Title: Association between the cardiometabolic index and non-alcoholic fatty liver disease:
insights from a general population
Version: 0 Date: 29 Aug 2021
Reviewer's report:
Dr. Jiawang Zou et al. have reported that higher cardiometabolic index (CMI) has independent
association with NAFLD risk in the general population. They use big data and analyze them in
detail. This study is an interesting study that can find NAFLD patients in the general population
using CMI, which calculated as Waist-to-height ratio (WHtR) multiplied by TG/HDL-C ratio.
I have some questions and comments, however, that I believe the authors need to address, as
follows:
1. Wakabayashi I et al. reported (Clin Chim Acta. 2015) that CMI is repeatable marker for the
effective identification of hyperglycemia and diabetes. They showed the cutoff values of CMI
for hyperglycemia and diabetes were determined to be 0.799 and 0.800, respectively, in women
and to be 1.625 and 1.748, respectively, in men.
In this manuscript, the authors showed that there is a strong positive correlation between higher
CMI and the risk of NAFLD in the general population.  If so, they should indicate a cutoff value
for CMI to determine NAFLD.
2. Based on the results of this study, can waist circumference, height, triglycerides, and HDL
cholesterol (CMI) be used to diagnose NAFLD non-invasively, and how accurate can it be said
to be?
3. The authors have often analyzed the relationship between CMI and NAFLD, but have they
analyzed the relationship with fibrosis using, for example, the FIB-4 Index? If so, the data should
be presented.
1. Please change ‘WhtR’ in line 2 on table 1, to ‘WHtR’.
Title: Association between the cardiometabolic index and non-alcoholic fatty liver disease:
insights from a general population
Version: 0 Date: 29 Aug 2021
Reviewer's report:
Dr. Jiawang Zou et al. have reported that higher cardiometabolic index (CMI) has independent
association with NAFLD risk in the general population. They use big data and analyze them in
detail. This study is an interesting study that can find NAFLD patients in the general population
using CMI, which calculated as Waist-to-height ratio (WHtR) multiplied by TG/HDL-C ratio.
I have some questions and comments, however, that I believe the authors need to address, as
follows:
1. Wakabayashi I et al. reported (Clin Chim Acta. 2015) that CMI is repeatable marker for the
effective identification of hyperglycemia and diabetes. They showed the cutoff values of CMI
for hyperglycemia and diabetes were determined to be 0.799 and 0.800, respectively, in women
and to be 1.625 and 1.748, respectively, in men.
In this manuscript, the authors showed that there is a strong positive correlation between higher
CMI and the risk of NAFLD in the general population.  If so, they should indicate a cutoff value
for CMI to determine NAFLD.
2. Based on the results of this study, can waist circumference, height, triglycerides, and HDL
cholesterol (CMI) be used to diagnose NAFLD non-invasively, and how accurate can it be said
to be?
3. The authors have often analyzed the relationship between CMI and NAFLD, but have they
analyzed the relationship with fibrosis using, for example, the FIB-4 Index? If so, the data should
be presented.
1. Please change ‘WhtR’ in line 2 on table 1, to ‘WHtR’.
Please review this paper.
user
Title: Association between the cardiometabolic index and non-alcoholic fatty liver disease:
insights from a general population
Version: 0 Date: 29 Aug 2021
Reviewer's report:
Dr. Jiawang Zou et al. have reported that higher cardiometabolic index (CMI) has independent
association with NAFLD risk in the general population. They use big data and analyze them in
detail. This study is an interesting study that can find NAFLD patients in the general population
using CMI, which calculated as Waist-to-height ratio (WHtR) multiplied by TG/HDL-C ratio.
I have some questions and comments, however, that I believe the authors need to address, as
follows:
1. Wakabayashi I et al. reported (Clin Chim Acta. 2015) that CMI is repeatable marker for the
effective identification of hyperglycemia and diabetes. They showed the cutoff values of CMI
for hyperglycemia and diabetes were determined to be 0.799 and 0.800, respectively, in women
and to be 1.625 and 1.748, respectively, in men.
In this manuscript, the authors showed that there is a strong positive correlation between higher
CMI and the risk of NAFLD in the general population.  If so, they should indicate a cutoff value
for CMI to determine NAFLD.
2. Based on the results of this study, can waist circumference, height, triglycerides, and HDL
cholesterol (CMI) be used to diagnose NAFLD non-invasively, and how accurate can it be said
to be?
3. The authors have often analyzed the relationship between CMI and NAFLD, but have they
analyzed the relationship with fibrosis using, for example, the FIB-4 Index? If so, the data should
be presented.
1. Please change ‘WhtR’ in line 2 on table 1, to ‘WHtR’.
assistant