Reviewer ’s report  
 
Title: Combined Effects of Lifestyle Risk Factors  on Fatty Liver Index  
 
Version: 2 Date: 24 Feb 2020  
 
Reviewer: Ludovico Abenavoli  
 
Reviewer's report:  
 
- Introduction section:  fatty liver is the main liver disease wo rldwide and it encompasses a 
spectrum from simple steatosis to steatohepatitis, fibrosis, or cirrhosis. The mechanisms involved 
in its occurrence and its progression to fibrosis, are probably due to a metabolic profile expressed 
within the context of a gen etic predisposition and is associated with a higher energy food intake. 
Several scientific advances have identified insulin resistance as the key aspect in the 
pathophysiology of  this condition (PMID:27610012). Also is important to highlight the role of 
junk food and western life style (PMID:32077594)  
 
- Discussion section: is pivotal for the Author, to highlight the role of healthy diet, as a 
Mediterranean diet. In fact, lifestyle interventions remain the first -line treatment for fatty liver. 
The interest  in antioxidants has increased over time, and literature reports an inverse association 
between nutrients rich in antioxidants and the risk of mortality due to non -communicable 
diseases, including liver steatosis. Mediterranean diet is a model characterize d by main 
consumption of plant -based foods and fish and reduced consumption of meat and dairy products. 
This diet represents the gold standard in preventive medicine, probably due to the harmonic 
combination of many foods with antioxidant and anti -inflamma tory properties. It contributes 
substantially to the reduction of the onset of many chronic diseases (PMID:31438482)  
 
 
 
Are the methods 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 statistical 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 qua lity 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 salar y from an  
organisation that may in any way gain or 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 publicati on 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 manuscript?  
 
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 decla re that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
none  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my repor t 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 Creativ e 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: Combined Effects of Lifestyle Risk Factors  on Fatty Liver Index  
 
Version: 2 Date: 24 Feb 2020  
 
Reviewer: Ludovico Abenavoli  
 
Reviewer's report:  
 
- Introduction section:  fatty liver is the main liver disease wo rldwide and it encompasses a 
spectrum from simple steatosis to steatohepatitis, fibrosis, or cirrhosis. The mechanisms involved 
in its occurrence and its progression to fibrosis, are probably due to a metabolic profile expressed 
within the context of a gen etic predisposition and is associated with a higher energy food intake. 
Several scientific advances have identified insulin resistance as the key aspect in the 
pathophysiology of  this condition (PMID:27610012). Also is important to highlight the role of 
junk food and western life style (PMID:32077594)  
 
- Discussion section: is pivotal for the Author, to highlight the role of healthy diet, as a 
Mediterranean diet. In fact, lifestyle interventions remain the first -line treatment for fatty liver. 
The interest  in antioxidants has increased over time, and literature reports an inverse association 
between nutrients rich in antioxidants and the risk of mortality due to non -communicable 
diseases, including liver steatosis. Mediterranean diet is a model characterize d by main 
consumption of plant -based foods and fish and reduced consumption of meat and dairy products. 
This diet represents the gold standard in preventive medicine, probably due to the harmonic 
combination of many foods with antioxidant and anti -inflamma tory properties. It contributes 
substantially to the reduction of the onset of many chronic diseases (PMID:31438482)  
 
 
 
Are the methods 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 statistical 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 qua lity 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 salar y from an  
organisation that may in any way gain or 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 publicati on 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 manuscript?  
 
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 decla re that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
none  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my repor t 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 Creativ e 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: Combined Effects of Lifestyle Risk Factors  on Fatty Liver Index  
 
Version: 2 Date: 24 Feb 2020  
 
Reviewer: Ludovico Abenavoli  
 
Reviewer's report:  
 
- Introduction section:  fatty liver is the main liver disease wo rldwide and it encompasses a 
spectrum from simple steatosis to steatohepatitis, fibrosis, or cirrhosis. The mechanisms involved 
in its occurrence and its progression to fibrosis, are probably due to a metabolic profile expressed 
within the context of a gen etic predisposition and is associated with a higher energy food intake. 
Several scientific advances have identified insulin resistance as the key aspect in the 
pathophysiology of  this condition (PMID:27610012). Also is important to highlight the role of 
junk food and western life style (PMID:32077594)  
 
- Discussion section: is pivotal for the Author, to highlight the role of healthy diet, as a 
Mediterranean diet. In fact, lifestyle interventions remain the first -line treatment for fatty liver. 
The interest  in antioxidants has increased over time, and literature reports an inverse association 
between nutrients rich in antioxidants and the risk of mortality due to non -communicable 
diseases, including liver steatosis. Mediterranean diet is a model characterize d by main 
consumption of plant -based foods and fish and reduced consumption of meat and dairy products. 
This diet represents the gold standard in preventive medicine, probably due to the harmonic 
combination of many foods with antioxidant and anti -inflamma tory properties. It contributes 
substantially to the reduction of the onset of many chronic diseases (PMID:31438482)  
 
 
 
Are the methods 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 statistical 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 qua lity 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 salar y from an  
organisation that may in any way gain or 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 publicati on 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 manuscript?  
 
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 decla re that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
none  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my repor t 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 Creativ e 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