Title: Association of “A Body Shape Index” with the risk of developing colorectal cancer in
U.S. patients with metabolic syndrome: Evidence from the NHANES 1999-2018
Version: 1 Date: 16 Sep 2024
Reviewer:  Amira A A Othman
Reviewer's report:
First of all
I want to congratulate the authors on their work. In this study, Kurexi et al used data from
the 1999-2018 National Health and Nutrition Examination Survey (NHANES) for Americans,
this research aims to investigate the association between “A Body Shape Index” and the risk
of developing colorectal cancer among individuals with MetS utilizing data from the National
Health and Nutrition Examination Survey (NHANES).
The second-highest cancer-related death rate is linked to colorectal cancer, one of the three
most common types of cancer worldwide*. Traditional body-shape indices such as Waist
Circumference (WC), Hip Circumference (HC), and Waist-to-Hip Ratio (WHR) are associated
with colorectal cancer (CRC) risk, but are correlated with Body Mass Index (BMI), and
adjustment for BMI introduces a strong correlation with height**. However, these factors do
not provide any additional insights into the etiology or differential risk of colorectal cancer.
(*:doi.org/10.3322/caac.21660, ** doi.org/10.1038/s41366-024-01479-6)
The authors tried to contribute to this field of research with new findings, nevertheless, there is
an observation for which sufficient justification must be obtained.
In Title:
1. The authors may consider indicating the locality at which the National Health and Nutrition
Examination Survey (NHANES) was performed and the age of the participants.
I suggest “Association of “A Body Shape Index” with the risk of developing colorectal cancer
in adult US patients with metabolic syndrome: Evidence from the NHANES 1999-2018”
2. Could you please explain why NHANES 2019-2020 was excluded?
In Abstract section
3. The type of the study is to be mentioned.
4. More data about the enrolled patients are to be mentioned (ex. Age, sex, etc.)
5. It would help if you described the aim of your statistical analysis. For example, Multivariate
linear regression models were used to examine the linear connection between A Body Shape
Index and colorectal cancer incidence. Fitted smoothing curves and threshold effect analysis
were used to describe the nonlinear relationship.
In the Introduction section:
6. Try to provide a summarized description of The National Health and Nutrition Examination
Survey (NHANES) in the background section. You may use the following
“NHANES (www.cdc.gov/nchs/nhanes) is designed to assess the health and nutritional status
of adults and children in the United States. The survey is distinctive in that it incorporates
both physical examinations and interviews. Several cross-sectional, nationally representative
health examination surveys are part of the NHANES program. Questions about demographics,
health insurance status, dietary habits, acute and chronic medical issues, mental health, and
prescription drug use are all included in the health interview. Exam components can change
between survey cycles but typically include blood pressure, dental exams, vision, hearing,
dermatology, fitness, balance and strength testing, respiratory testing, taste and smell, and
body measurements (weight, height, skin folds, body composition scans). Hematology, organ
and endocrine function (e.g., thyroid, kidney), environmental exposure, dietary biomarkers,
metabolic and cardiovascular health, and infectious disease are a few examples of laboratory
components.”.
7. Authors must give an account of A Body Shape Index (ABSI), specifically developed
as a transformation of waist circumference (WC), statistically independent of BMI to better
evaluate the relative contribution of WC to central obesity and clinical outcomes. Please give
an account of its calculation and importance as a predictor for MetS, etc. (doi: 10.1371/
journal.pone.0185013).
8. “To our knowledge, no study has explored the association between abdominal obesity levels
assessed by the ABSI and the risk of developing CRC among patients with MetS”. Please
explain this sentence in the notion of doi: 10.3389/fmed.2023.1208489 and doi: 10.1186/
s12885-023-10762-0.
In the Methods section:
9. What are the diagnostic criteria for CRC?
10. What was the source of the covariate data?
11. Statistical analysis:
- Continuous variables were presented as mean ± standard deviation.
- In logistic regression analyses, is it multivariate or univariate? Please identify.
In the Results section:
12. In Tables: You can title the statistical test column as “Test of significance” and use U= for
the Mann–Whitney U test, T= for the T-test, and #2 = for the Chi-square test, etc.
13. Subgroup analyses must be performed to evaluate the association between “A Body Shape
Index” and the risk of developing colorectal cancer among individuals with MetS utilizing
data from the National Health and Nutrition Examination Survey. Subgroup analyses based on
differences in diagnostic components were performed to elaborate correlations. The results were
presented in forest plots using odds ratios (ORs) and 95% confidence intervals (CIs).
14. Log2 logarithmic transformation shall be analyzed.
15. Future article readers may not know whether the above-mentioned variables were originally
collected as continuous data during data collection by NHANES, or whether the data were
originally categorized in the current study. In addition, in case there is a methodology article
published by NHANES or by other authors that specifically describes the variables, the authors
of the current study may consider citing that paper in the methodology section where the authors
of the current study mentioned the NHANES website.
16. The marital status category should be categorized into cohabitation (married/living with a
partner) and solitude (widowed/divorced/separated/unmarried).”
In the Discussion section:
17. The discussion section is one of the final parts of a research paper, in which an author
describes, analyzes, and interprets their findings. They explain the significance of those results
and tie everything back to the research question(s). In this manuscript, there is confusion between
what should be written in the introduction section and the discussion section. Please reconstruct
the discussion section.
18. The bias associated with using a self-reported outcome variable was not mentioned by the
authors. Since the majority of gallstones are clinically silent, it is possible to incorrectly diagnose
someone as having or not having gallstones. Results could get skewed as a result.
In the conclusion section:
19. The conclusion should restate your main points and provide closure.
- Significant association: a positive or negative correlation, to be precise.
Title: Association of “A Body Shape Index” with the risk of developing colorectal cancer in
U.S. patients with metabolic syndrome: Evidence from the NHANES 1999-2018
Version: 1 Date: 16 Sep 2024
Reviewer:  Amira A A Othman
Reviewer's report:
First of all
I want to congratulate the authors on their work. In this study, Kurexi et al used data from
the 1999-2018 National Health and Nutrition Examination Survey (NHANES) for Americans,
this research aims to investigate the association between “A Body Shape Index” and the risk
of developing colorectal cancer among individuals with MetS utilizing data from the National
Health and Nutrition Examination Survey (NHANES).
The second-highest cancer-related death rate is linked to colorectal cancer, one of the three
most common types of cancer worldwide*. Traditional body-shape indices such as Waist
Circumference (WC), Hip Circumference (HC), and Waist-to-Hip Ratio (WHR) are associated
with colorectal cancer (CRC) risk, but are correlated with Body Mass Index (BMI), and
adjustment for BMI introduces a strong correlation with height**. However, these factors do
not provide any additional insights into the etiology or differential risk of colorectal cancer.
(*:doi.org/10.3322/caac.21660, ** doi.org/10.1038/s41366-024-01479-6)
The authors tried to contribute to this field of research with new findings, nevertheless, there is
an observation for which sufficient justification must be obtained.
In Title:
1. The authors may consider indicating the locality at which the National Health and Nutrition
Examination Survey (NHANES) was performed and the age of the participants.
I suggest “Association of “A Body Shape Index” with the risk of developing colorectal cancer
in adult US patients with metabolic syndrome: Evidence from the NHANES 1999-2018”
2. Could you please explain why NHANES 2019-2020 was excluded?
In Abstract section
3. The type of the study is to be mentioned.
4. More data about the enrolled patients are to be mentioned (ex. Age, sex, etc.)
5. It would help if you described the aim of your statistical analysis. For example, Multivariate
linear regression models were used to examine the linear connection between A Body Shape
Index and colorectal cancer incidence. Fitted smoothing curves and threshold effect analysis
were used to describe the nonlinear relationship.
In the Introduction section:
6. Try to provide a summarized description of The National Health and Nutrition Examination
Survey (NHANES) in the background section. You may use the following
“NHANES (www.cdc.gov/nchs/nhanes) is designed to assess the health and nutritional status
of adults and children in the United States. The survey is distinctive in that it incorporates
both physical examinations and interviews. Several cross-sectional, nationally representative
health examination surveys are part of the NHANES program. Questions about demographics,
health insurance status, dietary habits, acute and chronic medical issues, mental health, and
prescription drug use are all included in the health interview. Exam components can change
between survey cycles but typically include blood pressure, dental exams, vision, hearing,
dermatology, fitness, balance and strength testing, respiratory testing, taste and smell, and
body measurements (weight, height, skin folds, body composition scans). Hematology, organ
and endocrine function (e.g., thyroid, kidney), environmental exposure, dietary biomarkers,
metabolic and cardiovascular health, and infectious disease are a few examples of laboratory
components.”.
7. Authors must give an account of A Body Shape Index (ABSI), specifically developed
as a transformation of waist circumference (WC), statistically independent of BMI to better
evaluate the relative contribution of WC to central obesity and clinical outcomes. Please give
an account of its calculation and importance as a predictor for MetS, etc. (doi: 10.1371/
journal.pone.0185013).
8. “To our knowledge, no study has explored the association between abdominal obesity levels
assessed by the ABSI and the risk of developing CRC among patients with MetS”. Please
explain this sentence in the notion of doi: 10.3389/fmed.2023.1208489 and doi: 10.1186/
s12885-023-10762-0.
In the Methods section:
9. What are the diagnostic criteria for CRC?
10. What was the source of the covariate data?
11. Statistical analysis:
- Continuous variables were presented as mean ± standard deviation.
- In logistic regression analyses, is it multivariate or univariate? Please identify.
In the Results section:
12. In Tables: You can title the statistical test column as “Test of significance” and use U= for
the Mann–Whitney U test, T= for the T-test, and #2 = for the Chi-square test, etc.
13. Subgroup analyses must be performed to evaluate the association between “A Body Shape
Index” and the risk of developing colorectal cancer among individuals with MetS utilizing
data from the National Health and Nutrition Examination Survey. Subgroup analyses based on
differences in diagnostic components were performed to elaborate correlations. The results were
presented in forest plots using odds ratios (ORs) and 95% confidence intervals (CIs).
14. Log2 logarithmic transformation shall be analyzed.
15. Future article readers may not know whether the above-mentioned variables were originally
collected as continuous data during data collection by NHANES, or whether the data were
originally categorized in the current study. In addition, in case there is a methodology article
published by NHANES or by other authors that specifically describes the variables, the authors
of the current study may consider citing that paper in the methodology section where the authors
of the current study mentioned the NHANES website.
16. The marital status category should be categorized into cohabitation (married/living with a
partner) and solitude (widowed/divorced/separated/unmarried).”
In the Discussion section:
17. The discussion section is one of the final parts of a research paper, in which an author
describes, analyzes, and interprets their findings. They explain the significance of those results
and tie everything back to the research question(s). In this manuscript, there is confusion between
what should be written in the introduction section and the discussion section. Please reconstruct
the discussion section.
18. The bias associated with using a self-reported outcome variable was not mentioned by the
authors. Since the majority of gallstones are clinically silent, it is possible to incorrectly diagnose
someone as having or not having gallstones. Results could get skewed as a result.
In the conclusion section:
19. The conclusion should restate your main points and provide closure.
- Significant association: a positive or negative correlation, to be precise.
Please review this paper.
user
Title: Association of “A Body Shape Index” with the risk of developing colorectal cancer in
U.S. patients with metabolic syndrome: Evidence from the NHANES 1999-2018
Version: 1 Date: 16 Sep 2024
Reviewer:  Amira A A Othman
Reviewer's report:
First of all
I want to congratulate the authors on their work. In this study, Kurexi et al used data from
the 1999-2018 National Health and Nutrition Examination Survey (NHANES) for Americans,
this research aims to investigate the association between “A Body Shape Index” and the risk
of developing colorectal cancer among individuals with MetS utilizing data from the National
Health and Nutrition Examination Survey (NHANES).
The second-highest cancer-related death rate is linked to colorectal cancer, one of the three
most common types of cancer worldwide*. Traditional body-shape indices such as Waist
Circumference (WC), Hip Circumference (HC), and Waist-to-Hip Ratio (WHR) are associated
with colorectal cancer (CRC) risk, but are correlated with Body Mass Index (BMI), and
adjustment for BMI introduces a strong correlation with height**. However, these factors do
not provide any additional insights into the etiology or differential risk of colorectal cancer.
(*:doi.org/10.3322/caac.21660, ** doi.org/10.1038/s41366-024-01479-6)
The authors tried to contribute to this field of research with new findings, nevertheless, there is
an observation for which sufficient justification must be obtained.
In Title:
1. The authors may consider indicating the locality at which the National Health and Nutrition
Examination Survey (NHANES) was performed and the age of the participants.
I suggest “Association of “A Body Shape Index” with the risk of developing colorectal cancer
in adult US patients with metabolic syndrome: Evidence from the NHANES 1999-2018”
2. Could you please explain why NHANES 2019-2020 was excluded?
In Abstract section
3. The type of the study is to be mentioned.
4. More data about the enrolled patients are to be mentioned (ex. Age, sex, etc.)
5. It would help if you described the aim of your statistical analysis. For example, Multivariate
linear regression models were used to examine the linear connection between A Body Shape
Index and colorectal cancer incidence. Fitted smoothing curves and threshold effect analysis
were used to describe the nonlinear relationship.
In the Introduction section:
6. Try to provide a summarized description of The National Health and Nutrition Examination
Survey (NHANES) in the background section. You may use the following
“NHANES (www.cdc.gov/nchs/nhanes) is designed to assess the health and nutritional status
of adults and children in the United States. The survey is distinctive in that it incorporates
both physical examinations and interviews. Several cross-sectional, nationally representative
health examination surveys are part of the NHANES program. Questions about demographics,
health insurance status, dietary habits, acute and chronic medical issues, mental health, and
prescription drug use are all included in the health interview. Exam components can change
between survey cycles but typically include blood pressure, dental exams, vision, hearing,
dermatology, fitness, balance and strength testing, respiratory testing, taste and smell, and
body measurements (weight, height, skin folds, body composition scans). Hematology, organ
and endocrine function (e.g., thyroid, kidney), environmental exposure, dietary biomarkers,
metabolic and cardiovascular health, and infectious disease are a few examples of laboratory
components.”.
7. Authors must give an account of A Body Shape Index (ABSI), specifically developed
as a transformation of waist circumference (WC), statistically independent of BMI to better
evaluate the relative contribution of WC to central obesity and clinical outcomes. Please give
an account of its calculation and importance as a predictor for MetS, etc. (doi: 10.1371/
journal.pone.0185013).
8. “To our knowledge, no study has explored the association between abdominal obesity levels
assessed by the ABSI and the risk of developing CRC among patients with MetS”. Please
explain this sentence in the notion of doi: 10.3389/fmed.2023.1208489 and doi: 10.1186/
s12885-023-10762-0.
In the Methods section:
9. What are the diagnostic criteria for CRC?
10. What was the source of the covariate data?
11. Statistical analysis:
- Continuous variables were presented as mean ± standard deviation.
- In logistic regression analyses, is it multivariate or univariate? Please identify.
In the Results section:
12. In Tables: You can title the statistical test column as “Test of significance” and use U= for
the Mann–Whitney U test, T= for the T-test, and #2 = for the Chi-square test, etc.
13. Subgroup analyses must be performed to evaluate the association between “A Body Shape
Index” and the risk of developing colorectal cancer among individuals with MetS utilizing
data from the National Health and Nutrition Examination Survey. Subgroup analyses based on
differences in diagnostic components were performed to elaborate correlations. The results were
presented in forest plots using odds ratios (ORs) and 95% confidence intervals (CIs).
14. Log2 logarithmic transformation shall be analyzed.
15. Future article readers may not know whether the above-mentioned variables were originally
collected as continuous data during data collection by NHANES, or whether the data were
originally categorized in the current study. In addition, in case there is a methodology article
published by NHANES or by other authors that specifically describes the variables, the authors
of the current study may consider citing that paper in the methodology section where the authors
of the current study mentioned the NHANES website.
16. The marital status category should be categorized into cohabitation (married/living with a
partner) and solitude (widowed/divorced/separated/unmarried).”
In the Discussion section:
17. The discussion section is one of the final parts of a research paper, in which an author
describes, analyzes, and interprets their findings. They explain the significance of those results
and tie everything back to the research question(s). In this manuscript, there is confusion between
what should be written in the introduction section and the discussion section. Please reconstruct
the discussion section.
18. The bias associated with using a self-reported outcome variable was not mentioned by the
authors. Since the majority of gallstones are clinically silent, it is possible to incorrectly diagnose
someone as having or not having gallstones. Results could get skewed as a result.
In the conclusion section:
19. The conclusion should restate your main points and provide closure.
- Significant association: a positive or negative correlation, to be precise.
assistant