Reviewer's report
Title:Discrimination of individuals in a general population at high-risk for
alcoholic and non-alcoholic fatty liver disease based on liver stiffness
Version: 1Date:30 January 2011
Reviewer: Do Young Kim
Reviewer's report:
The authors investigated the value of liver stiffness measurement (LSM) by
FibroScan in 416 healthy adults who underwent general check-up. Fatty liver was
diagnosed by ultrasonography (US). With BMI and daily alcohol consumption,
patients were divided into alcoholic and non-alcoholic fatty liver disease,
respectively. The 171 subjects with no fatty liver in US, normal BMI and liver test,
and no/non-habitual alcohol consumption were set as control. The authors found
that LSM in 171 subjects was 4.3±0.85kPa. The LSM was significantly higher in
subjects with fatty liver than those without fatty liver. BMI was found to be the
only independent factor associated with higher LSM value.
[Comments]
1. Although the authors stated that liver biopsy is hard to conduct in routine
patient care or health check-up, it is a major drawback of this study that a
reference standard of fatty liver. In spite of relatively high positive predictive value
of US in diagnosis of fatty liver, US is not the gold standard for diagnosis of fatty
liver.{Major compulsory revision)
2.Rrather small number of subjects in this study may not be representative of
general population. Moreover, the subjects would not be purely indicative of
general population since there is possibility of some symptoms or signs in these
subjects.(Major compulsory revision)
3. Normal value of LSM values in healthy adults have already been reported (Kim
SU, et al. Liver International). (Minor essential revision)
4. Deleting ALT levels and other factors from multivariate analysis may not be
appropriate.(Major compulsory revision)
5. High ALT is well known to affect LSM score. Considering this, Figure 6 show
the same result as that of Figure 4.(Minor essential revision)
6. The authors would discuss more on the debate of relationship between LSM
and steatosis.(Major compulsory revision)
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests.
Reviewer's report
Title:Discrimination of individuals in a general population at high-risk for
alcoholic and non-alcoholic fatty liver disease based on liver stiffness
Version: 1Date:30 January 2011
Reviewer: Do Young Kim
Reviewer's report:
The authors investigated the value of liver stiffness measurement (LSM) by
FibroScan in 416 healthy adults who underwent general check-up. Fatty liver was
diagnosed by ultrasonography (US). With BMI and daily alcohol consumption,
patients were divided into alcoholic and non-alcoholic fatty liver disease,
respectively. The 171 subjects with no fatty liver in US, normal BMI and liver test,
and no/non-habitual alcohol consumption were set as control. The authors found
that LSM in 171 subjects was 4.3±0.85kPa. The LSM was significantly higher in
subjects with fatty liver than those without fatty liver. BMI was found to be the
only independent factor associated with higher LSM value.
[Comments]
1. Although the authors stated that liver biopsy is hard to conduct in routine
patient care or health check-up, it is a major drawback of this study that a
reference standard of fatty liver. In spite of relatively high positive predictive value
of US in diagnosis of fatty liver, US is not the gold standard for diagnosis of fatty
liver.{Major compulsory revision)
2.Rrather small number of subjects in this study may not be representative of
general population. Moreover, the subjects would not be purely indicative of
general population since there is possibility of some symptoms or signs in these
subjects.(Major compulsory revision)
3. Normal value of LSM values in healthy adults have already been reported (Kim
SU, et al. Liver International). (Minor essential revision)
4. Deleting ALT levels and other factors from multivariate analysis may not be
appropriate.(Major compulsory revision)
5. High ALT is well known to affect LSM score. Considering this, Figure 6 show
the same result as that of Figure 4.(Minor essential revision)
6. The authors would discuss more on the debate of relationship between LSM
and steatosis.(Major compulsory revision)
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests.
Please review this paper.
user
Reviewer's report
Title:Discrimination of individuals in a general population at high-risk for
alcoholic and non-alcoholic fatty liver disease based on liver stiffness
Version: 1Date:30 January 2011
Reviewer: Do Young Kim
Reviewer's report:
The authors investigated the value of liver stiffness measurement (LSM) by
FibroScan in 416 healthy adults who underwent general check-up. Fatty liver was
diagnosed by ultrasonography (US). With BMI and daily alcohol consumption,
patients were divided into alcoholic and non-alcoholic fatty liver disease,
respectively. The 171 subjects with no fatty liver in US, normal BMI and liver test,
and no/non-habitual alcohol consumption were set as control. The authors found
that LSM in 171 subjects was 4.3±0.85kPa. The LSM was significantly higher in
subjects with fatty liver than those without fatty liver. BMI was found to be the
only independent factor associated with higher LSM value.
[Comments]
1. Although the authors stated that liver biopsy is hard to conduct in routine
patient care or health check-up, it is a major drawback of this study that a
reference standard of fatty liver. In spite of relatively high positive predictive value
of US in diagnosis of fatty liver, US is not the gold standard for diagnosis of fatty
liver.{Major compulsory revision)
2.Rrather small number of subjects in this study may not be representative of
general population. Moreover, the subjects would not be purely indicative of
general population since there is possibility of some symptoms or signs in these
subjects.(Major compulsory revision)
3. Normal value of LSM values in healthy adults have already been reported (Kim
SU, et al. Liver International). (Minor essential revision)
4. Deleting ALT levels and other factors from multivariate analysis may not be
appropriate.(Major compulsory revision)
5. High ALT is well known to affect LSM score. Considering this, Figure 6 show
the same result as that of Figure 4.(Minor essential revision)
6. The authors would discuss more on the debate of relationship between LSM
and steatosis.(Major compulsory revision)
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests.
assistant