Title: Effect of Synbiotics on the Cardiovascular Risk Factors in Patients with Non- alcoholic
Fatty Liver: A GRADE Evidence Systematic Review, Meta-analysis
Version: 0 Date: 30 Jan 2025
Reviewer's report:
The manuscript is well-structured and methodologically rigid, but addressing inconsistencies in
study selection, refining heterogeneity analysis, and improving clinical relevance discussions
would strengthen its impact.
In Section 3.1, Selection and Characteristics of Studies, the numbers do not seem to add up
correctly (full text: 17 - 3 - 1 = ?). Please verify and clarify the discrepancy.
Could you provide more details about the cohorts in Table 1? Specifically, including parameters
such as gender distribution, the type of symbiotic supplements used (bacterial strains, method of
bacterial cultivation), baseline comorbidities, and the classification criteria for NAFLD/NASH
severity. Additionally, would it be possible to conduct a subgroup analysis based on baseline
disease severity, NAFLD/NASH classification at enrollment, or variations in supplement types?
Given that many outcomes exhibit substantial heterogeneity (I² > 90%), could you discuss
potential key contributors to this variability for each outcome?
Can you provide additional evidence linking statistical significance to clinical relevance? While
the reductions in WC (5 cm) and SBP (10–20 mmHg) are mentioned as clinically meaningful,
could you extend this discussion to other parameters?
The discussion effectively compares findings with prior meta-analyses. However, differences in
study inclusion criteria (e.g., duration thresholds, population characteristics) should be compared
to explain conflicting results.
The figures should be refined and some should be rescaled, the error bars are not visible therefore
less informative.
Can you provide a list of full-text excluded articles in the supplementary files? This is customary
to meta-analysis.
Potentially over-stated claims that may need some modification
"Although other studies have been performed in this field, none were as comprehensive as ours.",
you may provide reasons.
"Overall, supplementation with synbiotics positively improved cardiovascular risk factors in
patients with NAFLD." "Synbiotics have improving and favorable effects on weight, WC, SBP,
DBP, CRP, TNF-a, TC, LDL-C, and TG.", you may refer to statistical significance but not
directly clinical significance in this preliminary reports of your findings.
Title: Effect of Synbiotics on the Cardiovascular Risk Factors in Patients with Non- alcoholic
Fatty Liver: A GRADE Evidence Systematic Review, Meta-analysis
Version: 0 Date: 30 Jan 2025
Reviewer's report:
The manuscript is well-structured and methodologically rigid, but addressing inconsistencies in
study selection, refining heterogeneity analysis, and improving clinical relevance discussions
would strengthen its impact.
In Section 3.1, Selection and Characteristics of Studies, the numbers do not seem to add up
correctly (full text: 17 - 3 - 1 = ?). Please verify and clarify the discrepancy.
Could you provide more details about the cohorts in Table 1? Specifically, including parameters
such as gender distribution, the type of symbiotic supplements used (bacterial strains, method of
bacterial cultivation), baseline comorbidities, and the classification criteria for NAFLD/NASH
severity. Additionally, would it be possible to conduct a subgroup analysis based on baseline
disease severity, NAFLD/NASH classification at enrollment, or variations in supplement types?
Given that many outcomes exhibit substantial heterogeneity (I² > 90%), could you discuss
potential key contributors to this variability for each outcome?
Can you provide additional evidence linking statistical significance to clinical relevance? While
the reductions in WC (5 cm) and SBP (10–20 mmHg) are mentioned as clinically meaningful,
could you extend this discussion to other parameters?
The discussion effectively compares findings with prior meta-analyses. However, differences in
study inclusion criteria (e.g., duration thresholds, population characteristics) should be compared
to explain conflicting results.
The figures should be refined and some should be rescaled, the error bars are not visible therefore
less informative.
Can you provide a list of full-text excluded articles in the supplementary files? This is customary
to meta-analysis.
Potentially over-stated claims that may need some modification
"Although other studies have been performed in this field, none were as comprehensive as ours.",
you may provide reasons.
"Overall, supplementation with synbiotics positively improved cardiovascular risk factors in
patients with NAFLD." "Synbiotics have improving and favorable effects on weight, WC, SBP,
DBP, CRP, TNF-a, TC, LDL-C, and TG.", you may refer to statistical significance but not
directly clinical significance in this preliminary reports of your findings.
Please review this paper.
user
Title: Effect of Synbiotics on the Cardiovascular Risk Factors in Patients with Non- alcoholic
Fatty Liver: A GRADE Evidence Systematic Review, Meta-analysis
Version: 0 Date: 30 Jan 2025
Reviewer's report:
The manuscript is well-structured and methodologically rigid, but addressing inconsistencies in
study selection, refining heterogeneity analysis, and improving clinical relevance discussions
would strengthen its impact.
In Section 3.1, Selection and Characteristics of Studies, the numbers do not seem to add up
correctly (full text: 17 - 3 - 1 = ?). Please verify and clarify the discrepancy.
Could you provide more details about the cohorts in Table 1? Specifically, including parameters
such as gender distribution, the type of symbiotic supplements used (bacterial strains, method of
bacterial cultivation), baseline comorbidities, and the classification criteria for NAFLD/NASH
severity. Additionally, would it be possible to conduct a subgroup analysis based on baseline
disease severity, NAFLD/NASH classification at enrollment, or variations in supplement types?
Given that many outcomes exhibit substantial heterogeneity (I² > 90%), could you discuss
potential key contributors to this variability for each outcome?
Can you provide additional evidence linking statistical significance to clinical relevance? While
the reductions in WC (5 cm) and SBP (10–20 mmHg) are mentioned as clinically meaningful,
could you extend this discussion to other parameters?
The discussion effectively compares findings with prior meta-analyses. However, differences in
study inclusion criteria (e.g., duration thresholds, population characteristics) should be compared
to explain conflicting results.
The figures should be refined and some should be rescaled, the error bars are not visible therefore
less informative.
Can you provide a list of full-text excluded articles in the supplementary files? This is customary
to meta-analysis.
Potentially over-stated claims that may need some modification
"Although other studies have been performed in this field, none were as comprehensive as ours.",
you may provide reasons.
"Overall, supplementation with synbiotics positively improved cardiovascular risk factors in
patients with NAFLD." "Synbiotics have improving and favorable effects on weight, WC, SBP,
DBP, CRP, TNF-a, TC, LDL-C, and TG.", you may refer to statistical significance but not
directly clinical significance in this preliminary reports of your findings.
assistant