Reviewer ’s report  
 
Title:  Strong As sociation between Metabolically -Abnormal Obesity and Gallstone Disease in 
Adults under 50 Years  
 
Version: 0 Date: 01 Mar 2019 
 
Reviewer:  Reviewer  2 
 
Reviewer’s report:  
 
PEER REVIEWER ASSESSMENTS:  
 
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research 
question(s) (brief or other articl e types: is there a clear objective)?  
 
Yes - there is a clear objective  
 
 
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for the 
objective?  
 
No - there are minor issues  
 
 
EXECUTION - Are the experiments and analyses pe rformed with technical rigor to allow 
confidence in the results?  
 
Yes - experiments and analyses were performed appropriately  
 
 
Statistics - Is the use of statistics in the manuscript appropriate?  
 
Yes - appropriate statistical analyses have been used in the study  
 
 
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not 
overstated?  
 
No - there are major issues  
 
 
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically 
sound? If not, can revisions be made to make the work technically sound?  
 
Probably - with minor revisions  
PEER REVIEWER COMMENTS:  
 
GENERAL COMMENTS: Overall Impression  
 
I like the premise of the study,  
  
What have the authors done well  
 
The study is well designed for an Asian population and relevant to China.  
  
 
REQUESTED REVISIONS:  
 
In what ways does it not meet best practice  
 
They need to acknowledge that this was a study of Asian people in Taiwan does not mean it is 
not best practi ce. But this at the least needs to be acknowledged .x  
 
Are there additional revisions the authors should make -consider  
 
1. Line 148 the difference here of  7% versus 6.4% is meaningless; say they were no different ! 
You could also analyze the controlling  MA by looking at the age difference. Younger patients 
when they get older and to the age of the older MHNO group but as you report the groups on 
lines 146 -148 there really is no clinically relevant difference  also see lines 199 -202 this needs to 
be chang ed as well  
 
2. Line 188 -189 add the percentages here rather than making the reader go to the table like I had 
to do! Similar line 191  
 
3. The definition of obesity may vary between countries. I do not know the country of origin of 
this paper at this point  of my review (It is blinded) but my guess is that it is from Asia and if so 
this needs to be discussed separately. Actually now when I read on, I see the Declarations and it 
seems that this study did originate from Taiwan and acknowledgement of this being  an Asian 
study MUST BE DISCUSSED!  
 
4. To this reviewer, the lack of difference of the MA and Obesity profiles of older patients >50 
yo is probably one of the most Interesting findings  and warrants a full discussion. Does this 
mean that most gallstones fro m MA patients  start before the age of 50? Does it mean that 
obesity and MA is no longer important after age 50+?  
 
5. The limitations section needs to be markedly expanded to address the population studied In 
relationship to the Western world.  
 
 
ADDITIONAL R EQUESTS/SUGGESTIONS:  
 
Other changes that the authors should consider to improve the manuscript  
 
1. On line 74 and in tables 1 and 3, change gender to sex. It is sex (the genotype) that you need to 
investigate, not the phenotype (gender)  in science  
 
2.  line 78 metabolically unhealthy is not a medical term. Be more specific  
  
Note: This reviewer report can be downloaded - see attached pdf file.  
 
Are the methods appropriate and well described?  
If not, please specify wha t is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are 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 recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects req uire further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
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 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 of 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 interest s? 
 
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.  
 
This reviewer has been recruited by a partner organization, Research Square. Reviewers with 
declared or apparent competing interests are not utilized for these reviews. This reviewer has 
agreed to publication of their comments online under a Creative Commo ns Attribution License 
attributed to Research Square and was paid a small honorarium for completing the review within 
a specified timeframe. Honoraria for reviews such as this are paid regardless of the reviewer 
recommendation.  
 
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 u pload 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/lice nses/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:  Strong As sociation between Metabolically -Abnormal Obesity and Gallstone Disease in 
Adults under 50 Years  
 
Version: 0 Date: 01 Mar 2019 
 
Reviewer:  Reviewer  2 
 
Reviewer’s report:  
 
PEER REVIEWER ASSESSMENTS:  
 
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research 
question(s) (brief or other articl e types: is there a clear objective)?  
 
Yes - there is a clear objective  
 
 
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for the 
objective?  
 
No - there are minor issues  
 
 
EXECUTION - Are the experiments and analyses pe rformed with technical rigor to allow 
confidence in the results?  
 
Yes - experiments and analyses were performed appropriately  
 
 
Statistics - Is the use of statistics in the manuscript appropriate?  
 
Yes - appropriate statistical analyses have been used in the study  
 
 
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not 
overstated?  
 
No - there are major issues  
 
 
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically 
sound? If not, can revisions be made to make the work technically sound?  
 
Probably - with minor revisions  
PEER REVIEWER COMMENTS:  
 
GENERAL COMMENTS: Overall Impression  
 
I like the premise of the study,  
  
What have the authors done well  
 
The study is well designed for an Asian population and relevant to China.  
  
 
REQUESTED REVISIONS:  
 
In what ways does it not meet best practice  
 
They need to acknowledge that this was a study of Asian people in Taiwan does not mean it is 
not best practi ce. But this at the least needs to be acknowledged .x  
 
Are there additional revisions the authors should make -consider  
 
1. Line 148 the difference here of  7% versus 6.4% is meaningless; say they were no different ! 
You could also analyze the controlling  MA by looking at the age difference. Younger patients 
when they get older and to the age of the older MHNO group but as you report the groups on 
lines 146 -148 there really is no clinically relevant difference  also see lines 199 -202 this needs to 
be chang ed as well  
 
2. Line 188 -189 add the percentages here rather than making the reader go to the table like I had 
to do! Similar line 191  
 
3. The definition of obesity may vary between countries. I do not know the country of origin of 
this paper at this point  of my review (It is blinded) but my guess is that it is from Asia and if so 
this needs to be discussed separately. Actually now when I read on, I see the Declarations and it 
seems that this study did originate from Taiwan and acknowledgement of this being  an Asian 
study MUST BE DISCUSSED!  
 
4. To this reviewer, the lack of difference of the MA and Obesity profiles of older patients >50 
yo is probably one of the most Interesting findings  and warrants a full discussion. Does this 
mean that most gallstones fro m MA patients  start before the age of 50? Does it mean that 
obesity and MA is no longer important after age 50+?  
 
5. The limitations section needs to be markedly expanded to address the population studied In 
relationship to the Western world.  
 
 
ADDITIONAL R EQUESTS/SUGGESTIONS:  
 
Other changes that the authors should consider to improve the manuscript  
 
1. On line 74 and in tables 1 and 3, change gender to sex. It is sex (the genotype) that you need to 
investigate, not the phenotype (gender)  in science  
 
2.  line 78 metabolically unhealthy is not a medical term. Be more specific  
  
Note: This reviewer report can be downloaded - see attached pdf file.  
 
Are the methods appropriate and well described?  
If not, please specify wha t is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are 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 recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects req uire further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
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 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 of 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 interest s? 
 
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.  
 
This reviewer has been recruited by a partner organization, Research Square. Reviewers with 
declared or apparent competing interests are not utilized for these reviews. This reviewer has 
agreed to publication of their comments online under a Creative Commo ns Attribution License 
attributed to Research Square and was paid a small honorarium for completing the review within 
a specified timeframe. Honoraria for reviews such as this are paid regardless of the reviewer 
recommendation.  
 
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 u pload 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/lice nses/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:  Strong As sociation between Metabolically -Abnormal Obesity and Gallstone Disease in 
Adults under 50 Years  
 
Version: 0 Date: 01 Mar 2019 
 
Reviewer:  Reviewer  2 
 
Reviewer’s report:  
 
PEER REVIEWER ASSESSMENTS:  
 
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research 
question(s) (brief or other articl e types: is there a clear objective)?  
 
Yes - there is a clear objective  
 
 
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for the 
objective?  
 
No - there are minor issues  
 
 
EXECUTION - Are the experiments and analyses pe rformed with technical rigor to allow 
confidence in the results?  
 
Yes - experiments and analyses were performed appropriately  
 
 
Statistics - Is the use of statistics in the manuscript appropriate?  
 
Yes - appropriate statistical analyses have been used in the study  
 
 
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not 
overstated?  
 
No - there are major issues  
 
 
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically 
sound? If not, can revisions be made to make the work technically sound?  
 
Probably - with minor revisions  
PEER REVIEWER COMMENTS:  
 
GENERAL COMMENTS: Overall Impression  
 
I like the premise of the study,  
  
What have the authors done well  
 
The study is well designed for an Asian population and relevant to China.  
  
 
REQUESTED REVISIONS:  
 
In what ways does it not meet best practice  
 
They need to acknowledge that this was a study of Asian people in Taiwan does not mean it is 
not best practi ce. But this at the least needs to be acknowledged .x  
 
Are there additional revisions the authors should make -consider  
 
1. Line 148 the difference here of  7% versus 6.4% is meaningless; say they were no different ! 
You could also analyze the controlling  MA by looking at the age difference. Younger patients 
when they get older and to the age of the older MHNO group but as you report the groups on 
lines 146 -148 there really is no clinically relevant difference  also see lines 199 -202 this needs to 
be chang ed as well  
 
2. Line 188 -189 add the percentages here rather than making the reader go to the table like I had 
to do! Similar line 191  
 
3. The definition of obesity may vary between countries. I do not know the country of origin of 
this paper at this point  of my review (It is blinded) but my guess is that it is from Asia and if so 
this needs to be discussed separately. Actually now when I read on, I see the Declarations and it 
seems that this study did originate from Taiwan and acknowledgement of this being  an Asian 
study MUST BE DISCUSSED!  
 
4. To this reviewer, the lack of difference of the MA and Obesity profiles of older patients >50 
yo is probably one of the most Interesting findings  and warrants a full discussion. Does this 
mean that most gallstones fro m MA patients  start before the age of 50? Does it mean that 
obesity and MA is no longer important after age 50+?  
 
5. The limitations section needs to be markedly expanded to address the population studied In 
relationship to the Western world.  
 
 
ADDITIONAL R EQUESTS/SUGGESTIONS:  
 
Other changes that the authors should consider to improve the manuscript  
 
1. On line 74 and in tables 1 and 3, change gender to sex. It is sex (the genotype) that you need to 
investigate, not the phenotype (gender)  in science  
 
2.  line 78 metabolically unhealthy is not a medical term. Be more specific  
  
Note: This reviewer report can be downloaded - see attached pdf file.  
 
Are the methods appropriate and well described?  
If not, please specify wha t is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are 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 recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects req uire further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
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 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 of 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 interest s? 
 
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.  
 
This reviewer has been recruited by a partner organization, Research Square. Reviewers with 
declared or apparent competing interests are not utilized for these reviews. This reviewer has 
agreed to publication of their comments online under a Creative Commo ns Attribution License 
attributed to Research Square and was paid a small honorarium for completing the review within 
a specified timeframe. Honoraria for reviews such as this are paid regardless of the reviewer 
recommendation.  
 
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 u pload 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/lice nses/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