Title: Combined association of Chewing Capacity and Depression with Constipation: A Cross-
Sectional Study
Version: 1 Date: 15 May 2025
Reviewer's report:
The authors assessed the combined association of chewing capacity and depression with
constipation. Below I summarize my recommendations:
1# The author states in the introduction that the reason for conducting this research is: "Since
both factors are prevalent among aging populations, understanding their combined influence
could provide critical insights for targeted interventions." However, it can be observed from
the results section that the research was not conducted within the elderly population, and the
methods section does not explain the age range of the participants in this study.
2# The exclusion criteria are unclear and described imprecisely as “or other relevant covariates.”
Figure 1 or the main text should clearly show which study participants were excluded to ensure
transparency for the readers.
3# For some variables, such as uric acid, creatinine, and total bilirubin, is there evidence to
support their adjustment as confounding factors?
4# The inclusion and exclusion criteria for participants are somewhat confusing. The
author excluded participants with missing data for certain variables, such as hypertension,
cardiovascular disease (CVD), and hyperlipidemia. While the methods section provides
definitions for hypertension and CVD, it does not specify the diagnostic criteria for
hyperlipidemia. Furthermore, these three variables were not adjusted for as confounding factors.
In addition, diabetes, which was adjusted for as a confounder, also lacks an explanation of its
diagnostic criteria.
5# Additionally, the author did not consider several key factors that significantly affect
constipation, such as diet and physical activity.
6# Although the author labels Table 1 as “Weighted characteristics of participants,” there
is no indication in the methods section that the complex sampling design of NHANES—
including weights, clustering, and stratification—was taken into account. Moreover, based on
the description of the statistical methods and the presentation of results in Table 1, it appears
that the author likely conducted a conventional analysis rather than a weighted one.
7# The sensitivity analysis and mediation analysis are not adequately described in the statistical
methods section.
Title: Combined association of Chewing Capacity and Depression with Constipation: A Cross-
Sectional Study
Version: 1 Date: 15 May 2025
Reviewer's report:
The authors assessed the combined association of chewing capacity and depression with
constipation. Below I summarize my recommendations:
1# The author states in the introduction that the reason for conducting this research is: "Since
both factors are prevalent among aging populations, understanding their combined influence
could provide critical insights for targeted interventions." However, it can be observed from
the results section that the research was not conducted within the elderly population, and the
methods section does not explain the age range of the participants in this study.
2# The exclusion criteria are unclear and described imprecisely as “or other relevant covariates.”
Figure 1 or the main text should clearly show which study participants were excluded to ensure
transparency for the readers.
3# For some variables, such as uric acid, creatinine, and total bilirubin, is there evidence to
support their adjustment as confounding factors?
4# The inclusion and exclusion criteria for participants are somewhat confusing. The
author excluded participants with missing data for certain variables, such as hypertension,
cardiovascular disease (CVD), and hyperlipidemia. While the methods section provides
definitions for hypertension and CVD, it does not specify the diagnostic criteria for
hyperlipidemia. Furthermore, these three variables were not adjusted for as confounding factors.
In addition, diabetes, which was adjusted for as a confounder, also lacks an explanation of its
diagnostic criteria.
5# Additionally, the author did not consider several key factors that significantly affect
constipation, such as diet and physical activity.
6# Although the author labels Table 1 as “Weighted characteristics of participants,” there
is no indication in the methods section that the complex sampling design of NHANES—
including weights, clustering, and stratification—was taken into account. Moreover, based on
the description of the statistical methods and the presentation of results in Table 1, it appears
that the author likely conducted a conventional analysis rather than a weighted one.
7# The sensitivity analysis and mediation analysis are not adequately described in the statistical
methods section.
Please review this paper.
user
Title: Combined association of Chewing Capacity and Depression with Constipation: A Cross-
Sectional Study
Version: 1 Date: 15 May 2025
Reviewer's report:
The authors assessed the combined association of chewing capacity and depression with
constipation. Below I summarize my recommendations:
1# The author states in the introduction that the reason for conducting this research is: "Since
both factors are prevalent among aging populations, understanding their combined influence
could provide critical insights for targeted interventions." However, it can be observed from
the results section that the research was not conducted within the elderly population, and the
methods section does not explain the age range of the participants in this study.
2# The exclusion criteria are unclear and described imprecisely as “or other relevant covariates.”
Figure 1 or the main text should clearly show which study participants were excluded to ensure
transparency for the readers.
3# For some variables, such as uric acid, creatinine, and total bilirubin, is there evidence to
support their adjustment as confounding factors?
4# The inclusion and exclusion criteria for participants are somewhat confusing. The
author excluded participants with missing data for certain variables, such as hypertension,
cardiovascular disease (CVD), and hyperlipidemia. While the methods section provides
definitions for hypertension and CVD, it does not specify the diagnostic criteria for
hyperlipidemia. Furthermore, these three variables were not adjusted for as confounding factors.
In addition, diabetes, which was adjusted for as a confounder, also lacks an explanation of its
diagnostic criteria.
5# Additionally, the author did not consider several key factors that significantly affect
constipation, such as diet and physical activity.
6# Although the author labels Table 1 as “Weighted characteristics of participants,” there
is no indication in the methods section that the complex sampling design of NHANES—
including weights, clustering, and stratification—was taken into account. Moreover, based on
the description of the statistical methods and the presentation of results in Table 1, it appears
that the author likely conducted a conventional analysis rather than a weighted one.
7# The sensitivity analysis and mediation analysis are not adequately described in the statistical
methods section.
assistant