Title: Overweight and vitamin D deficiency are common in patients with irritable bowel
syndrome. A cross-sectional study
Version: 3 Date: 16 Jun 2024
Reviewer's report:
1. Please change "Albeit vitamin D supplements in 21.5% of IBS patients, 23.65% had vitamin
D levels <50 nmol/L, compared with 26.0% in controls (p=0.720)" to "Despite 21.5% of IBS
patients taking vitamin D supplements, 23.65% of them had vitamin D levels below 50 nmol/L,
which is similar to the 26.0% observed in the control group (p=0.720)."
2. Please change "dietary supplementals" to "vitamin supplements".
3. The age difference between IBS patients and controls is a confounding factor that might
influence the results. The study does not account for potential seasonal variations in vitamin D
levels, which could confound the results. These are limitations that should be mentioned and
discussed.
4. The presentation of data could be improved by including more visual aids, such as box plots,
to illustrate key findings and dispersion of results.
5. "Other studies have found lower levels of vitamin D in IBS patients compared with non-
IBS patients [64]." - In addition to this, it's relevant to highlight that common environmental
exposures, such as air pollutants and microbial exposure, have also been linked to IBS
development, gut dysbiosis (citation: pubmed.ncbi.nlm.nih.gov/38699957), and reduced levels
of vitamin D and other micronutrients.
6. The conclusion does not seem to follow from the rest of the findings. The authors write
that, "In conclusion, the high degree of comorbidity and extraintestinal symptoms in IBS
may be associated with vitamin D deficiency and/or overweight [23,24,43] and may thus not
solely be directly related to IBS per se." This statement is an overreach as it is suggesting a
causative relationship that is not fully supported by the cross-sectional study design, which
only identifies associations, not causation. Moreover, the conclusion should more accurately
reflect the findings by acknowledging the complexity of IBS and the multifactorial nature of
its symptoms, including the potential contributions of nutritional deficiencies and comorbid
conditions. A more appropriate conclusion would emphasize the need for further research
to explore these associations in greater detail and consider longitudinal studies to establish
causative links.
7. Why are there two clinical registration numbers, "ClinicalTrials.gov, NCT05192603 (Date of
registration 11/29/2021) and NCT03306381 (Date of registration 09/18/2017), respectively"?
Title: Overweight and vitamin D deficiency are common in patients with irritable bowel
syndrome. A cross-sectional study
Version: 3 Date: 16 Jun 2024
Reviewer's report:
1. Please change "Albeit vitamin D supplements in 21.5% of IBS patients, 23.65% had vitamin
D levels <50 nmol/L, compared with 26.0% in controls (p=0.720)" to "Despite 21.5% of IBS
patients taking vitamin D supplements, 23.65% of them had vitamin D levels below 50 nmol/L,
which is similar to the 26.0% observed in the control group (p=0.720)."
2. Please change "dietary supplementals" to "vitamin supplements".
3. The age difference between IBS patients and controls is a confounding factor that might
influence the results. The study does not account for potential seasonal variations in vitamin D
levels, which could confound the results. These are limitations that should be mentioned and
discussed.
4. The presentation of data could be improved by including more visual aids, such as box plots,
to illustrate key findings and dispersion of results.
5. "Other studies have found lower levels of vitamin D in IBS patients compared with non-
IBS patients [64]." - In addition to this, it's relevant to highlight that common environmental
exposures, such as air pollutants and microbial exposure, have also been linked to IBS
development, gut dysbiosis (citation: pubmed.ncbi.nlm.nih.gov/38699957), and reduced levels
of vitamin D and other micronutrients.
6. The conclusion does not seem to follow from the rest of the findings. The authors write
that, "In conclusion, the high degree of comorbidity and extraintestinal symptoms in IBS
may be associated with vitamin D deficiency and/or overweight [23,24,43] and may thus not
solely be directly related to IBS per se." This statement is an overreach as it is suggesting a
causative relationship that is not fully supported by the cross-sectional study design, which
only identifies associations, not causation. Moreover, the conclusion should more accurately
reflect the findings by acknowledging the complexity of IBS and the multifactorial nature of
its symptoms, including the potential contributions of nutritional deficiencies and comorbid
conditions. A more appropriate conclusion would emphasize the need for further research
to explore these associations in greater detail and consider longitudinal studies to establish
causative links.
7. Why are there two clinical registration numbers, "ClinicalTrials.gov, NCT05192603 (Date of
registration 11/29/2021) and NCT03306381 (Date of registration 09/18/2017), respectively"?
Please review this paper.
user
Title: Overweight and vitamin D deficiency are common in patients with irritable bowel
syndrome. A cross-sectional study
Version: 3 Date: 16 Jun 2024
Reviewer's report:
1. Please change "Albeit vitamin D supplements in 21.5% of IBS patients, 23.65% had vitamin
D levels <50 nmol/L, compared with 26.0% in controls (p=0.720)" to "Despite 21.5% of IBS
patients taking vitamin D supplements, 23.65% of them had vitamin D levels below 50 nmol/L,
which is similar to the 26.0% observed in the control group (p=0.720)."
2. Please change "dietary supplementals" to "vitamin supplements".
3. The age difference between IBS patients and controls is a confounding factor that might
influence the results. The study does not account for potential seasonal variations in vitamin D
levels, which could confound the results. These are limitations that should be mentioned and
discussed.
4. The presentation of data could be improved by including more visual aids, such as box plots,
to illustrate key findings and dispersion of results.
5. "Other studies have found lower levels of vitamin D in IBS patients compared with non-
IBS patients [64]." - In addition to this, it's relevant to highlight that common environmental
exposures, such as air pollutants and microbial exposure, have also been linked to IBS
development, gut dysbiosis (citation: pubmed.ncbi.nlm.nih.gov/38699957), and reduced levels
of vitamin D and other micronutrients.
6. The conclusion does not seem to follow from the rest of the findings. The authors write
that, "In conclusion, the high degree of comorbidity and extraintestinal symptoms in IBS
may be associated with vitamin D deficiency and/or overweight [23,24,43] and may thus not
solely be directly related to IBS per se." This statement is an overreach as it is suggesting a
causative relationship that is not fully supported by the cross-sectional study design, which
only identifies associations, not causation. Moreover, the conclusion should more accurately
reflect the findings by acknowledging the complexity of IBS and the multifactorial nature of
its symptoms, including the potential contributions of nutritional deficiencies and comorbid
conditions. A more appropriate conclusion would emphasize the need for further research
to explore these associations in greater detail and consider longitudinal studies to establish
causative links.
7. Why are there two clinical registration numbers, "ClinicalTrials.gov, NCT05192603 (Date of
registration 11/29/2021) and NCT03306381 (Date of registration 09/18/2017), respectively"?
assistant