Reviewer’s report
Title: Predictors of advanced fibrosis in elderly patients with biopsy-confirmed nonalcoholic fatty
liver disease: The GOASIA study
Version: 0 Date: 28 Sep 2019
Reviewer: David Kleiner
Reviewer's report:
This study describes the utility of the generally accepted non-invasive fibrosis surrogates in identifying
which elderly patients with fatty liver disease have advanced fibrosis.  The study combines data from
multiple medical centers across Asia from cohorts collected at various times over the last 16 years.  The
main result is that the readily available calculated indices of fibrosis are not as useful in the elderly
Asian population, similar to results obtained from cohorts in other parts of the world.  There are only a
couple of issues that could be addressed that would be of benefit to readers.
1. Description of cohort - Given that the patients were drawn from different (but overlapping) time
periods and from multiple centers, were there any significant differences in patient demongraphics or in
the distribution of liver disease seen on biopsy that might affect interpretation of the results?
2. Methods - collection of laboratory data.  What was time interval between the laboratory test results
and the liver biopsy?  Was there an outer limit?
3. Results - The results are all expressed as summary data statistics.  It would be useful to include a
figure showing the distribution of non-invasive index results plotted against fibrosis stage comparing
the elderly to the younger patients. 
Are the methods appropriate and well described?
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 adequately 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 manuscript or would you recommend an
additional statistical review?
If an additional statistical review is recommended, please specify 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, fees, funding, or salary from an
organisation that may in any way gain or lose financially from the publication of this
manuscript, either now or in the future?
2. Do you hold any stocks or shares in an organisation that 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 currently 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 interests' below.
If your reply is yes to any, please give details below.
I declare that I have no competing interests.
I agree to the open peer review policy of the journal. I understand 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/licenses/by/4.0/ ). I understand that any comments
which I do not wish to be included in my named report can be included 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: Predictors of advanced fibrosis in elderly patients with biopsy-confirmed nonalcoholic fatty
liver disease: The GOASIA study
Version: 0 Date: 28 Sep 2019
Reviewer: David Kleiner
Reviewer's report:
This study describes the utility of the generally accepted non-invasive fibrosis surrogates in identifying
which elderly patients with fatty liver disease have advanced fibrosis.  The study combines data from
multiple medical centers across Asia from cohorts collected at various times over the last 16 years.  The
main result is that the readily available calculated indices of fibrosis are not as useful in the elderly
Asian population, similar to results obtained from cohorts in other parts of the world.  There are only a
couple of issues that could be addressed that would be of benefit to readers.
1. Description of cohort - Given that the patients were drawn from different (but overlapping) time
periods and from multiple centers, were there any significant differences in patient demongraphics or in
the distribution of liver disease seen on biopsy that might affect interpretation of the results?
2. Methods - collection of laboratory data.  What was time interval between the laboratory test results
and the liver biopsy?  Was there an outer limit?
3. Results - The results are all expressed as summary data statistics.  It would be useful to include a
figure showing the distribution of non-invasive index results plotted against fibrosis stage comparing
the elderly to the younger patients. 
Are the methods appropriate and well described?
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 adequately 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 manuscript or would you recommend an
additional statistical review?
If an additional statistical review is recommended, please specify 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, fees, funding, or salary from an
organisation that may in any way gain or lose financially from the publication of this
manuscript, either now or in the future?
2. Do you hold any stocks or shares in an organisation that 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 currently 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 interests' below.
If your reply is yes to any, please give details below.
I declare that I have no competing interests.
I agree to the open peer review policy of the journal. I understand 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/licenses/by/4.0/ ). I understand that any comments
which I do not wish to be included in my named report can be included 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: Predictors of advanced fibrosis in elderly patients with biopsy-confirmed nonalcoholic fatty
liver disease: The GOASIA study
Version: 0 Date: 28 Sep 2019
Reviewer: David Kleiner
Reviewer's report:
This study describes the utility of the generally accepted non-invasive fibrosis surrogates in identifying
which elderly patients with fatty liver disease have advanced fibrosis.  The study combines data from
multiple medical centers across Asia from cohorts collected at various times over the last 16 years.  The
main result is that the readily available calculated indices of fibrosis are not as useful in the elderly
Asian population, similar to results obtained from cohorts in other parts of the world.  There are only a
couple of issues that could be addressed that would be of benefit to readers.
1. Description of cohort - Given that the patients were drawn from different (but overlapping) time
periods and from multiple centers, were there any significant differences in patient demongraphics or in
the distribution of liver disease seen on biopsy that might affect interpretation of the results?
2. Methods - collection of laboratory data.  What was time interval between the laboratory test results
and the liver biopsy?  Was there an outer limit?
3. Results - The results are all expressed as summary data statistics.  It would be useful to include a
figure showing the distribution of non-invasive index results plotted against fibrosis stage comparing
the elderly to the younger patients. 
Are the methods appropriate and well described?
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 adequately 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 manuscript or would you recommend an
additional statistical review?
If an additional statistical review is recommended, please specify 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, fees, funding, or salary from an
organisation that may in any way gain or lose financially from the publication of this
manuscript, either now or in the future?
2. Do you hold any stocks or shares in an organisation that 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 currently 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 interests' below.
If your reply is yes to any, please give details below.
I declare that I have no competing interests.
I agree to the open peer review policy of the journal. I understand 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/licenses/by/4.0/ ). I understand that any comments
which I do not wish to be included in my named report can be included as confidential comments
to the editors, which will not be published.
I agree to the open peer review policy of the journal
assistant