Reviewer's report
Title:Gallstones associated with non-alcoholic fatty liver disease in female rather
than male: a longitudinal cohort study
Version:1Date:12 February 2014
Reviewer: Frank Tacke
Reviewer's report:
This is an interesting longitudinal cohort study aiming at elucidating the
relationship between NAFLD and gallstones.
- As the authors point out themselves, the association between NAFLD and
gallstones is well established from several cohorts (from different parts of the
world), which limits the novelty of the current analysis.
- Language and grammar needs some thorough editing, ideally by a native
speaker.
- A major difficulty in interpreting the data is the validity of the ultrasound exam.
Did all subject undergo abdominal ultrasound at the time-point of inclusion into
the study? How was the quality of the ultrasound validated? Did an independent
observer confirm diagnosis of hepatic steatosis? How was alcohol intake
quantified? In how many individuals was NAFLD assumed (diagnosed) without
proper exclusion of other causes (HBV, HCV, alcohol etc.)?
- A major limitation is that ALT and AST levels are not reported. This basically
precludes to accurately stage NAFLD (into either ‘benign steatosis’, NASH,
fibrosis, cirrhosis or HCC).
- The authors not only need to assess the association between NAFLD and
gallstones, but also with its disease-specific complications. That means, does the
presence of gallstones predispose to cirrhosis or HCC? Does the presence of
NAFLD predispose to symptomatic cholecystolithiasis, cholecystitis or
empyema?
- As the authors point out, gallstones and NAFLD share the same risk factors.
Table 1 presents possible confounding factors. However, the factor NAFLD
(yes/no) needs to be compared to ‘cardiovascular disease’, ‘diabetes’, ‘arterial
hypertension’ etc. Is NAFLD then still an independent predictor of gallstones?
- Was the use of medication (e.g., statins, aspirin, ace-inhibitors etc.) monitored?
How did distinct drugs or classes of drugs impact NAFLD and/or gallstones?
- NAFLD is apparently not a risk factor for gallstones in male. This needs to be
properly discussed. On the other hand, the reader is left wondering whether the
proposed causal relationship between NAFLD and gallstones is really true (why
should this differ between male and female subjects?).
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Not suitable for publication unless extensively edited
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:Gallstones associated with non-alcoholic fatty liver disease in female rather
than male: a longitudinal cohort study
Version:1Date:12 February 2014
Reviewer: Frank Tacke
Reviewer's report:
This is an interesting longitudinal cohort study aiming at elucidating the
relationship between NAFLD and gallstones.
- As the authors point out themselves, the association between NAFLD and
gallstones is well established from several cohorts (from different parts of the
world), which limits the novelty of the current analysis.
- Language and grammar needs some thorough editing, ideally by a native
speaker.
- A major difficulty in interpreting the data is the validity of the ultrasound exam.
Did all subject undergo abdominal ultrasound at the time-point of inclusion into
the study? How was the quality of the ultrasound validated? Did an independent
observer confirm diagnosis of hepatic steatosis? How was alcohol intake
quantified? In how many individuals was NAFLD assumed (diagnosed) without
proper exclusion of other causes (HBV, HCV, alcohol etc.)?
- A major limitation is that ALT and AST levels are not reported. This basically
precludes to accurately stage NAFLD (into either ‘benign steatosis’, NASH,
fibrosis, cirrhosis or HCC).
- The authors not only need to assess the association between NAFLD and
gallstones, but also with its disease-specific complications. That means, does the
presence of gallstones predispose to cirrhosis or HCC? Does the presence of
NAFLD predispose to symptomatic cholecystolithiasis, cholecystitis or
empyema?
- As the authors point out, gallstones and NAFLD share the same risk factors.
Table 1 presents possible confounding factors. However, the factor NAFLD
(yes/no) needs to be compared to ‘cardiovascular disease’, ‘diabetes’, ‘arterial
hypertension’ etc. Is NAFLD then still an independent predictor of gallstones?
- Was the use of medication (e.g., statins, aspirin, ace-inhibitors etc.) monitored?
How did distinct drugs or classes of drugs impact NAFLD and/or gallstones?
- NAFLD is apparently not a risk factor for gallstones in male. This needs to be
properly discussed. On the other hand, the reader is left wondering whether the
proposed causal relationship between NAFLD and gallstones is really true (why
should this differ between male and female subjects?).
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Not suitable for publication unless extensively edited
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:Gallstones associated with non-alcoholic fatty liver disease in female rather
than male: a longitudinal cohort study
Version:1Date:12 February 2014
Reviewer: Frank Tacke
Reviewer's report:
This is an interesting longitudinal cohort study aiming at elucidating the
relationship between NAFLD and gallstones.
- As the authors point out themselves, the association between NAFLD and
gallstones is well established from several cohorts (from different parts of the
world), which limits the novelty of the current analysis.
- Language and grammar needs some thorough editing, ideally by a native
speaker.
- A major difficulty in interpreting the data is the validity of the ultrasound exam.
Did all subject undergo abdominal ultrasound at the time-point of inclusion into
the study? How was the quality of the ultrasound validated? Did an independent
observer confirm diagnosis of hepatic steatosis? How was alcohol intake
quantified? In how many individuals was NAFLD assumed (diagnosed) without
proper exclusion of other causes (HBV, HCV, alcohol etc.)?
- A major limitation is that ALT and AST levels are not reported. This basically
precludes to accurately stage NAFLD (into either ‘benign steatosis’, NASH,
fibrosis, cirrhosis or HCC).
- The authors not only need to assess the association between NAFLD and
gallstones, but also with its disease-specific complications. That means, does the
presence of gallstones predispose to cirrhosis or HCC? Does the presence of
NAFLD predispose to symptomatic cholecystolithiasis, cholecystitis or
empyema?
- As the authors point out, gallstones and NAFLD share the same risk factors.
Table 1 presents possible confounding factors. However, the factor NAFLD
(yes/no) needs to be compared to ‘cardiovascular disease’, ‘diabetes’, ‘arterial
hypertension’ etc. Is NAFLD then still an independent predictor of gallstones?
- Was the use of medication (e.g., statins, aspirin, ace-inhibitors etc.) monitored?
How did distinct drugs or classes of drugs impact NAFLD and/or gallstones?
- NAFLD is apparently not a risk factor for gallstones in male. This needs to be
properly discussed. On the other hand, the reader is left wondering whether the
proposed causal relationship between NAFLD and gallstones is really true (why
should this differ between male and female subjects?).
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Not suitable for publication unless extensively edited
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.
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