Reviewer ’s report  
 
Title:  Diagnostic accuracy of controlled attenuation parameter (CAP) as a non -invasive test for 
steatosis in suspected non alcoholic fatty liver disease: a systematic review and meta -analysis  
 
Version: 1 Date: 12 Dec 2018 
 
Reviewer:  Research  Square  
 
Reviewer’s report:  
 
"STATISTICAL REVIEWER ASSESSMENT:  
 
Is the study design appropriate for the research question (considering whether the analyzed 
population accurately reflects the design a nd whether you see any problems with 
control/comparison groups, e.g., likely confounders)?  
 
No - there are minor issues  
 
 
Are methodologies adequate and well implemented (considering whether assumptions are 
addressed and whether analyses are robust)?  
 
No - there are minor issues  
 
 
Are the analyses adequately communicated (considering whether reporting details are adequate 
and whether figures and tables are well labeled and described)?  
 
No - there are minor issues  
 
 
Does the interpretation accurately reflect the a nalyses without overstatement (considering 
whether limitations/bias are acknowledged and whether accurate descriptors, e.g., 'significant', 
are used?  
 
Yes - interpretation accurately reflects analyses, limitations/bias are acknowledged, accurate 
descriptors  are used  
 
 
Could an appropriately REVISED version of this work represent a statistically sound 
contribution?  
 
Yes - current version has sound statistics  
 
 
STATISTICAL REVIEWER COMMENTS:  
 
When asked to particpate in this pilot program I expected the article to be of poor quality. I stand 
to be corrected, as the analsyis was extremely detailed and I only have minor issues, many of 
which are just for further clarity and elaboration.  
 
 
REQUESTED REVISIONS:  
 
1. The authors have long list of operating characterist ics they require for study inclusion. 
Can they comment on the potential number of studies excluded due to limited amount of 
missing elements? I am concerned that the restrictively long list, while important to the 
analysis may create a selection bias due t o poor reporting more broadly.  
 
2. Primary figures appear to be of very poor pixel quality. It would be nice if they could be 
improved.  
 
3. Can the authors provide further detail on how they pooled overall measures for figures 3 -
5, S1. This is my key quest ion and what I feel is the major omission in this draft. The 
meta -analytic methods (and the limitations of them) are not very well developed. 
Citations are needed and there are no details about why a MH versus DerSimonian Laird 
test were executed or the se nsitivity of the arbitrary cut -offs chosen by the authors.  
 
4. Figure S2, S3, and S4, why switch the ordering of the 2 axes?  
 
5. It is unclear what figure S6 is showing. Please describe the content of the figure with 
greater detail.  
 
6. For general reading and clarity, please have one figure per page in the supplement.  
 
7. Table S1 is hard to read. "  
 
Are the metho ds 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.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional st atistical review is recommended, please specify what aspects require 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:  
 
Acceptable  
 
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 o r 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 man uscript?  
 
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 repl y 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 Commons 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 upload 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/licenses/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:  Diagnostic accuracy of controlled attenuation parameter (CAP) as a non -invasive test for 
steatosis in suspected non alcoholic fatty liver disease: a systematic review and meta -analysis  
 
Version: 1 Date: 12 Dec 2018 
 
Reviewer:  Research  Square  
 
Reviewer’s report:  
 
"STATISTICAL REVIEWER ASSESSMENT:  
 
Is the study design appropriate for the research question (considering whether the analyzed 
population accurately reflects the design a nd whether you see any problems with 
control/comparison groups, e.g., likely confounders)?  
 
No - there are minor issues  
 
 
Are methodologies adequate and well implemented (considering whether assumptions are 
addressed and whether analyses are robust)?  
 
No - there are minor issues  
 
 
Are the analyses adequately communicated (considering whether reporting details are adequate 
and whether figures and tables are well labeled and described)?  
 
No - there are minor issues  
 
 
Does the interpretation accurately reflect the a nalyses without overstatement (considering 
whether limitations/bias are acknowledged and whether accurate descriptors, e.g., 'significant', 
are used?  
 
Yes - interpretation accurately reflects analyses, limitations/bias are acknowledged, accurate 
descriptors  are used  
 
 
Could an appropriately REVISED version of this work represent a statistically sound 
contribution?  
 
Yes - current version has sound statistics  
 
 
STATISTICAL REVIEWER COMMENTS:  
 
When asked to particpate in this pilot program I expected the article to be of poor quality. I stand 
to be corrected, as the analsyis was extremely detailed and I only have minor issues, many of 
which are just for further clarity and elaboration.  
 
 
REQUESTED REVISIONS:  
 
1. The authors have long list of operating characterist ics they require for study inclusion. 
Can they comment on the potential number of studies excluded due to limited amount of 
missing elements? I am concerned that the restrictively long list, while important to the 
analysis may create a selection bias due t o poor reporting more broadly.  
 
2. Primary figures appear to be of very poor pixel quality. It would be nice if they could be 
improved.  
 
3. Can the authors provide further detail on how they pooled overall measures for figures 3 -
5, S1. This is my key quest ion and what I feel is the major omission in this draft. The 
meta -analytic methods (and the limitations of them) are not very well developed. 
Citations are needed and there are no details about why a MH versus DerSimonian Laird 
test were executed or the se nsitivity of the arbitrary cut -offs chosen by the authors.  
 
4. Figure S2, S3, and S4, why switch the ordering of the 2 axes?  
 
5. It is unclear what figure S6 is showing. Please describe the content of the figure with 
greater detail.  
 
6. For general reading and clarity, please have one figure per page in the supplement.  
 
7. Table S1 is hard to read. "  
 
Are the metho ds 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.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional st atistical review is recommended, please specify what aspects require 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:  
 
Acceptable  
 
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 o r 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 man uscript?  
 
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 repl y 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 Commons 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 upload 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/licenses/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:  Diagnostic accuracy of controlled attenuation parameter (CAP) as a non -invasive test for 
steatosis in suspected non alcoholic fatty liver disease: a systematic review and meta -analysis  
 
Version: 1 Date: 12 Dec 2018 
 
Reviewer:  Research  Square  
 
Reviewer’s report:  
 
"STATISTICAL REVIEWER ASSESSMENT:  
 
Is the study design appropriate for the research question (considering whether the analyzed 
population accurately reflects the design a nd whether you see any problems with 
control/comparison groups, e.g., likely confounders)?  
 
No - there are minor issues  
 
 
Are methodologies adequate and well implemented (considering whether assumptions are 
addressed and whether analyses are robust)?  
 
No - there are minor issues  
 
 
Are the analyses adequately communicated (considering whether reporting details are adequate 
and whether figures and tables are well labeled and described)?  
 
No - there are minor issues  
 
 
Does the interpretation accurately reflect the a nalyses without overstatement (considering 
whether limitations/bias are acknowledged and whether accurate descriptors, e.g., 'significant', 
are used?  
 
Yes - interpretation accurately reflects analyses, limitations/bias are acknowledged, accurate 
descriptors  are used  
 
 
Could an appropriately REVISED version of this work represent a statistically sound 
contribution?  
 
Yes - current version has sound statistics  
 
 
STATISTICAL REVIEWER COMMENTS:  
 
When asked to particpate in this pilot program I expected the article to be of poor quality. I stand 
to be corrected, as the analsyis was extremely detailed and I only have minor issues, many of 
which are just for further clarity and elaboration.  
 
 
REQUESTED REVISIONS:  
 
1. The authors have long list of operating characterist ics they require for study inclusion. 
Can they comment on the potential number of studies excluded due to limited amount of 
missing elements? I am concerned that the restrictively long list, while important to the 
analysis may create a selection bias due t o poor reporting more broadly.  
 
2. Primary figures appear to be of very poor pixel quality. It would be nice if they could be 
improved.  
 
3. Can the authors provide further detail on how they pooled overall measures for figures 3 -
5, S1. This is my key quest ion and what I feel is the major omission in this draft. The 
meta -analytic methods (and the limitations of them) are not very well developed. 
Citations are needed and there are no details about why a MH versus DerSimonian Laird 
test were executed or the se nsitivity of the arbitrary cut -offs chosen by the authors.  
 
4. Figure S2, S3, and S4, why switch the ordering of the 2 axes?  
 
5. It is unclear what figure S6 is showing. Please describe the content of the figure with 
greater detail.  
 
6. For general reading and clarity, please have one figure per page in the supplement.  
 
7. Table S1 is hard to read. "  
 
Are the metho ds 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.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional st atistical review is recommended, please specify what aspects require 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:  
 
Acceptable  
 
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 o r 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 man uscript?  
 
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 repl y 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 Commons 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 upload 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/licenses/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