Title: Association of Alpha-1 Acid Glycoprotein with Hepatic Steatosis and Liver Fibrosis
Among Women: A Population-Based Study
Version: 4 Date: 29 Jun 2025
Reviewer's report:
I have reviewed the revised manuscript titled "Association of Alpha-1 Acid Glycoprotein with
Hepatic Steatosis and Liver Fibrosis Among Women: A Population-Based Study" and the
authors’ detailed point-by-point response to reviewers.
The authors have adequately addressed the major comments from the prior review, including:
Explicit incorporation of the non-linear (L-shaped) relationship between AGP and LSM in the
abstract and main text;
Clarification of the study population restriction to women aged 18–49 years;
Careful handling of multicollinearity in the modeling strategy, supported by VIF analysis;
Execution of sensitivity analyses excluding hs-CRP (Tables S1, S2);
Confirmation that NHANES complex survey design (weights, strata, clusters) was applied to all
models, including non-linear and subgroup analyses;
Revision of figure captions and table formatting, and a clearer presentation of covariates.
The revised manuscript demonstrates improved clarity, and the Discussion section provides
a more thoughtful interpretation of the complex non-linear findings. However, a few minor
concerns remain:
Some sections, particularly the Discussion, still contain repetitive or awkward phrasing that
could benefit from additional language editing.
Interpretation of subgroup findings (especially where interaction p-values are marginal or non-
significant) should be presented more cautiously to avoid overstatement.
A few formatting details in Tables 1 and 2 could be further refined for consistency and
readability.
Overall, this is a scientifically sound and clinically relevant study that leverages a large,
nationally representative dataset to explore an under-investigated biomarker in liver health. With
minor revisions to language and presentation, the manuscript would be suitable for publication.
Title: Association of Alpha-1 Acid Glycoprotein with Hepatic Steatosis and Liver Fibrosis
Among Women: A Population-Based Study
Version: 4 Date: 29 Jun 2025
Reviewer's report:
I have reviewed the revised manuscript titled "Association of Alpha-1 Acid Glycoprotein with
Hepatic Steatosis and Liver Fibrosis Among Women: A Population-Based Study" and the
authors’ detailed point-by-point response to reviewers.
The authors have adequately addressed the major comments from the prior review, including:
Explicit incorporation of the non-linear (L-shaped) relationship between AGP and LSM in the
abstract and main text;
Clarification of the study population restriction to women aged 18–49 years;
Careful handling of multicollinearity in the modeling strategy, supported by VIF analysis;
Execution of sensitivity analyses excluding hs-CRP (Tables S1, S2);
Confirmation that NHANES complex survey design (weights, strata, clusters) was applied to all
models, including non-linear and subgroup analyses;
Revision of figure captions and table formatting, and a clearer presentation of covariates.
The revised manuscript demonstrates improved clarity, and the Discussion section provides
a more thoughtful interpretation of the complex non-linear findings. However, a few minor
concerns remain:
Some sections, particularly the Discussion, still contain repetitive or awkward phrasing that
could benefit from additional language editing.
Interpretation of subgroup findings (especially where interaction p-values are marginal or non-
significant) should be presented more cautiously to avoid overstatement.
A few formatting details in Tables 1 and 2 could be further refined for consistency and
readability.
Overall, this is a scientifically sound and clinically relevant study that leverages a large,
nationally representative dataset to explore an under-investigated biomarker in liver health. With
minor revisions to language and presentation, the manuscript would be suitable for publication.
Please review this paper.
user
Title: Association of Alpha-1 Acid Glycoprotein with Hepatic Steatosis and Liver Fibrosis
Among Women: A Population-Based Study
Version: 4 Date: 29 Jun 2025
Reviewer's report:
I have reviewed the revised manuscript titled "Association of Alpha-1 Acid Glycoprotein with
Hepatic Steatosis and Liver Fibrosis Among Women: A Population-Based Study" and the
authors’ detailed point-by-point response to reviewers.
The authors have adequately addressed the major comments from the prior review, including:
Explicit incorporation of the non-linear (L-shaped) relationship between AGP and LSM in the
abstract and main text;
Clarification of the study population restriction to women aged 18–49 years;
Careful handling of multicollinearity in the modeling strategy, supported by VIF analysis;
Execution of sensitivity analyses excluding hs-CRP (Tables S1, S2);
Confirmation that NHANES complex survey design (weights, strata, clusters) was applied to all
models, including non-linear and subgroup analyses;
Revision of figure captions and table formatting, and a clearer presentation of covariates.
The revised manuscript demonstrates improved clarity, and the Discussion section provides
a more thoughtful interpretation of the complex non-linear findings. However, a few minor
concerns remain:
Some sections, particularly the Discussion, still contain repetitive or awkward phrasing that
could benefit from additional language editing.
Interpretation of subgroup findings (especially where interaction p-values are marginal or non-
significant) should be presented more cautiously to avoid overstatement.
A few formatting details in Tables 1 and 2 could be further refined for consistency and
readability.
Overall, this is a scientifically sound and clinically relevant study that leverages a large,
nationally representative dataset to explore an under-investigated biomarker in liver health. With
minor revisions to language and presentation, the manuscript would be suitable for publication.
assistant