Title: Elevated fasting glucose level increases the risk of fatty liver disease: A 10-year study
of 31,154 individuals
Version: 1 Date: 23 Aug 2022
Reviewer's report:
This is a retrospective observational  study aimed to analyze the relationship of elevated fasting
glucose level with FLD.  31,154 patients were  enrolled in the study who were evaluated in the
hospital over a 10 year period.
The study is well designed and evaluates multiple risk factors associated with FLD. However I
will recommend some revisions before acceptance.
1. Introduction mentions that ' This study aimed to analyze the median time-to-onset, cumulative
prevalence and influencing factors for the occurrence of FLD in medical examiners.'  Please
elaborate and answer these questions in the conclusion section
2. Introduction mentions that 'This study aimed to analyze the median time-to-onset, cumulative
prevalence and influencing factors for the occurrence of FLD in medical examiners. ' I think you
meant to say examinees (not examiners). Please edit that
3. Another limitation worth discussing is the confounding factors associated with high FBG
and incidence of FLD. Patients with metabolic syndrome, obesity are at higher risk of both pre-
diabetes, diabetes and FLD.
4. In the results section you have mentioned the median time to onset of FLD was 5.2 years. Is
the 5.2 years after the first diagnosis of elevated FBG ? can you please elaborate.
Similarly when you mention the 1, 3, 5, 7 year prevalence rates, is that the time period from
the first diagnosis of FBG ?
5. Exclusion criteria does not include patients with pre-diabetes and diabetes. These patients are
already at a higher risk of FLD and will alter the results of the study.  It  is a major limitation
of the study and should be mentioned
Title: Elevated fasting glucose level increases the risk of fatty liver disease: A 10-year study
of 31,154 individuals
Version: 1 Date: 23 Aug 2022
Reviewer's report:
This is a retrospective observational  study aimed to analyze the relationship of elevated fasting
glucose level with FLD.  31,154 patients were  enrolled in the study who were evaluated in the
hospital over a 10 year period.
The study is well designed and evaluates multiple risk factors associated with FLD. However I
will recommend some revisions before acceptance.
1. Introduction mentions that ' This study aimed to analyze the median time-to-onset, cumulative
prevalence and influencing factors for the occurrence of FLD in medical examiners.'  Please
elaborate and answer these questions in the conclusion section
2. Introduction mentions that 'This study aimed to analyze the median time-to-onset, cumulative
prevalence and influencing factors for the occurrence of FLD in medical examiners. ' I think you
meant to say examinees (not examiners). Please edit that
3. Another limitation worth discussing is the confounding factors associated with high FBG
and incidence of FLD. Patients with metabolic syndrome, obesity are at higher risk of both pre-
diabetes, diabetes and FLD.
4. In the results section you have mentioned the median time to onset of FLD was 5.2 years. Is
the 5.2 years after the first diagnosis of elevated FBG ? can you please elaborate.
Similarly when you mention the 1, 3, 5, 7 year prevalence rates, is that the time period from
the first diagnosis of FBG ?
5. Exclusion criteria does not include patients with pre-diabetes and diabetes. These patients are
already at a higher risk of FLD and will alter the results of the study.  It  is a major limitation
of the study and should be mentioned
Please review this paper.
user
Title: Elevated fasting glucose level increases the risk of fatty liver disease: A 10-year study
of 31,154 individuals
Version: 1 Date: 23 Aug 2022
Reviewer's report:
This is a retrospective observational  study aimed to analyze the relationship of elevated fasting
glucose level with FLD.  31,154 patients were  enrolled in the study who were evaluated in the
hospital over a 10 year period.
The study is well designed and evaluates multiple risk factors associated with FLD. However I
will recommend some revisions before acceptance.
1. Introduction mentions that ' This study aimed to analyze the median time-to-onset, cumulative
prevalence and influencing factors for the occurrence of FLD in medical examiners.'  Please
elaborate and answer these questions in the conclusion section
2. Introduction mentions that 'This study aimed to analyze the median time-to-onset, cumulative
prevalence and influencing factors for the occurrence of FLD in medical examiners. ' I think you
meant to say examinees (not examiners). Please edit that
3. Another limitation worth discussing is the confounding factors associated with high FBG
and incidence of FLD. Patients with metabolic syndrome, obesity are at higher risk of both pre-
diabetes, diabetes and FLD.
4. In the results section you have mentioned the median time to onset of FLD was 5.2 years. Is
the 5.2 years after the first diagnosis of elevated FBG ? can you please elaborate.
Similarly when you mention the 1, 3, 5, 7 year prevalence rates, is that the time period from
the first diagnosis of FBG ?
5. Exclusion criteria does not include patients with pre-diabetes and diabetes. These patients are
already at a higher risk of FLD and will alter the results of the study.  It  is a major limitation
of the study and should be mentioned
assistant