Title:  Higher serum uric acid to HDL-cholesterol ratio is associated with onset of non-alcoholic
fatty liver disease in a non-obese Chinese population with normal blood lipid levels
Version: 2 Date: 21 Jan 2022
Reviewer's report:
The manuscript by professor Xiaoping Wu's group is an interesting compact work that unravels
the difficult clinical problem: NAFLD in lean human subjects. It is a retrospective cohort study
(n=9838 individuals) and a post-hoc analysis of a previous study.  They conclude that serum uric
acid to HDL-cholesterol ratio serves as an inexpensive and reliable predictor of NAFLD in lean
Chinese people with normal blood lipid levels, and that it could be used to identify individuals
at high risk of NAFLD.
I have some comments:
1) The text of the manuscript should be revised by a native english-speaker.
2)  The manuscript should have page numbers
3) Background: The first two sentences should be more precise.
4) It is known that this is a post-hoc analysis, but the inclusion criteria could be mentioned
shortly in Methods. In the present form, only the exclusion criteria are mentioned.
5) How many patients were on lipid lowering medication or serum uric acid decreasing
medication? How many patients suffered from diabetes?
6) In Methdos, what is globulin (GLB)? Is it serum immunoglobulin G?
7) To be exact, BMI is not calculated so as mentioned in the data collection paragraph.
8)  The authors mention several times that "During the five-year follow-up period, the overall
prevalence rate of NAFLD was 8,7%." Is this prevalence percentage at the beginning of the
period or at the end of the period?
9) What is the correlation between weight or BMI of the individuals in this study and serum uric
acid level? Is serum uric acid just a surrogate marker of BMI?
10) What do the authors know about the dietary habits and alcohol consumption of the study
population? This has influence of serum levels of HDL-C and uric acid.
11) Figures 4 and 5 are unclear, because the number of curves is high and the text boxes at the
bottom corner are so small. Could these figures be improved?
Title:  Higher serum uric acid to HDL-cholesterol ratio is associated with onset of non-alcoholic
fatty liver disease in a non-obese Chinese population with normal blood lipid levels
Version: 2 Date: 21 Jan 2022
Reviewer's report:
The manuscript by professor Xiaoping Wu's group is an interesting compact work that unravels
the difficult clinical problem: NAFLD in lean human subjects. It is a retrospective cohort study
(n=9838 individuals) and a post-hoc analysis of a previous study.  They conclude that serum uric
acid to HDL-cholesterol ratio serves as an inexpensive and reliable predictor of NAFLD in lean
Chinese people with normal blood lipid levels, and that it could be used to identify individuals
at high risk of NAFLD.
I have some comments:
1) The text of the manuscript should be revised by a native english-speaker.
2)  The manuscript should have page numbers
3) Background: The first two sentences should be more precise.
4) It is known that this is a post-hoc analysis, but the inclusion criteria could be mentioned
shortly in Methods. In the present form, only the exclusion criteria are mentioned.
5) How many patients were on lipid lowering medication or serum uric acid decreasing
medication? How many patients suffered from diabetes?
6) In Methdos, what is globulin (GLB)? Is it serum immunoglobulin G?
7) To be exact, BMI is not calculated so as mentioned in the data collection paragraph.
8)  The authors mention several times that "During the five-year follow-up period, the overall
prevalence rate of NAFLD was 8,7%." Is this prevalence percentage at the beginning of the
period or at the end of the period?
9) What is the correlation between weight or BMI of the individuals in this study and serum uric
acid level? Is serum uric acid just a surrogate marker of BMI?
10) What do the authors know about the dietary habits and alcohol consumption of the study
population? This has influence of serum levels of HDL-C and uric acid.
11) Figures 4 and 5 are unclear, because the number of curves is high and the text boxes at the
bottom corner are so small. Could these figures be improved?
Please review this paper.
user
Title:  Higher serum uric acid to HDL-cholesterol ratio is associated with onset of non-alcoholic
fatty liver disease in a non-obese Chinese population with normal blood lipid levels
Version: 2 Date: 21 Jan 2022
Reviewer's report:
The manuscript by professor Xiaoping Wu's group is an interesting compact work that unravels
the difficult clinical problem: NAFLD in lean human subjects. It is a retrospective cohort study
(n=9838 individuals) and a post-hoc analysis of a previous study.  They conclude that serum uric
acid to HDL-cholesterol ratio serves as an inexpensive and reliable predictor of NAFLD in lean
Chinese people with normal blood lipid levels, and that it could be used to identify individuals
at high risk of NAFLD.
I have some comments:
1) The text of the manuscript should be revised by a native english-speaker.
2)  The manuscript should have page numbers
3) Background: The first two sentences should be more precise.
4) It is known that this is a post-hoc analysis, but the inclusion criteria could be mentioned
shortly in Methods. In the present form, only the exclusion criteria are mentioned.
5) How many patients were on lipid lowering medication or serum uric acid decreasing
medication? How many patients suffered from diabetes?
6) In Methdos, what is globulin (GLB)? Is it serum immunoglobulin G?
7) To be exact, BMI is not calculated so as mentioned in the data collection paragraph.
8)  The authors mention several times that "During the five-year follow-up period, the overall
prevalence rate of NAFLD was 8,7%." Is this prevalence percentage at the beginning of the
period or at the end of the period?
9) What is the correlation between weight or BMI of the individuals in this study and serum uric
acid level? Is serum uric acid just a surrogate marker of BMI?
10) What do the authors know about the dietary habits and alcohol consumption of the study
population? This has influence of serum levels of HDL-C and uric acid.
11) Figures 4 and 5 are unclear, because the number of curves is high and the text boxes at the
bottom corner are so small. Could these figures be improved?
assistant