. A rationale for selecting CMI, USFLI, and
TyG as comparators instead of these well-established biomarkers should be provided.
(Reference: PMID: 34154309, PMID: 39159947)
assistant