Reviewer ’s report  
 
Title:  Relationship of Body Weigh t with Gastrointestinal Motor and Sensory Function: Studies 
in Anorexia Nervosa and Obesity  
 
Version: 0 Date:  04 Aug 2016 
 
Reviewer:  Ping-Huei  Tseng  
 
Reviewer’s report:  
 
The authors prospectively analyzed patients with anorexia nervosa (AN) and obesity (OB) and  
normal weight healthy controls (HC) to evaluate the relationship of body weight and 
postprandial gastrointestinal function and concurrent sensations of satiation. The authors found 
that AN have slower gastric emptying (determined by MRI) and heightened vi sceral perception 
(determined by symptom scores) compared to HC and OB on cross -sectional comparison. 
Longitudinal follow -up after weight rehabilitation in AN suggests these GI dysmotility findings 
are probably secondary to other factors that determine abn ormal body weight. Generally, this 
study is well conducted and highlights the relationship of GI motor and sensory function with 
body weight based on the solid measurement of GI motility and immediate sensory score 
analysis. However, before reaching some o f the conclusions, several issues regarding the 
subjects and methods may need to be further clarified by the authors.  
 
1. The definition of "healthy" controls may need to be further defined. Are they symptomatic? 
From Table 1, it seems that some of the HC had GI symptoms on GCSI and LDQ. Further more, 
since most readers are not familiar with these GI and psychiatric questionnaires, index references 
may be cited and scoring rules may be introduced briefly in the method section.  
 
2. Age and gender have been f ound to affect the GI motility, even among the HC, in previous 
studies. It seems that in this study OB were older and more male (upto 30%, compared with 15% 
in HC and 0% in AN). Since the case number were relatively small and further age -, gender -
adjusted comparison may not be feasible, the authors may want to discuss more on the impact of 
gender. Whether the longer gastric emptying in the AN group are related to the fact of all female 
participants.  
 
3. Moreover, the menstrual period has been suggested to a ffect the gastric emptying. Did the 
authors consider this issue during case enrollment? If not, this issue may be listed as one of the 
study limitations.  
 
4. The authors have observed a negative association between t50 and BMI between 12 and 
25kg/m2. Howev er, these patients were comprised of AN patients and HC only. Therefore, the 
significance of BMI on the t50 may be affected by the factor of AN itself. Maybe the authors 
could separate the correlation analysis of BMI and gastric emptying in AN and HC, resp ectively.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
No 
 
Does the work include the necessary controls?  
If not, please specify which controls ar e required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you rec ommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially from the publication o f this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied  for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I h ave no competing interests' 
below. If your reply is yes to any, please give details below.  
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be included as confidential comments 
to the editors, which will not be published . 
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title:  Relationship of Body Weigh t with Gastrointestinal Motor and Sensory Function: Studies 
in Anorexia Nervosa and Obesity  
 
Version: 0 Date:  04 Aug 2016 
 
Reviewer:  Ping-Huei  Tseng  
 
Reviewer’s report:  
 
The authors prospectively analyzed patients with anorexia nervosa (AN) and obesity (OB) and  
normal weight healthy controls (HC) to evaluate the relationship of body weight and 
postprandial gastrointestinal function and concurrent sensations of satiation. The authors found 
that AN have slower gastric emptying (determined by MRI) and heightened vi sceral perception 
(determined by symptom scores) compared to HC and OB on cross -sectional comparison. 
Longitudinal follow -up after weight rehabilitation in AN suggests these GI dysmotility findings 
are probably secondary to other factors that determine abn ormal body weight. Generally, this 
study is well conducted and highlights the relationship of GI motor and sensory function with 
body weight based on the solid measurement of GI motility and immediate sensory score 
analysis. However, before reaching some o f the conclusions, several issues regarding the 
subjects and methods may need to be further clarified by the authors.  
 
1. The definition of "healthy" controls may need to be further defined. Are they symptomatic? 
From Table 1, it seems that some of the HC had GI symptoms on GCSI and LDQ. Further more, 
since most readers are not familiar with these GI and psychiatric questionnaires, index references 
may be cited and scoring rules may be introduced briefly in the method section.  
 
2. Age and gender have been f ound to affect the GI motility, even among the HC, in previous 
studies. It seems that in this study OB were older and more male (upto 30%, compared with 15% 
in HC and 0% in AN). Since the case number were relatively small and further age -, gender -
adjusted comparison may not be feasible, the authors may want to discuss more on the impact of 
gender. Whether the longer gastric emptying in the AN group are related to the fact of all female 
participants.  
 
3. Moreover, the menstrual period has been suggested to a ffect the gastric emptying. Did the 
authors consider this issue during case enrollment? If not, this issue may be listed as one of the 
study limitations.  
 
4. The authors have observed a negative association between t50 and BMI between 12 and 
25kg/m2. Howev er, these patients were comprised of AN patients and HC only. Therefore, the 
significance of BMI on the t50 may be affected by the factor of AN itself. Maybe the authors 
could separate the correlation analysis of BMI and gastric emptying in AN and HC, resp ectively.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
No 
 
Does the work include the necessary controls?  
If not, please specify which controls ar e required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you rec ommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially from the publication o f this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied  for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I h ave no competing interests' 
below. If your reply is yes to any, please give details below.  
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be included as confidential comments 
to the editors, which will not be published . 
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title:  Relationship of Body Weigh t with Gastrointestinal Motor and Sensory Function: Studies 
in Anorexia Nervosa and Obesity  
 
Version: 0 Date:  04 Aug 2016 
 
Reviewer:  Ping-Huei  Tseng  
 
Reviewer’s report:  
 
The authors prospectively analyzed patients with anorexia nervosa (AN) and obesity (OB) and  
normal weight healthy controls (HC) to evaluate the relationship of body weight and 
postprandial gastrointestinal function and concurrent sensations of satiation. The authors found 
that AN have slower gastric emptying (determined by MRI) and heightened vi sceral perception 
(determined by symptom scores) compared to HC and OB on cross -sectional comparison. 
Longitudinal follow -up after weight rehabilitation in AN suggests these GI dysmotility findings 
are probably secondary to other factors that determine abn ormal body weight. Generally, this 
study is well conducted and highlights the relationship of GI motor and sensory function with 
body weight based on the solid measurement of GI motility and immediate sensory score 
analysis. However, before reaching some o f the conclusions, several issues regarding the 
subjects and methods may need to be further clarified by the authors.  
 
1. The definition of "healthy" controls may need to be further defined. Are they symptomatic? 
From Table 1, it seems that some of the HC had GI symptoms on GCSI and LDQ. Further more, 
since most readers are not familiar with these GI and psychiatric questionnaires, index references 
may be cited and scoring rules may be introduced briefly in the method section.  
 
2. Age and gender have been f ound to affect the GI motility, even among the HC, in previous 
studies. It seems that in this study OB were older and more male (upto 30%, compared with 15% 
in HC and 0% in AN). Since the case number were relatively small and further age -, gender -
adjusted comparison may not be feasible, the authors may want to discuss more on the impact of 
gender. Whether the longer gastric emptying in the AN group are related to the fact of all female 
participants.  
 
3. Moreover, the menstrual period has been suggested to a ffect the gastric emptying. Did the 
authors consider this issue during case enrollment? If not, this issue may be listed as one of the 
study limitations.  
 
4. The authors have observed a negative association between t50 and BMI between 12 and 
25kg/m2. Howev er, these patients were comprised of AN patients and HC only. Therefore, the 
significance of BMI on the t50 may be affected by the factor of AN itself. Maybe the authors 
could separate the correlation analysis of BMI and gastric emptying in AN and HC, resp ectively.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
No 
 
Does the work include the necessary controls?  
If not, please specify which controls ar e required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you rec ommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially from the publication o f this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied  for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I h ave no competing interests' 
below. If your reply is yes to any, please give details below.  
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be included as confidential comments 
to the editors, which will not be published . 
 
I agree to the open peer review policy of the journal  
assistant