Title: Change Lifestyle Modification Plan/Transtheoretical Model in Non-alcoholic Simple
Fatty Liver Disease: A pilot randomized study
Version: 1 Date: 09 Jun 2022
Reviewer:  Lee-lee Lai
Reviewer's report:
6th June 2022
Dr Stefano Bellentani
Editorial Board Member
BMC Gastroenterology
Dear Dr Bellentani
Dear Authors
Manuscript Submission ID  4b08d728-c836-49db-a1d1-857d3a36009f
Change Lifestyle Modification Plan/Transtheoretical Model in Non-alcoholic Simple Fatty
Liver Disease: A pilot randomized study
Reviewer comments to authors:
# 1. Page 5, line 100 (inclusion) 105 (exclusion)
The inclusion criteria were as follows: (1) Aged between 18 and 60; (2) Patients diagnosed
with the simple fatty liver disease according to ultrasound imaging; (3) Basic ability in reading,
writing and understanding; (4) Liver function was normal or basically normal, that is, alanine
aminotransferase (ALT), aspartate aminotransferase (11), #-glutamyl transpeptidase (GGT) did
not exceed the normal range of 10u/L. The exclusion criteria were: (1) Women during pregnancy
or breastfeeding; (2) Patients with anxiety, depression and mental illness history; (3) Patients
with motor dysfunction; (4) Patients who were taking liver-protecting drugs and lipid-lowering
drugs.
How about the diabetes patients? Are they will be included or excluded in this study? As we
know, majority of the diabetes patients have NAFLD due to uncontrolled sugar levels.
# 2. Page 7 line 131
The control group received routine health guidance and follow-up intervention. May I know
what is the routine health guidance? Can elaborate more on this?
# 3. Page 8 line 152
Ten intervention strategies can be implemented corresponding to these 5 stages. May I know
what are the ten intervention strategies? Can elaborate more on this?
# 4. Page 8, line 158
A behavioural change assessment questionnaire was used for evaluation.
How do you distribute the questionnaire? Do the participants have to answer the questionnaire
face to face or online? How do you ensure the participants answer the questionnaire honestly?
# 5. Page 8, line 167
For patients with good behavioural changes, encouragement and affirmation were given, and
they proceeded to the next stage in order.
How do you grade the participants who have good, moderate and bad behavioural changes?
# 6. Page 9, line 185
The patients were advised to quit smoking and limit alcohol, and maintain a good life schedule
and mood.
How do you ensure participants will quit smoking, limit alcohol intake and maintain a good life
schedule and mood?
# 7. Page 11, line 222
The patient had a light diet the day before and fasted for more than 8 hours before the venous
blood was drawn. How about the liver ultrasound? Is the liver ultrasound done the same day
with venous blood taking?
If the blood taking is on the same day as the liver ultrasound is better. You can compare the
blood results with ultrasound findings, more accurate.
# 8. Page 16, line 344
This study has some limitations.
Your study limitation also needs to include Fibroscan® and liver biopsy (histopathology) results
to evaluate the NAFLD progress.
Lee-Lee Lai
Title: Change Lifestyle Modification Plan/Transtheoretical Model in Non-alcoholic Simple
Fatty Liver Disease: A pilot randomized study
Version: 1 Date: 09 Jun 2022
Reviewer:  Lee-lee Lai
Reviewer's report:
6th June 2022
Dr Stefano Bellentani
Editorial Board Member
BMC Gastroenterology
Dear Dr Bellentani
Dear Authors
Manuscript Submission ID  4b08d728-c836-49db-a1d1-857d3a36009f
Change Lifestyle Modification Plan/Transtheoretical Model in Non-alcoholic Simple Fatty
Liver Disease: A pilot randomized study
Reviewer comments to authors:
# 1. Page 5, line 100 (inclusion) 105 (exclusion)
The inclusion criteria were as follows: (1) Aged between 18 and 60; (2) Patients diagnosed
with the simple fatty liver disease according to ultrasound imaging; (3) Basic ability in reading,
writing and understanding; (4) Liver function was normal or basically normal, that is, alanine
aminotransferase (ALT), aspartate aminotransferase (11), #-glutamyl transpeptidase (GGT) did
not exceed the normal range of 10u/L. The exclusion criteria were: (1) Women during pregnancy
or breastfeeding; (2) Patients with anxiety, depression and mental illness history; (3) Patients
with motor dysfunction; (4) Patients who were taking liver-protecting drugs and lipid-lowering
drugs.
How about the diabetes patients? Are they will be included or excluded in this study? As we
know, majority of the diabetes patients have NAFLD due to uncontrolled sugar levels.
# 2. Page 7 line 131
The control group received routine health guidance and follow-up intervention. May I know
what is the routine health guidance? Can elaborate more on this?
# 3. Page 8 line 152
Ten intervention strategies can be implemented corresponding to these 5 stages. May I know
what are the ten intervention strategies? Can elaborate more on this?
# 4. Page 8, line 158
A behavioural change assessment questionnaire was used for evaluation.
How do you distribute the questionnaire? Do the participants have to answer the questionnaire
face to face or online? How do you ensure the participants answer the questionnaire honestly?
# 5. Page 8, line 167
For patients with good behavioural changes, encouragement and affirmation were given, and
they proceeded to the next stage in order.
How do you grade the participants who have good, moderate and bad behavioural changes?
# 6. Page 9, line 185
The patients were advised to quit smoking and limit alcohol, and maintain a good life schedule
and mood.
How do you ensure participants will quit smoking, limit alcohol intake and maintain a good life
schedule and mood?
# 7. Page 11, line 222
The patient had a light diet the day before and fasted for more than 8 hours before the venous
blood was drawn. How about the liver ultrasound? Is the liver ultrasound done the same day
with venous blood taking?
If the blood taking is on the same day as the liver ultrasound is better. You can compare the
blood results with ultrasound findings, more accurate.
# 8. Page 16, line 344
This study has some limitations.
Your study limitation also needs to include Fibroscan® and liver biopsy (histopathology) results
to evaluate the NAFLD progress.
Lee-Lee Lai
Please review this paper.
user
Title: Change Lifestyle Modification Plan/Transtheoretical Model in Non-alcoholic Simple
Fatty Liver Disease: A pilot randomized study
Version: 1 Date: 09 Jun 2022
Reviewer:  Lee-lee Lai
Reviewer's report:
6th June 2022
Dr Stefano Bellentani
Editorial Board Member
BMC Gastroenterology
Dear Dr Bellentani
Dear Authors
Manuscript Submission ID  4b08d728-c836-49db-a1d1-857d3a36009f
Change Lifestyle Modification Plan/Transtheoretical Model in Non-alcoholic Simple Fatty
Liver Disease: A pilot randomized study
Reviewer comments to authors:
# 1. Page 5, line 100 (inclusion) 105 (exclusion)
The inclusion criteria were as follows: (1) Aged between 18 and 60; (2) Patients diagnosed
with the simple fatty liver disease according to ultrasound imaging; (3) Basic ability in reading,
writing and understanding; (4) Liver function was normal or basically normal, that is, alanine
aminotransferase (ALT), aspartate aminotransferase (11), #-glutamyl transpeptidase (GGT) did
not exceed the normal range of 10u/L. The exclusion criteria were: (1) Women during pregnancy
or breastfeeding; (2) Patients with anxiety, depression and mental illness history; (3) Patients
with motor dysfunction; (4) Patients who were taking liver-protecting drugs and lipid-lowering
drugs.
How about the diabetes patients? Are they will be included or excluded in this study? As we
know, majority of the diabetes patients have NAFLD due to uncontrolled sugar levels.
# 2. Page 7 line 131
The control group received routine health guidance and follow-up intervention. May I know
what is the routine health guidance? Can elaborate more on this?
# 3. Page 8 line 152
Ten intervention strategies can be implemented corresponding to these 5 stages. May I know
what are the ten intervention strategies? Can elaborate more on this?
# 4. Page 8, line 158
A behavioural change assessment questionnaire was used for evaluation.
How do you distribute the questionnaire? Do the participants have to answer the questionnaire
face to face or online? How do you ensure the participants answer the questionnaire honestly?
# 5. Page 8, line 167
For patients with good behavioural changes, encouragement and affirmation were given, and
they proceeded to the next stage in order.
How do you grade the participants who have good, moderate and bad behavioural changes?
# 6. Page 9, line 185
The patients were advised to quit smoking and limit alcohol, and maintain a good life schedule
and mood.
How do you ensure participants will quit smoking, limit alcohol intake and maintain a good life
schedule and mood?
# 7. Page 11, line 222
The patient had a light diet the day before and fasted for more than 8 hours before the venous
blood was drawn. How about the liver ultrasound? Is the liver ultrasound done the same day
with venous blood taking?
If the blood taking is on the same day as the liver ultrasound is better. You can compare the
blood results with ultrasound findings, more accurate.
# 8. Page 16, line 344
This study has some limitations.
Your study limitation also needs to include Fibroscan® and liver biopsy (histopathology) results
to evaluate the NAFLD progress.
Lee-Lee Lai
assistant