Title: Hypertension and diabetes mellitus are associated with high FIB-4 index in a health
checkup examination cohort without known liver disease
Version: 1 Date: 22 Jul 2022
Reviewer's report:
In the present manuscript the authors report the results of a cross sectional study investigating the
prevalence of elevated FIB-4 in the general Japanese population as well as the factors associated
with a higher FIB-4 score. The topic is of some interest and the population is large enough for
statistical analysis to be applied properly.
I have the following comments:
- Please revise the English (e.g “the prevalence of NAFLD has increased from 17.9% in 2016
to 18.8% in 2030”, we are not in 2030 yet, so it is expected to increase)
- It seems that a high number of participants were excluded because data were lacking on
variables included in the FIB-4 evaluation. Could you provide data showing that the features of
included and excluded participants were not different?
- It is not clear to this reviewer why participants with significant alcohol consumption were not
excluded from the study, given that authors chose to apply the NAFLD definition. Please also
describe if a particular questionnaire was used to estimate the degree of alcohol consumption
- It is not clear how authors chose variables to be included in the multivariate logistic regression
model. Please specify. I also suspect that the association between hypertension, diabetes and
high FIB-4 could become not significant after adjusting for age. Could you please also include
age in the model?
- Related to the previous point authors should report Odds Ratios and not Hazard ratios, since
odds ratios are obtained from logistic regression. Did the authors convert them in HR? If so,
please describe how. It is also not clear how the OR/HR for albumin and WBC is reported. Is
it for a standard deviation increase?
- I believe the manuscript might gain in interest if these results were compared with
recent studies perfomed on the association between NAFLD and hypertension (doi: 10.1097/
MEG.0000000000002299 and doi: 10.1161/HYPERTENSIONAHA.120.15220)
Title: Hypertension and diabetes mellitus are associated with high FIB-4 index in a health
checkup examination cohort without known liver disease
Version: 1 Date: 22 Jul 2022
Reviewer's report:
In the present manuscript the authors report the results of a cross sectional study investigating the
prevalence of elevated FIB-4 in the general Japanese population as well as the factors associated
with a higher FIB-4 score. The topic is of some interest and the population is large enough for
statistical analysis to be applied properly.
I have the following comments:
- Please revise the English (e.g “the prevalence of NAFLD has increased from 17.9% in 2016
to 18.8% in 2030”, we are not in 2030 yet, so it is expected to increase)
- It seems that a high number of participants were excluded because data were lacking on
variables included in the FIB-4 evaluation. Could you provide data showing that the features of
included and excluded participants were not different?
- It is not clear to this reviewer why participants with significant alcohol consumption were not
excluded from the study, given that authors chose to apply the NAFLD definition. Please also
describe if a particular questionnaire was used to estimate the degree of alcohol consumption
- It is not clear how authors chose variables to be included in the multivariate logistic regression
model. Please specify. I also suspect that the association between hypertension, diabetes and
high FIB-4 could become not significant after adjusting for age. Could you please also include
age in the model?
- Related to the previous point authors should report Odds Ratios and not Hazard ratios, since
odds ratios are obtained from logistic regression. Did the authors convert them in HR? If so,
please describe how. It is also not clear how the OR/HR for albumin and WBC is reported. Is
it for a standard deviation increase?
- I believe the manuscript might gain in interest if these results were compared with
recent studies perfomed on the association between NAFLD and hypertension (doi: 10.1097/
MEG.0000000000002299 and doi: 10.1161/HYPERTENSIONAHA.120.15220)
Please review this paper.
user
Title: Hypertension and diabetes mellitus are associated with high FIB-4 index in a health
checkup examination cohort without known liver disease
Version: 1 Date: 22 Jul 2022
Reviewer's report:
In the present manuscript the authors report the results of a cross sectional study investigating the
prevalence of elevated FIB-4 in the general Japanese population as well as the factors associated
with a higher FIB-4 score. The topic is of some interest and the population is large enough for
statistical analysis to be applied properly.
I have the following comments:
- Please revise the English (e.g “the prevalence of NAFLD has increased from 17.9% in 2016
to 18.8% in 2030”, we are not in 2030 yet, so it is expected to increase)
- It seems that a high number of participants were excluded because data were lacking on
variables included in the FIB-4 evaluation. Could you provide data showing that the features of
included and excluded participants were not different?
- It is not clear to this reviewer why participants with significant alcohol consumption were not
excluded from the study, given that authors chose to apply the NAFLD definition. Please also
describe if a particular questionnaire was used to estimate the degree of alcohol consumption
- It is not clear how authors chose variables to be included in the multivariate logistic regression
model. Please specify. I also suspect that the association between hypertension, diabetes and
high FIB-4 could become not significant after adjusting for age. Could you please also include
age in the model?
- Related to the previous point authors should report Odds Ratios and not Hazard ratios, since
odds ratios are obtained from logistic regression. Did the authors convert them in HR? If so,
please describe how. It is also not clear how the OR/HR for albumin and WBC is reported. Is
it for a standard deviation increase?
- I believe the manuscript might gain in interest if these results were compared with
recent studies perfomed on the association between NAFLD and hypertension (doi: 10.1097/
MEG.0000000000002299 and doi: 10.1161/HYPERTENSIONAHA.120.15220)
assistant