Title: The Effect of Biological Agent on Body Composition in Patients with Crohn’s Disease
Version: 1 Date: 11 Jan 2023
Reviewer's report:
In the manuscript entitled „ The Effect of Biological Agent on Body Composition in Patients
with Crohn’s Disease”, Eun Jeong Choi and colleagues present a multicenter study to explore
the influence of biologics on body composition in Crohn’s disease. Firstly, authors reported that
the prevalence of sarcopenia was high, and the body composition values were different between
patients with and without sarcopenia. Then they compared the body composition before and
after biological therapy, and found biologics could improve body composition in CD patients
with sarcopenia but not those without sarcopenia. Finally, the authors investigated the predictors
of surgery in patients with sarcopenia, and found gender and penetrating CD were risk factors
of surgery. The authors conclude that biological agents could increase all body composition
parameters in CD patients with sarcopenia. These patients are more likely to experience surgery.
It is hard for me to understand the key point of the manuscript very well. In my opinion, the
manuscript includes two irrelevant parts: sarcopenia affected the efficacy of biologics on body
composition, and sarcopenia increased the risk of surgery which has been proved previously. As
the authors found biologics were able to improve body composition in CD, it will be interesting
to investigate whether the improvement of body composition caused by biologic therapy could
reduce the risk of surgery in CD patients with sarcopenia.
In addition, I have a few comments.
1. The design of the present study should be a longitudinal study instead of a cross-sectional
study.
2. What was the criteria for moderate-to-severe CD, and what was the indication for biologics
therapy?
3. What was the time point of follow-up abdominal CT?  CT conducted at different time points
(remission or active disease?) would influence the results.
4. The body composition could be influenced by other factors such as diet and physical activity
during the period of therapy.
5. Why there was no difference in patients without sarcopenia? Did all those patients response
well to biologics?
Title: The Effect of Biological Agent on Body Composition in Patients with Crohn’s Disease
Version: 1 Date: 11 Jan 2023
Reviewer's report:
In the manuscript entitled „ The Effect of Biological Agent on Body Composition in Patients
with Crohn’s Disease”, Eun Jeong Choi and colleagues present a multicenter study to explore
the influence of biologics on body composition in Crohn’s disease. Firstly, authors reported that
the prevalence of sarcopenia was high, and the body composition values were different between
patients with and without sarcopenia. Then they compared the body composition before and
after biological therapy, and found biologics could improve body composition in CD patients
with sarcopenia but not those without sarcopenia. Finally, the authors investigated the predictors
of surgery in patients with sarcopenia, and found gender and penetrating CD were risk factors
of surgery. The authors conclude that biological agents could increase all body composition
parameters in CD patients with sarcopenia. These patients are more likely to experience surgery.
It is hard for me to understand the key point of the manuscript very well. In my opinion, the
manuscript includes two irrelevant parts: sarcopenia affected the efficacy of biologics on body
composition, and sarcopenia increased the risk of surgery which has been proved previously. As
the authors found biologics were able to improve body composition in CD, it will be interesting
to investigate whether the improvement of body composition caused by biologic therapy could
reduce the risk of surgery in CD patients with sarcopenia.
In addition, I have a few comments.
1. The design of the present study should be a longitudinal study instead of a cross-sectional
study.
2. What was the criteria for moderate-to-severe CD, and what was the indication for biologics
therapy?
3. What was the time point of follow-up abdominal CT?  CT conducted at different time points
(remission or active disease?) would influence the results.
4. The body composition could be influenced by other factors such as diet and physical activity
during the period of therapy.
5. Why there was no difference in patients without sarcopenia? Did all those patients response
well to biologics?
Please review this paper.
user
Title: The Effect of Biological Agent on Body Composition in Patients with Crohn’s Disease
Version: 1 Date: 11 Jan 2023
Reviewer's report:
In the manuscript entitled „ The Effect of Biological Agent on Body Composition in Patients
with Crohn’s Disease”, Eun Jeong Choi and colleagues present a multicenter study to explore
the influence of biologics on body composition in Crohn’s disease. Firstly, authors reported that
the prevalence of sarcopenia was high, and the body composition values were different between
patients with and without sarcopenia. Then they compared the body composition before and
after biological therapy, and found biologics could improve body composition in CD patients
with sarcopenia but not those without sarcopenia. Finally, the authors investigated the predictors
of surgery in patients with sarcopenia, and found gender and penetrating CD were risk factors
of surgery. The authors conclude that biological agents could increase all body composition
parameters in CD patients with sarcopenia. These patients are more likely to experience surgery.
It is hard for me to understand the key point of the manuscript very well. In my opinion, the
manuscript includes two irrelevant parts: sarcopenia affected the efficacy of biologics on body
composition, and sarcopenia increased the risk of surgery which has been proved previously. As
the authors found biologics were able to improve body composition in CD, it will be interesting
to investigate whether the improvement of body composition caused by biologic therapy could
reduce the risk of surgery in CD patients with sarcopenia.
In addition, I have a few comments.
1. The design of the present study should be a longitudinal study instead of a cross-sectional
study.
2. What was the criteria for moderate-to-severe CD, and what was the indication for biologics
therapy?
3. What was the time point of follow-up abdominal CT?  CT conducted at different time points
(remission or active disease?) would influence the results.
4. The body composition could be influenced by other factors such as diet and physical activity
during the period of therapy.
5. Why there was no difference in patients without sarcopenia? Did all those patients response
well to biologics?
assistant