Reviewer ’s report  
 
Title: Anthropometric, Biochemical and Clinical Assessment  of Malnutrition among Egyptian 
Children w ith Chronic Liver Diseases: A Single Institutional Cross -sectional Study  
 
Version: 0 Date: 27 Mar 2019  
 
Reviewer: Claudia Mandato  
 
Reviewer's report:  
 
The manuscript entitled "Anthropometric, Biochemical and Clinical Assessment of Malnutrition 
among Egyptian Children with Chronic Liver Diseases: A Single Institutional Cross -sectional 
Study" analyzes the  nutritional status of children affected by chronic liver disfunction and its 
relations to  markers of disease severity. This is a crucial topic as malnutrition  has been related 
to a worse prognosis in this population of children.  
 
 
I have some concern rega rding the manuscript:  
 
1. Introduction and discussion section does not refer to the most recent pubblications in this field: 
Nutritional Needs and Support for Children with Chronic Liver Disease, Nutrients 2017, 9, 1127; 
doi:10.3390/nu9101127 ; EASL Clinica l Practice Guidelines on nutrition in chronic liver 
disease, Journal of Hepatology 2019 vol. 70 j 172 -193; Nutrition and Liver Disease, Nutrients 
2018, 10, 9; doi:10.3390/nu10010009. In particular, authors should refer to sarcopenia and 
discuss on the  new er tools for nutritional assessment such as handgrip strenght (a sim ple, 
inexpensive, and effective method to detect malnutrition in cirrhotic patients) , DEXA or 
Tetrapolar bioelectrical impedance analysis (BIA). Please add these references and comments  
 
2. Authors did not report dietary regimen of the malnourished and healthy children, which could 
have influenced the biochemical paramenthers, including IGF -1 
 
3. Please report that Prealbumin is a more sensitive marker of malnutrition compared to albumin, 
as it has a shorter half -life. 
 
4. Authors concluded with the sentence: Our results identified anthropometric arm indicators and 
MUAC/A measurement as the most effective applied methods for assessing nutritional status in 
CLD children. I  believe study result are insufficiently to support this sentence which should be 
change in:  "Our results identified anthropometric arm indicators and MUAC/A measurement as 
an effective applied methods for assessing nutritional status in CLD children".  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
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 manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competin g interests, considering the following questions:  
 
1.  Have you in the past five years received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares in an organisation t hat may in any way gain or 
lose financially from the publication of this manuscript, either now or in the 
future?  
 
3.  Do you hold or are you currently applying for any patents relating t o 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 have  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 understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload wil l 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 in cluded 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: Anthropometric, Biochemical and Clinical Assessment  of Malnutrition among Egyptian 
Children w ith Chronic Liver Diseases: A Single Institutional Cross -sectional Study  
 
Version: 0 Date: 27 Mar 2019  
 
Reviewer: Claudia Mandato  
 
Reviewer's report:  
 
The manuscript entitled "Anthropometric, Biochemical and Clinical Assessment of Malnutrition 
among Egyptian Children with Chronic Liver Diseases: A Single Institutional Cross -sectional 
Study" analyzes the  nutritional status of children affected by chronic liver disfunction and its 
relations to  markers of disease severity. This is a crucial topic as malnutrition  has been related 
to a worse prognosis in this population of children.  
 
 
I have some concern rega rding the manuscript:  
 
1. Introduction and discussion section does not refer to the most recent pubblications in this field: 
Nutritional Needs and Support for Children with Chronic Liver Disease, Nutrients 2017, 9, 1127; 
doi:10.3390/nu9101127 ; EASL Clinica l Practice Guidelines on nutrition in chronic liver 
disease, Journal of Hepatology 2019 vol. 70 j 172 -193; Nutrition and Liver Disease, Nutrients 
2018, 10, 9; doi:10.3390/nu10010009. In particular, authors should refer to sarcopenia and 
discuss on the  new er tools for nutritional assessment such as handgrip strenght (a sim ple, 
inexpensive, and effective method to detect malnutrition in cirrhotic patients) , DEXA or 
Tetrapolar bioelectrical impedance analysis (BIA). Please add these references and comments  
 
2. Authors did not report dietary regimen of the malnourished and healthy children, which could 
have influenced the biochemical paramenthers, including IGF -1 
 
3. Please report that Prealbumin is a more sensitive marker of malnutrition compared to albumin, 
as it has a shorter half -life. 
 
4. Authors concluded with the sentence: Our results identified anthropometric arm indicators and 
MUAC/A measurement as the most effective applied methods for assessing nutritional status in 
CLD children. I  believe study result are insufficiently to support this sentence which should be 
change in:  "Our results identified anthropometric arm indicators and MUAC/A measurement as 
an effective applied methods for assessing nutritional status in CLD children".  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
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 manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competin g interests, considering the following questions:  
 
1.  Have you in the past five years received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares in an organisation t hat may in any way gain or 
lose financially from the publication of this manuscript, either now or in the 
future?  
 
3.  Do you hold or are you currently applying for any patents relating t o 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 have  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 understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload wil l 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 in cluded 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: Anthropometric, Biochemical and Clinical Assessment  of Malnutrition among Egyptian 
Children w ith Chronic Liver Diseases: A Single Institutional Cross -sectional Study  
 
Version: 0 Date: 27 Mar 2019  
 
Reviewer: Claudia Mandato  
 
Reviewer's report:  
 
The manuscript entitled "Anthropometric, Biochemical and Clinical Assessment of Malnutrition 
among Egyptian Children with Chronic Liver Diseases: A Single Institutional Cross -sectional 
Study" analyzes the  nutritional status of children affected by chronic liver disfunction and its 
relations to  markers of disease severity. This is a crucial topic as malnutrition  has been related 
to a worse prognosis in this population of children.  
 
 
I have some concern rega rding the manuscript:  
 
1. Introduction and discussion section does not refer to the most recent pubblications in this field: 
Nutritional Needs and Support for Children with Chronic Liver Disease, Nutrients 2017, 9, 1127; 
doi:10.3390/nu9101127 ; EASL Clinica l Practice Guidelines on nutrition in chronic liver 
disease, Journal of Hepatology 2019 vol. 70 j 172 -193; Nutrition and Liver Disease, Nutrients 
2018, 10, 9; doi:10.3390/nu10010009. In particular, authors should refer to sarcopenia and 
discuss on the  new er tools for nutritional assessment such as handgrip strenght (a sim ple, 
inexpensive, and effective method to detect malnutrition in cirrhotic patients) , DEXA or 
Tetrapolar bioelectrical impedance analysis (BIA). Please add these references and comments  
 
2. Authors did not report dietary regimen of the malnourished and healthy children, which could 
have influenced the biochemical paramenthers, including IGF -1 
 
3. Please report that Prealbumin is a more sensitive marker of malnutrition compared to albumin, 
as it has a shorter half -life. 
 
4. Authors concluded with the sentence: Our results identified anthropometric arm indicators and 
MUAC/A measurement as the most effective applied methods for assessing nutritional status in 
CLD children. I  believe study result are insufficiently to support this sentence which should be 
change in:  "Our results identified anthropometric arm indicators and MUAC/A measurement as 
an effective applied methods for assessing nutritional status in CLD children".  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
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 manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competin g interests, considering the following questions:  
 
1.  Have you in the past five years received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares in an organisation t hat may in any way gain or 
lose financially from the publication of this manuscript, either now or in the 
future?  
 
3.  Do you hold or are you currently applying for any patents relating t o 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 have  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 understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload wil l 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 in cluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant