Title: Utility of handgrip strength (HGS) and bioelectrical impedance analysis (BIA) in the
diagnosis of sarcopenia in cirrhotic patients.
Version: 2 Date: 15 Dec 2021
Reviewer:  Hsueh-kuan Lu
Reviewer's report:
In this study, "Utility of handgrip strength (HGS) and bioelectrical impedance analysis (BIA)
in the diagnosis of sarcopenia in cirrhotic patients", the authors compared CT, BIA and the
diagnosis of cirrhotic patients with sarcopenia. The topic is very interesting. However, there
seems to be some doubts about the "recruitment exclusion conditions", the authors are requested
to confirm and explain.
First, in the summary statement "The HGS was strongly correlated with skeleton muscle
index (SMI) by CT (r=0.81, p<0.001) and had an excellent diagnostic performance for
detecting sarcopenia by using JSH criteria the sensitivity, specificity, NPV and PPV were
88.2%,100%,100%, and 98.7% respectively. In contrast, only 2 of 30 patients (6.7%) met
sarcopenic criteria by BIA. Among sarcopenic patients, the result showed a fair correlation
between SMI and BIA (r2 = 0.54; P<0.002)”.
Why used "r" for the former and "r2" for the latter? Furthermore, why did the statistics of “only
2 of 30 patients (6.7%) met sarcopenic criteria by BIA” reach the level of “P<0.002” and have
the conclusion of "fair correlation"? Please confirm it by the authors.
BIA can predict sarcopenia. It does not mean that BIA can predict sarcopenia in unhealthy
people with uneven body water distribution. May I ask the authors, what is the principle of
using BIA to assess body composition, including muscle mass? What are the limiting factors
for measurement?
Any edema or ascites will affect the accuracy and validity of the BIA measurement. Why
the exclusion clause adopted by the authors is "Ascites grade >2 by International Ascites
Club grading system"? Why was the subjects recruited in this study selected for the restricted
population of BIA instruments? The authors are requested to confirm and explain them.
The study recruited restricted populations measured by BIA instruments. Perhaps, the
predictable presentation of the "conclusion" was of course "inaccurate."
Title: Utility of handgrip strength (HGS) and bioelectrical impedance analysis (BIA) in the
diagnosis of sarcopenia in cirrhotic patients.
Version: 2 Date: 15 Dec 2021
Reviewer:  Hsueh-kuan Lu
Reviewer's report:
In this study, "Utility of handgrip strength (HGS) and bioelectrical impedance analysis (BIA)
in the diagnosis of sarcopenia in cirrhotic patients", the authors compared CT, BIA and the
diagnosis of cirrhotic patients with sarcopenia. The topic is very interesting. However, there
seems to be some doubts about the "recruitment exclusion conditions", the authors are requested
to confirm and explain.
First, in the summary statement "The HGS was strongly correlated with skeleton muscle
index (SMI) by CT (r=0.81, p<0.001) and had an excellent diagnostic performance for
detecting sarcopenia by using JSH criteria the sensitivity, specificity, NPV and PPV were
88.2%,100%,100%, and 98.7% respectively. In contrast, only 2 of 30 patients (6.7%) met
sarcopenic criteria by BIA. Among sarcopenic patients, the result showed a fair correlation
between SMI and BIA (r2 = 0.54; P<0.002)”.
Why used "r" for the former and "r2" for the latter? Furthermore, why did the statistics of “only
2 of 30 patients (6.7%) met sarcopenic criteria by BIA” reach the level of “P<0.002” and have
the conclusion of "fair correlation"? Please confirm it by the authors.
BIA can predict sarcopenia. It does not mean that BIA can predict sarcopenia in unhealthy
people with uneven body water distribution. May I ask the authors, what is the principle of
using BIA to assess body composition, including muscle mass? What are the limiting factors
for measurement?
Any edema or ascites will affect the accuracy and validity of the BIA measurement. Why
the exclusion clause adopted by the authors is "Ascites grade >2 by International Ascites
Club grading system"? Why was the subjects recruited in this study selected for the restricted
population of BIA instruments? The authors are requested to confirm and explain them.
The study recruited restricted populations measured by BIA instruments. Perhaps, the
predictable presentation of the "conclusion" was of course "inaccurate."
Please review this paper.
user
Title: Utility of handgrip strength (HGS) and bioelectrical impedance analysis (BIA) in the
diagnosis of sarcopenia in cirrhotic patients.
Version: 2 Date: 15 Dec 2021
Reviewer:  Hsueh-kuan Lu
Reviewer's report:
In this study, "Utility of handgrip strength (HGS) and bioelectrical impedance analysis (BIA)
in the diagnosis of sarcopenia in cirrhotic patients", the authors compared CT, BIA and the
diagnosis of cirrhotic patients with sarcopenia. The topic is very interesting. However, there
seems to be some doubts about the "recruitment exclusion conditions", the authors are requested
to confirm and explain.
First, in the summary statement "The HGS was strongly correlated with skeleton muscle
index (SMI) by CT (r=0.81, p<0.001) and had an excellent diagnostic performance for
detecting sarcopenia by using JSH criteria the sensitivity, specificity, NPV and PPV were
88.2%,100%,100%, and 98.7% respectively. In contrast, only 2 of 30 patients (6.7%) met
sarcopenic criteria by BIA. Among sarcopenic patients, the result showed a fair correlation
between SMI and BIA (r2 = 0.54; P<0.002)”.
Why used "r" for the former and "r2" for the latter? Furthermore, why did the statistics of “only
2 of 30 patients (6.7%) met sarcopenic criteria by BIA” reach the level of “P<0.002” and have
the conclusion of "fair correlation"? Please confirm it by the authors.
BIA can predict sarcopenia. It does not mean that BIA can predict sarcopenia in unhealthy
people with uneven body water distribution. May I ask the authors, what is the principle of
using BIA to assess body composition, including muscle mass? What are the limiting factors
for measurement?
Any edema or ascites will affect the accuracy and validity of the BIA measurement. Why
the exclusion clause adopted by the authors is "Ascites grade >2 by International Ascites
Club grading system"? Why was the subjects recruited in this study selected for the restricted
population of BIA instruments? The authors are requested to confirm and explain them.
The study recruited restricted populations measured by BIA instruments. Perhaps, the
predictable presentation of the "conclusion" was of course "inaccurate."
assistant