Reviewer ’s report  
 
Title: Anthropometric, Biochemical and Clinical Assessment  of Malnutrition among Egyptian 
Children with Chronic Liver Diseases: A Single Institutional Cross -sectio nal Study  
 
Version: 0 Date: 22 Apr 2019  
 
Reviewer: Claudio Augusto Marroni  
 
Reviewer's report:  
 
The aim of this study was to evaluate nut ritional changes in children with chronic hepatopathy 
from 6 months to 6 years. There is great dispersion in the age group, which may hinder the 
homogeneity of the evaluation.  
 
Compares two groups: the sick group with normal group.  
 
The exclusion criteria ar e rigid, trying to achieve greater uniformity of the sick group.  
 
In the clinical evaluation there is an adequate distribution of cases regarding gravity (CTP A, B 
and C)  
 
They emphasize the importance of nutritional evaluation and its diagnosis in the progn osis of 
chronic hepatic disease. They point out the lack of a golden standard in the nutritional evaluation 
of cirrhotics. The evaluation should be broad and varied, contemplating a set of different 
methods, with different parameters, which complement each  other, including the participation of 
laboratory results, which improves the evaluation as a whole.  
 
The anthropometric parameters used, which provide us the Z score, pediatric peculiarity, give 
very different reports between the two groups, valuing measur es assessed in the upper limbs (fat 
and muscle area), with a score Z -3 to -2. There is a statistical correlation between the 
anthropometric parameters and the laboratory tests, obviously, due to the present disease, which 
is aggravated in the clinical com parison (CTP C), emphasizing sarcopenia indirectly, but very 
importantly.  
 
Anthropometric measures, even though they are not the most accurate, and evaluating a segment 
and not the global one, present advantages because they are simple, easy, fast, inexpens ive, fast 
interpretation, acceptable, can have greater population coverage, and are replicable.  
 
Methods such as EBI could be more scientific, however, in young children, there is a lack of 
standardization, probably why it was not used.  
 
This is an unpublish ed study that diagnoses malnutrition in children with chronic hepatopathy 
and can thus serve as a parameter for supplementary and complementary therapeutic intervention 
aiming at a better quality of life and preparation for liver transplantation.  
 
We recomm end publishing the paper  
 
Are the methods appropriate and well d escribed?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequatel y supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1.  Have you in the past five years received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain or lose financially from the 
public ation of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares in an organisation t hat may in any way gain or 
lose financially from the publication of this manuscript, either now or in the 
future?  
 
3.  Do you hold or are you curre ntly applying for any patents  relating to the content 
of the manuscript?  
 
4.  Have you received reimbursements, fees, funding, or salary from an organization 
that holds or has applied for patents relating to the content of the manuscript?  
 
5.  Do you have any other financial competing interests?  
 
6.  Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have  no competing intere sts' 
below. If your reply is y es to any, please give details below.  
 
'I declare that I have no competing interests' below  
 
I agree to the open peer review policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/lice nses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Anthropometric, Biochemical and Clinical Assessment  of Malnutrition among Egyptian 
Children with Chronic Liver Diseases: A Single Institutional Cross -sectio nal Study  
 
Version: 0 Date: 22 Apr 2019  
 
Reviewer: Claudio Augusto Marroni  
 
Reviewer's report:  
 
The aim of this study was to evaluate nut ritional changes in children with chronic hepatopathy 
from 6 months to 6 years. There is great dispersion in the age group, which may hinder the 
homogeneity of the evaluation.  
 
Compares two groups: the sick group with normal group.  
 
The exclusion criteria ar e rigid, trying to achieve greater uniformity of the sick group.  
 
In the clinical evaluation there is an adequate distribution of cases regarding gravity (CTP A, B 
and C)  
 
They emphasize the importance of nutritional evaluation and its diagnosis in the progn osis of 
chronic hepatic disease. They point out the lack of a golden standard in the nutritional evaluation 
of cirrhotics. The evaluation should be broad and varied, contemplating a set of different 
methods, with different parameters, which complement each  other, including the participation of 
laboratory results, which improves the evaluation as a whole.  
 
The anthropometric parameters used, which provide us the Z score, pediatric peculiarity, give 
very different reports between the two groups, valuing measur es assessed in the upper limbs (fat 
and muscle area), with a score Z -3 to -2. There is a statistical correlation between the 
anthropometric parameters and the laboratory tests, obviously, due to the present disease, which 
is aggravated in the clinical com parison (CTP C), emphasizing sarcopenia indirectly, but very 
importantly.  
 
Anthropometric measures, even though they are not the most accurate, and evaluating a segment 
and not the global one, present advantages because they are simple, easy, fast, inexpens ive, fast 
interpretation, acceptable, can have greater population coverage, and are replicable.  
 
Methods such as EBI could be more scientific, however, in young children, there is a lack of 
standardization, probably why it was not used.  
 
This is an unpublish ed study that diagnoses malnutrition in children with chronic hepatopathy 
and can thus serve as a parameter for supplementary and complementary therapeutic intervention 
aiming at a better quality of life and preparation for liver transplantation.  
 
We recomm end publishing the paper  
 
Are the methods appropriate and well d escribed?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequatel y supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1.  Have you in the past five years received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain or lose financially from the 
public ation of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares in an organisation t hat may in any way gain or 
lose financially from the publication of this manuscript, either now or in the 
future?  
 
3.  Do you hold or are you curre ntly applying for any patents  relating to the content 
of the manuscript?  
 
4.  Have you received reimbursements, fees, funding, or salary from an organization 
that holds or has applied for patents relating to the content of the manuscript?  
 
5.  Do you have any other financial competing interests?  
 
6.  Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have  no competing intere sts' 
below. If your reply is y es to any, please give details below.  
 
'I declare that I have no competing interests' below  
 
I agree to the open peer review policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/lice nses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Anthropometric, Biochemical and Clinical Assessment  of Malnutrition among Egyptian 
Children with Chronic Liver Diseases: A Single Institutional Cross -sectio nal Study  
 
Version: 0 Date: 22 Apr 2019  
 
Reviewer: Claudio Augusto Marroni  
 
Reviewer's report:  
 
The aim of this study was to evaluate nut ritional changes in children with chronic hepatopathy 
from 6 months to 6 years. There is great dispersion in the age group, which may hinder the 
homogeneity of the evaluation.  
 
Compares two groups: the sick group with normal group.  
 
The exclusion criteria ar e rigid, trying to achieve greater uniformity of the sick group.  
 
In the clinical evaluation there is an adequate distribution of cases regarding gravity (CTP A, B 
and C)  
 
They emphasize the importance of nutritional evaluation and its diagnosis in the progn osis of 
chronic hepatic disease. They point out the lack of a golden standard in the nutritional evaluation 
of cirrhotics. The evaluation should be broad and varied, contemplating a set of different 
methods, with different parameters, which complement each  other, including the participation of 
laboratory results, which improves the evaluation as a whole.  
 
The anthropometric parameters used, which provide us the Z score, pediatric peculiarity, give 
very different reports between the two groups, valuing measur es assessed in the upper limbs (fat 
and muscle area), with a score Z -3 to -2. There is a statistical correlation between the 
anthropometric parameters and the laboratory tests, obviously, due to the present disease, which 
is aggravated in the clinical com parison (CTP C), emphasizing sarcopenia indirectly, but very 
importantly.  
 
Anthropometric measures, even though they are not the most accurate, and evaluating a segment 
and not the global one, present advantages because they are simple, easy, fast, inexpens ive, fast 
interpretation, acceptable, can have greater population coverage, and are replicable.  
 
Methods such as EBI could be more scientific, however, in young children, there is a lack of 
standardization, probably why it was not used.  
 
This is an unpublish ed study that diagnoses malnutrition in children with chronic hepatopathy 
and can thus serve as a parameter for supplementary and complementary therapeutic intervention 
aiming at a better quality of life and preparation for liver transplantation.  
 
We recomm end publishing the paper  
 
Are the methods appropriate and well d escribed?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequatel y supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1.  Have you in the past five years received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain or lose financially from the 
public ation of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares in an organisation t hat may in any way gain or 
lose financially from the publication of this manuscript, either now or in the 
future?  
 
3.  Do you hold or are you curre ntly applying for any patents  relating to the content 
of the manuscript?  
 
4.  Have you received reimbursements, fees, funding, or salary from an organization 
that holds or has applied for patents relating to the content of the manuscript?  
 
5.  Do you have any other financial competing interests?  
 
6.  Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have  no competing intere sts' 
below. If your reply is y es to any, please give details below.  
 
'I declare that I have no competing interests' below  
 
I agree to the open peer review policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/lice nses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant