Title: Sex- and reproductive status-specific relationships between body composition and non-
alcoholic fatty liver disease
Version: 1 Date: 14 Aug 2023
Reviewer's report:
NAFLD, is actually the most prevalent chronic liver disease, and most of the success in
controlling the disease, relies on an early identification of in risk individuals. That knowledge
is also decisive, to implement any preventive strategy, paying more attention to the risk groups.
In this work, the authors tried to evaluate the correlation between, liver steatosis, liver fibrosis,
sex and menopause status, in women.
The article is meritorious, the methodology is reproductible, and contributes to elucidate the
correlation of fat, fat distribution, and the physiopathology of NAFLD.
However, there are a few points, that should be addressed.
1) About methodology:
- Although apparently a population-based study, the sample is more a convenience one,
constituted by hospital patients. The authors use both words, “patients” and “participants”,
indistinctly in the text, what we suggest to be uniformized.
- Being hospital patients, with a considerable prevalence of diabetes and dyslipidemia, are there
anyone of them with a previous liver disease diagnostic (NAFLD or other)?
- The authors state that they exclude participants who took “hormonal drugs”. Can they be more
specific of what kind of drugs?
- As the patients were recruited in an “Hospital of Traditional Chinese Medicine”, did anyone of
them was taking any other drug that could influence fat deposition, in liver or subcutaneously?
- The authors use BIA to evaluate fat, and fat distribution. As BIA can be influenced by other
factors or conditions, like body water retention, being the study sample recruited in a hospital,
did any of the participants had diseases that could affect the BIA results?
2) Sample:
From “Additional files”, we notice that 87.7% of the patients, were in the 3th or 4th decades of
live, between 31 and 49 years in men (meddle age 39), and between 28 and 38 years (meddle
age of 33 years), in women. Is there any explanation to that imbalance of ages in the sample,
with a clear prevalence of relatively young people? Could it influence the results?
Also, +/- 65% of men and +/- 56.5% of the pre-menopausal women, had high grade liver steatosis
(S3 and S4). Is there any explanation to that?
3) Results:
Because economical, logistic and side effects reasons, BIA is more appropriate to use in
epidemiologic studies, although not so precise, than other tools, like CT, MR, or dual-energy
X-ray absorptiometry. Also, the present work was made, presumably with the vast majority of
patients of only one ethnicity, if not all of them. Combining the two conditions, the results should
be interpreted with cautious, and that should be stressed in the discussion. We can speculate that,
different populations, with different genetic inheritance, could have different results.
4) Correction required:
In “Additional files”, in tables S3 and S4, “Unjusted”, should be corrected to Unadjusted.
Title: Sex- and reproductive status-specific relationships between body composition and non-
alcoholic fatty liver disease
Version: 1 Date: 14 Aug 2023
Reviewer's report:
NAFLD, is actually the most prevalent chronic liver disease, and most of the success in
controlling the disease, relies on an early identification of in risk individuals. That knowledge
is also decisive, to implement any preventive strategy, paying more attention to the risk groups.
In this work, the authors tried to evaluate the correlation between, liver steatosis, liver fibrosis,
sex and menopause status, in women.
The article is meritorious, the methodology is reproductible, and contributes to elucidate the
correlation of fat, fat distribution, and the physiopathology of NAFLD.
However, there are a few points, that should be addressed.
1) About methodology:
- Although apparently a population-based study, the sample is more a convenience one,
constituted by hospital patients. The authors use both words, “patients” and “participants”,
indistinctly in the text, what we suggest to be uniformized.
- Being hospital patients, with a considerable prevalence of diabetes and dyslipidemia, are there
anyone of them with a previous liver disease diagnostic (NAFLD or other)?
- The authors state that they exclude participants who took “hormonal drugs”. Can they be more
specific of what kind of drugs?
- As the patients were recruited in an “Hospital of Traditional Chinese Medicine”, did anyone of
them was taking any other drug that could influence fat deposition, in liver or subcutaneously?
- The authors use BIA to evaluate fat, and fat distribution. As BIA can be influenced by other
factors or conditions, like body water retention, being the study sample recruited in a hospital,
did any of the participants had diseases that could affect the BIA results?
2) Sample:
From “Additional files”, we notice that 87.7% of the patients, were in the 3th or 4th decades of
live, between 31 and 49 years in men (meddle age 39), and between 28 and 38 years (meddle
age of 33 years), in women. Is there any explanation to that imbalance of ages in the sample,
with a clear prevalence of relatively young people? Could it influence the results?
Also, +/- 65% of men and +/- 56.5% of the pre-menopausal women, had high grade liver steatosis
(S3 and S4). Is there any explanation to that?
3) Results:
Because economical, logistic and side effects reasons, BIA is more appropriate to use in
epidemiologic studies, although not so precise, than other tools, like CT, MR, or dual-energy
X-ray absorptiometry. Also, the present work was made, presumably with the vast majority of
patients of only one ethnicity, if not all of them. Combining the two conditions, the results should
be interpreted with cautious, and that should be stressed in the discussion. We can speculate that,
different populations, with different genetic inheritance, could have different results.
4) Correction required:
In “Additional files”, in tables S3 and S4, “Unjusted”, should be corrected to Unadjusted.
Please review this paper.
user
Title: Sex- and reproductive status-specific relationships between body composition and non-
alcoholic fatty liver disease
Version: 1 Date: 14 Aug 2023
Reviewer's report:
NAFLD, is actually the most prevalent chronic liver disease, and most of the success in
controlling the disease, relies on an early identification of in risk individuals. That knowledge
is also decisive, to implement any preventive strategy, paying more attention to the risk groups.
In this work, the authors tried to evaluate the correlation between, liver steatosis, liver fibrosis,
sex and menopause status, in women.
The article is meritorious, the methodology is reproductible, and contributes to elucidate the
correlation of fat, fat distribution, and the physiopathology of NAFLD.
However, there are a few points, that should be addressed.
1) About methodology:
- Although apparently a population-based study, the sample is more a convenience one,
constituted by hospital patients. The authors use both words, “patients” and “participants”,
indistinctly in the text, what we suggest to be uniformized.
- Being hospital patients, with a considerable prevalence of diabetes and dyslipidemia, are there
anyone of them with a previous liver disease diagnostic (NAFLD or other)?
- The authors state that they exclude participants who took “hormonal drugs”. Can they be more
specific of what kind of drugs?
- As the patients were recruited in an “Hospital of Traditional Chinese Medicine”, did anyone of
them was taking any other drug that could influence fat deposition, in liver or subcutaneously?
- The authors use BIA to evaluate fat, and fat distribution. As BIA can be influenced by other
factors or conditions, like body water retention, being the study sample recruited in a hospital,
did any of the participants had diseases that could affect the BIA results?
2) Sample:
From “Additional files”, we notice that 87.7% of the patients, were in the 3th or 4th decades of
live, between 31 and 49 years in men (meddle age 39), and between 28 and 38 years (meddle
age of 33 years), in women. Is there any explanation to that imbalance of ages in the sample,
with a clear prevalence of relatively young people? Could it influence the results?
Also, +/- 65% of men and +/- 56.5% of the pre-menopausal women, had high grade liver steatosis
(S3 and S4). Is there any explanation to that?
3) Results:
Because economical, logistic and side effects reasons, BIA is more appropriate to use in
epidemiologic studies, although not so precise, than other tools, like CT, MR, or dual-energy
X-ray absorptiometry. Also, the present work was made, presumably with the vast majority of
patients of only one ethnicity, if not all of them. Combining the two conditions, the results should
be interpreted with cautious, and that should be stressed in the discussion. We can speculate that,
different populations, with different genetic inheritance, could have different results.
4) Correction required:
In “Additional files”, in tables S3 and S4, “Unjusted”, should be corrected to Unadjusted.
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