Title: Association of Life’s Essential 8 with Mortalities in Patients with Alcohol-Related Liver
Disease
Version: 0 Date: 11 Jul 2024
Reviewer:  Yi-Chuan Yu
Reviewer's report:
The authors seek to study the relationships between the LE8 score and the mortality rate of CVD.
I have the following recommendations/comments:
1. If the outcome is the mortality rate of ALD, then the title should reflect such to avoid
confusion. For example, Association between Life’s Essential 8 and all-cause mortality among
Alcoholic Disease Patients.
2. I’m a bit confused about the first sentence in the introduction section. ALD will lead to the
development of liver cancer or liver cirrhosis. Does the author mean that 25% and 30% of liver
cirrhosis and liver cancer deaths are due to ALD?
3. The authors may consider elaborating more on the following statement: “ALD and
cardiovascular diseases share some common risk factors. Meanwhile, previous studies have
mostly focused on individual factors affecting prognosis, neglecting the overall impact of
healthy lifestyles. Therefore, heart protection recommendations represented by the LE8 score
may also be effective in improving the prognosis of ALD. ” Some questions that should be
answered here: (1) what are the relationships between LE8 and CVD? (2) How LE8 can represent
the overall impact of healthy lifestyles? (3) what is the relationship between CVD and ALD?
(4) In which way does WHICH individual factor affect WHAT prognosis?
4. Please include the percentage of exclusion in the figure and the text. In addition, the reasons
for these exclusions should also be discussed briefly in the text.
5. Since LE8 is used as the exposure of interest, a detailed explanation of how LE is derived
should be included in the article.
6. NHANES is not so representative of the US population. To be fully representative, the study
sample is expected to share the same characteristics as the target population, which is a very
difficult thing to do. I recommend the authors remove related statements.
7. How is the follow-up time treated in the Cox model?
8. Please provide a copy of the Schoenfeld residual plot. Besides, the current analysis does not
seem to be commonly used in a cross-sectional study design.
9. How are interaction terms handled in the analysis? Please provide some details in the text.
10.Please include the in-text citation for R.
11. In the limitation section of the study, additional text should be added to explain how these
limitations affect the results. For example, in which direction does recall bias in this study affect
the study results?
12. Some grammar or spelling checks should be done before the submission. For example, it is
“demonstrated” not “demontrated”. There are 2 “the” in the following statement: “The results
of the subgroup analyses in Figure 4 indicated that the the association of LE8 score and all-
cause mortality…”.
Title: Association of Life’s Essential 8 with Mortalities in Patients with Alcohol-Related Liver
Disease
Version: 0 Date: 11 Jul 2024
Reviewer:  Yi-Chuan Yu
Reviewer's report:
The authors seek to study the relationships between the LE8 score and the mortality rate of CVD.
I have the following recommendations/comments:
1. If the outcome is the mortality rate of ALD, then the title should reflect such to avoid
confusion. For example, Association between Life’s Essential 8 and all-cause mortality among
Alcoholic Disease Patients.
2. I’m a bit confused about the first sentence in the introduction section. ALD will lead to the
development of liver cancer or liver cirrhosis. Does the author mean that 25% and 30% of liver
cirrhosis and liver cancer deaths are due to ALD?
3. The authors may consider elaborating more on the following statement: “ALD and
cardiovascular diseases share some common risk factors. Meanwhile, previous studies have
mostly focused on individual factors affecting prognosis, neglecting the overall impact of
healthy lifestyles. Therefore, heart protection recommendations represented by the LE8 score
may also be effective in improving the prognosis of ALD. ” Some questions that should be
answered here: (1) what are the relationships between LE8 and CVD? (2) How LE8 can represent
the overall impact of healthy lifestyles? (3) what is the relationship between CVD and ALD?
(4) In which way does WHICH individual factor affect WHAT prognosis?
4. Please include the percentage of exclusion in the figure and the text. In addition, the reasons
for these exclusions should also be discussed briefly in the text.
5. Since LE8 is used as the exposure of interest, a detailed explanation of how LE is derived
should be included in the article.
6. NHANES is not so representative of the US population. To be fully representative, the study
sample is expected to share the same characteristics as the target population, which is a very
difficult thing to do. I recommend the authors remove related statements.
7. How is the follow-up time treated in the Cox model?
8. Please provide a copy of the Schoenfeld residual plot. Besides, the current analysis does not
seem to be commonly used in a cross-sectional study design.
9. How are interaction terms handled in the analysis? Please provide some details in the text.
10.Please include the in-text citation for R.
11. In the limitation section of the study, additional text should be added to explain how these
limitations affect the results. For example, in which direction does recall bias in this study affect
the study results?
12. Some grammar or spelling checks should be done before the submission. For example, it is
“demonstrated” not “demontrated”. There are 2 “the” in the following statement: “The results
of the subgroup analyses in Figure 4 indicated that the the association of LE8 score and all-
cause mortality…”.
Please review this paper.
user
Title: Association of Life’s Essential 8 with Mortalities in Patients with Alcohol-Related Liver
Disease
Version: 0 Date: 11 Jul 2024
Reviewer:  Yi-Chuan Yu
Reviewer's report:
The authors seek to study the relationships between the LE8 score and the mortality rate of CVD.
I have the following recommendations/comments:
1. If the outcome is the mortality rate of ALD, then the title should reflect such to avoid
confusion. For example, Association between Life’s Essential 8 and all-cause mortality among
Alcoholic Disease Patients.
2. I’m a bit confused about the first sentence in the introduction section. ALD will lead to the
development of liver cancer or liver cirrhosis. Does the author mean that 25% and 30% of liver
cirrhosis and liver cancer deaths are due to ALD?
3. The authors may consider elaborating more on the following statement: “ALD and
cardiovascular diseases share some common risk factors. Meanwhile, previous studies have
mostly focused on individual factors affecting prognosis, neglecting the overall impact of
healthy lifestyles. Therefore, heart protection recommendations represented by the LE8 score
may also be effective in improving the prognosis of ALD. ” Some questions that should be
answered here: (1) what are the relationships between LE8 and CVD? (2) How LE8 can represent
the overall impact of healthy lifestyles? (3) what is the relationship between CVD and ALD?
(4) In which way does WHICH individual factor affect WHAT prognosis?
4. Please include the percentage of exclusion in the figure and the text. In addition, the reasons
for these exclusions should also be discussed briefly in the text.
5. Since LE8 is used as the exposure of interest, a detailed explanation of how LE is derived
should be included in the article.
6. NHANES is not so representative of the US population. To be fully representative, the study
sample is expected to share the same characteristics as the target population, which is a very
difficult thing to do. I recommend the authors remove related statements.
7. How is the follow-up time treated in the Cox model?
8. Please provide a copy of the Schoenfeld residual plot. Besides, the current analysis does not
seem to be commonly used in a cross-sectional study design.
9. How are interaction terms handled in the analysis? Please provide some details in the text.
10.Please include the in-text citation for R.
11. In the limitation section of the study, additional text should be added to explain how these
limitations affect the results. For example, in which direction does recall bias in this study affect
the study results?
12. Some grammar or spelling checks should be done before the submission. For example, it is
“demonstrated” not “demontrated”. There are 2 “the” in the following statement: “The results
of the subgroup analyses in Figure 4 indicated that the the association of LE8 score and all-
cause mortality…”.
assistant