Title: Characteristics of serum bile acid profiles among individuals with metabolic dysfunction-
associated steatotic liver disease
Version: 0 Date: 23 Feb 2025
Reviewer's report:
1. those with serious heart, brain, lung, kidney, and other systemic diseases – this is a vague
expression. Exclusion criteria should be stringent.
2. Please use inclusion criteria for NAFLD/MAFLD/MASLD as defined by AASLD/APASL/
EASL
3. The patients were instructed to adhere to a light diet and refrain from smoking and drinking
the day before sampling to minimize metabolic fluctuations.  – Please cite appropriate reference
in support of this statement.
4. All experimental data were analyzed using IBM SPSS Statistics for Windows, version 26.0
– Please mention full company details, country and city.
5. It is noteworthy that the levels of body mass index (BMI), ALT, TG, TC, and FBG were
markedly elevated in the MAFLD group compared to the healthy individuals (P = 0.008, P =
 0.005, P = 0.005, P = 0.006, P < 0.001). – What is noteworthy here? It is entirely expected.
Suggest authors to remove ‘noteworthy’.
6. In some section, we compared the data for each of the two groups. Therefore, the significance
level P = 0.05 was divided by two, which provides a significance level corrected for multiple
testing: P = 0.025. – Is this statistically appropriate? P value of 0.025 is used when doing a one-
tailed test. A one-tailed test is appropriate if the estimated value may depart from the reference
value in only one direction, left or right, but not both. Please clarify.
7. The analysis encompassed a total of 264 participants, including 215 participants diagnosed
with MAFLD and 49 controls. – Were the controls matched for age, sex and geography? It is
very important to have matched controls in such studies as metabolic parameters can vary widely
depending upon age, sex, etc.
8. What proportion of MAFLD subjects were overweight/obese or had normal BMI? Were
there any MAFLD subjects with normal BMI (lean NAFLD)? Similarly, what proportion of the
controls were overweight/obese or had normal BMI? Were these comparable between the two
groups? These details are very pertinent.
9. ALT levels, defined as normal (# 50 U/L for males and # 40 U/L for females) and elevated (>
 50 U/L for males and > 40 U/L for females), - What is the evidence for this cut-off? Is it based
on any guidelines, consensus or strong evidence? Please clarify.
10. What is the implication of elevated bile acid levels in MAFLD? Please discuss the therapeutic
implications. Despite these findings, molecules like obeticholic acid have failed to cause
significant headway. Are elevated bile acid levels the cause or effect of MAFLD? If these are
offshoots of hepatic steatosis, what therapeutic implication might this have? Kindly discuss.
Title: Characteristics of serum bile acid profiles among individuals with metabolic dysfunction-
associated steatotic liver disease
Version: 0 Date: 23 Feb 2025
Reviewer's report:
1. those with serious heart, brain, lung, kidney, and other systemic diseases – this is a vague
expression. Exclusion criteria should be stringent.
2. Please use inclusion criteria for NAFLD/MAFLD/MASLD as defined by AASLD/APASL/
EASL
3. The patients were instructed to adhere to a light diet and refrain from smoking and drinking
the day before sampling to minimize metabolic fluctuations.  – Please cite appropriate reference
in support of this statement.
4. All experimental data were analyzed using IBM SPSS Statistics for Windows, version 26.0
– Please mention full company details, country and city.
5. It is noteworthy that the levels of body mass index (BMI), ALT, TG, TC, and FBG were
markedly elevated in the MAFLD group compared to the healthy individuals (P = 0.008, P =
 0.005, P = 0.005, P = 0.006, P < 0.001). – What is noteworthy here? It is entirely expected.
Suggest authors to remove ‘noteworthy’.
6. In some section, we compared the data for each of the two groups. Therefore, the significance
level P = 0.05 was divided by two, which provides a significance level corrected for multiple
testing: P = 0.025. – Is this statistically appropriate? P value of 0.025 is used when doing a one-
tailed test. A one-tailed test is appropriate if the estimated value may depart from the reference
value in only one direction, left or right, but not both. Please clarify.
7. The analysis encompassed a total of 264 participants, including 215 participants diagnosed
with MAFLD and 49 controls. – Were the controls matched for age, sex and geography? It is
very important to have matched controls in such studies as metabolic parameters can vary widely
depending upon age, sex, etc.
8. What proportion of MAFLD subjects were overweight/obese or had normal BMI? Were
there any MAFLD subjects with normal BMI (lean NAFLD)? Similarly, what proportion of the
controls were overweight/obese or had normal BMI? Were these comparable between the two
groups? These details are very pertinent.
9. ALT levels, defined as normal (# 50 U/L for males and # 40 U/L for females) and elevated (>
 50 U/L for males and > 40 U/L for females), - What is the evidence for this cut-off? Is it based
on any guidelines, consensus or strong evidence? Please clarify.
10. What is the implication of elevated bile acid levels in MAFLD? Please discuss the therapeutic
implications. Despite these findings, molecules like obeticholic acid have failed to cause
significant headway. Are elevated bile acid levels the cause or effect of MAFLD? If these are
offshoots of hepatic steatosis, what therapeutic implication might this have? Kindly discuss.
Please review this paper.
user
Title: Characteristics of serum bile acid profiles among individuals with metabolic dysfunction-
associated steatotic liver disease
Version: 0 Date: 23 Feb 2025
Reviewer's report:
1. those with serious heart, brain, lung, kidney, and other systemic diseases – this is a vague
expression. Exclusion criteria should be stringent.
2. Please use inclusion criteria for NAFLD/MAFLD/MASLD as defined by AASLD/APASL/
EASL
3. The patients were instructed to adhere to a light diet and refrain from smoking and drinking
the day before sampling to minimize metabolic fluctuations.  – Please cite appropriate reference
in support of this statement.
4. All experimental data were analyzed using IBM SPSS Statistics for Windows, version 26.0
– Please mention full company details, country and city.
5. It is noteworthy that the levels of body mass index (BMI), ALT, TG, TC, and FBG were
markedly elevated in the MAFLD group compared to the healthy individuals (P = 0.008, P =
 0.005, P = 0.005, P = 0.006, P < 0.001). – What is noteworthy here? It is entirely expected.
Suggest authors to remove ‘noteworthy’.
6. In some section, we compared the data for each of the two groups. Therefore, the significance
level P = 0.05 was divided by two, which provides a significance level corrected for multiple
testing: P = 0.025. – Is this statistically appropriate? P value of 0.025 is used when doing a one-
tailed test. A one-tailed test is appropriate if the estimated value may depart from the reference
value in only one direction, left or right, but not both. Please clarify.
7. The analysis encompassed a total of 264 participants, including 215 participants diagnosed
with MAFLD and 49 controls. – Were the controls matched for age, sex and geography? It is
very important to have matched controls in such studies as metabolic parameters can vary widely
depending upon age, sex, etc.
8. What proportion of MAFLD subjects were overweight/obese or had normal BMI? Were
there any MAFLD subjects with normal BMI (lean NAFLD)? Similarly, what proportion of the
controls were overweight/obese or had normal BMI? Were these comparable between the two
groups? These details are very pertinent.
9. ALT levels, defined as normal (# 50 U/L for males and # 40 U/L for females) and elevated (>
 50 U/L for males and > 40 U/L for females), - What is the evidence for this cut-off? Is it based
on any guidelines, consensus or strong evidence? Please clarify.
10. What is the implication of elevated bile acid levels in MAFLD? Please discuss the therapeutic
implications. Despite these findings, molecules like obeticholic acid have failed to cause
significant headway. Are elevated bile acid levels the cause or effect of MAFLD? If these are
offshoots of hepatic steatosis, what therapeutic implication might this have? Kindly discuss.
assistant