Title: The prevalence of obesity and underweight in celiac patients at the time of diagnosis: a
systematic review and meta-analysis
Version: 2 Date: 22 Aug 2024
Reviewer's report:
I congratulate the authors on their work and the aim to answer an important question in the field
of celiac disease. I am not a meta analysis methodologist but the search and approach appears
sound.
Suggestions:
-In the eligibility section, formally state that this is an analysis of studies including "adults" with
celiac disease.
-Label abbreviations on the tables/figures.
-When drawing conclusions on the underweight individuals:
---I agree that highlighting that this is decreasing over time, but can you compare the 11% to
that reported in controls? This still may be more than the general population studied/reported.
You did highlight this for India in the discussion.
---Celiac disease should still be considered in those with a malabsorptive phenotype even though
the BMI may be changing.
-I agree with your restrictions to include those at baseline diagnosis, before a gluten free diet.
-While the proportion of obese/overweight celiac patients is increasing, please highlight in the
discussion that you did find that controls an OR of 1.25 for being obese/overweight.
-when referring to continent in the meta-regression, please clarify in the text/figure label if
referring to geography.
-In the discussion, first paragraph, clarify if reported prevalences are percentages (%).
-The discussion should have a  clear  conclusion/highlight that this study shows that it is common
for patients to be overweight/obese at diagnosis, confirming the reported change in phenotype
of celiac disease from that of strictly  malabsorptive/malnourished to now include those  without
clear evidence of malnutrition.  Some CD still presents with the classic phenotype, highlighted
by the 11% seen here.
Paragraph 3 in the discussion is somewhat confusion looking at gender. With your p value of
0.055, I would not ground too much on the female component seen here. I would also phrase
the association with age differently as the verbiage in this paragraph is somewhat unclear. Does
your data suggest that "in celiac patients, there is an association between higher age and being
overweight/obese"?
In paragraph 5 of the discussion,  caution with using the phrase that celiac disease is not common
in developing countries. Consider rephrasing that CD is less frequently diagnosed in developing
countries, and may be more suspect in those with an malnourished phenotype--unless you have
a source to show differences in prevalence of CD in the developing world.
Title: The prevalence of obesity and underweight in celiac patients at the time of diagnosis: a
systematic review and meta-analysis
Version: 2 Date: 22 Aug 2024
Reviewer's report:
I congratulate the authors on their work and the aim to answer an important question in the field
of celiac disease. I am not a meta analysis methodologist but the search and approach appears
sound.
Suggestions:
-In the eligibility section, formally state that this is an analysis of studies including "adults" with
celiac disease.
-Label abbreviations on the tables/figures.
-When drawing conclusions on the underweight individuals:
---I agree that highlighting that this is decreasing over time, but can you compare the 11% to
that reported in controls? This still may be more than the general population studied/reported.
You did highlight this for India in the discussion.
---Celiac disease should still be considered in those with a malabsorptive phenotype even though
the BMI may be changing.
-I agree with your restrictions to include those at baseline diagnosis, before a gluten free diet.
-While the proportion of obese/overweight celiac patients is increasing, please highlight in the
discussion that you did find that controls an OR of 1.25 for being obese/overweight.
-when referring to continent in the meta-regression, please clarify in the text/figure label if
referring to geography.
-In the discussion, first paragraph, clarify if reported prevalences are percentages (%).
-The discussion should have a  clear  conclusion/highlight that this study shows that it is common
for patients to be overweight/obese at diagnosis, confirming the reported change in phenotype
of celiac disease from that of strictly  malabsorptive/malnourished to now include those  without
clear evidence of malnutrition.  Some CD still presents with the classic phenotype, highlighted
by the 11% seen here.
Paragraph 3 in the discussion is somewhat confusion looking at gender. With your p value of
0.055, I would not ground too much on the female component seen here. I would also phrase
the association with age differently as the verbiage in this paragraph is somewhat unclear. Does
your data suggest that "in celiac patients, there is an association between higher age and being
overweight/obese"?
In paragraph 5 of the discussion,  caution with using the phrase that celiac disease is not common
in developing countries. Consider rephrasing that CD is less frequently diagnosed in developing
countries, and may be more suspect in those with an malnourished phenotype--unless you have
a source to show differences in prevalence of CD in the developing world.
Please review this paper.
user
Title: The prevalence of obesity and underweight in celiac patients at the time of diagnosis: a
systematic review and meta-analysis
Version: 2 Date: 22 Aug 2024
Reviewer's report:
I congratulate the authors on their work and the aim to answer an important question in the field
of celiac disease. I am not a meta analysis methodologist but the search and approach appears
sound.
Suggestions:
-In the eligibility section, formally state that this is an analysis of studies including "adults" with
celiac disease.
-Label abbreviations on the tables/figures.
-When drawing conclusions on the underweight individuals:
---I agree that highlighting that this is decreasing over time, but can you compare the 11% to
that reported in controls? This still may be more than the general population studied/reported.
You did highlight this for India in the discussion.
---Celiac disease should still be considered in those with a malabsorptive phenotype even though
the BMI may be changing.
-I agree with your restrictions to include those at baseline diagnosis, before a gluten free diet.
-While the proportion of obese/overweight celiac patients is increasing, please highlight in the
discussion that you did find that controls an OR of 1.25 for being obese/overweight.
-when referring to continent in the meta-regression, please clarify in the text/figure label if
referring to geography.
-In the discussion, first paragraph, clarify if reported prevalences are percentages (%).
-The discussion should have a  clear  conclusion/highlight that this study shows that it is common
for patients to be overweight/obese at diagnosis, confirming the reported change in phenotype
of celiac disease from that of strictly  malabsorptive/malnourished to now include those  without
clear evidence of malnutrition.  Some CD still presents with the classic phenotype, highlighted
by the 11% seen here.
Paragraph 3 in the discussion is somewhat confusion looking at gender. With your p value of
0.055, I would not ground too much on the female component seen here. I would also phrase
the association with age differently as the verbiage in this paragraph is somewhat unclear. Does
your data suggest that "in celiac patients, there is an association between higher age and being
overweight/obese"?
In paragraph 5 of the discussion,  caution with using the phrase that celiac disease is not common
in developing countries. Consider rephrasing that CD is less frequently diagnosed in developing
countries, and may be more suspect in those with an malnourished phenotype--unless you have
a source to show differences in prevalence of CD in the developing world.
assistant