Title: Metabolic Score for Visceral Fat is Correlated with All-Cause and Cardiovascular
Mortality among Individuals with Non-Alcoholic Fatty Liver Disease
Version: 0 Date: 03 Feb 2025
Reviewer's report:
This study aims to explore the correlation between METS-VF and both all-cause mortality
and cardiovascular disease (CVD)-related mortality among individuals with NAFLD. For this
purpose, the authors analyzed data from a cohort of 6,759 subjects from the US NHANES during
the period from 1999 to 2018 diagnosed with NAFLD. They found that elevated METS-VF
independently associates with an increased risk of all-cause and CVD mortality in individuals
with NAFLD.
Comments:
1. Introduction: The authors should use the new definition MASLD (PMID: 37363821) instead
of NAFLD or at least discuss this aspect.
2. Introduction: When the authors discuss that the incidence of cardiovascular adverse events is
higher in individuals with NAFLD, they should also highlight that this is not always the case and
briefly address the heterogeneity in the CVD risk in people with MASLD (PMID: 39681121).
3. Results: In the table 1 the data shown for waist circumference in cm appear not to be correct.
4. Results: For the calculation of the METS-VF height is being used and, for example, height is
not used for the calculation of the VAI or other presented indices of CVD-mortality risk. Because
height impacts on the estimation of total fat mass and the BMI-associated risk of diabetes
(PMID: 38968941) the authors should also perform their analyses in people with different height
categories (e.g. in sex-specific height tertiles).
5. Discussion: It cannot be excluded that increased METS-VF also strongly represents increased
liver fat content which, often, independently of visceral obesity contributes to insulin resistance
and the risk of CVD (PMID: 36754018). The authors should address this point.
6. Discussion: It is not clear to what extent the present findings help to improve the prediction of
total and CVD-mortality. It would also have been important that the authors test the relationship
of the METS-VF with mortality in people without MASLD and compare the predictive results in
people with and without MASLD. Furthermore, at this stage of research much interest exists in
the scientific community in the stratification of the cardiometabolic risk based on BMI, presence
or absence of metabolic health and prediabetes and clusters of people at risk for diabetes or
with diabetes (e.g. see PMID: 37156256). The authors should perform such analyses or at least
discuss this important point.
Title: Metabolic Score for Visceral Fat is Correlated with All-Cause and Cardiovascular
Mortality among Individuals with Non-Alcoholic Fatty Liver Disease
Version: 0 Date: 03 Feb 2025
Reviewer's report:
This study aims to explore the correlation between METS-VF and both all-cause mortality
and cardiovascular disease (CVD)-related mortality among individuals with NAFLD. For this
purpose, the authors analyzed data from a cohort of 6,759 subjects from the US NHANES during
the period from 1999 to 2018 diagnosed with NAFLD. They found that elevated METS-VF
independently associates with an increased risk of all-cause and CVD mortality in individuals
with NAFLD.
Comments:
1. Introduction: The authors should use the new definition MASLD (PMID: 37363821) instead
of NAFLD or at least discuss this aspect.
2. Introduction: When the authors discuss that the incidence of cardiovascular adverse events is
higher in individuals with NAFLD, they should also highlight that this is not always the case and
briefly address the heterogeneity in the CVD risk in people with MASLD (PMID: 39681121).
3. Results: In the table 1 the data shown for waist circumference in cm appear not to be correct.
4. Results: For the calculation of the METS-VF height is being used and, for example, height is
not used for the calculation of the VAI or other presented indices of CVD-mortality risk. Because
height impacts on the estimation of total fat mass and the BMI-associated risk of diabetes
(PMID: 38968941) the authors should also perform their analyses in people with different height
categories (e.g. in sex-specific height tertiles).
5. Discussion: It cannot be excluded that increased METS-VF also strongly represents increased
liver fat content which, often, independently of visceral obesity contributes to insulin resistance
and the risk of CVD (PMID: 36754018). The authors should address this point.
6. Discussion: It is not clear to what extent the present findings help to improve the prediction of
total and CVD-mortality. It would also have been important that the authors test the relationship
of the METS-VF with mortality in people without MASLD and compare the predictive results in
people with and without MASLD. Furthermore, at this stage of research much interest exists in
the scientific community in the stratification of the cardiometabolic risk based on BMI, presence
or absence of metabolic health and prediabetes and clusters of people at risk for diabetes or
with diabetes (e.g. see PMID: 37156256). The authors should perform such analyses or at least
discuss this important point.
Please review this paper.
user
Title: Metabolic Score for Visceral Fat is Correlated with All-Cause and Cardiovascular
Mortality among Individuals with Non-Alcoholic Fatty Liver Disease
Version: 0 Date: 03 Feb 2025
Reviewer's report:
This study aims to explore the correlation between METS-VF and both all-cause mortality
and cardiovascular disease (CVD)-related mortality among individuals with NAFLD. For this
purpose, the authors analyzed data from a cohort of 6,759 subjects from the US NHANES during
the period from 1999 to 2018 diagnosed with NAFLD. They found that elevated METS-VF
independently associates with an increased risk of all-cause and CVD mortality in individuals
with NAFLD.
Comments:
1. Introduction: The authors should use the new definition MASLD (PMID: 37363821) instead
of NAFLD or at least discuss this aspect.
2. Introduction: When the authors discuss that the incidence of cardiovascular adverse events is
higher in individuals with NAFLD, they should also highlight that this is not always the case and
briefly address the heterogeneity in the CVD risk in people with MASLD (PMID: 39681121).
3. Results: In the table 1 the data shown for waist circumference in cm appear not to be correct.
4. Results: For the calculation of the METS-VF height is being used and, for example, height is
not used for the calculation of the VAI or other presented indices of CVD-mortality risk. Because
height impacts on the estimation of total fat mass and the BMI-associated risk of diabetes
(PMID: 38968941) the authors should also perform their analyses in people with different height
categories (e.g. in sex-specific height tertiles).
5. Discussion: It cannot be excluded that increased METS-VF also strongly represents increased
liver fat content which, often, independently of visceral obesity contributes to insulin resistance
and the risk of CVD (PMID: 36754018). The authors should address this point.
6. Discussion: It is not clear to what extent the present findings help to improve the prediction of
total and CVD-mortality. It would also have been important that the authors test the relationship
of the METS-VF with mortality in people without MASLD and compare the predictive results in
people with and without MASLD. Furthermore, at this stage of research much interest exists in
the scientific community in the stratification of the cardiometabolic risk based on BMI, presence
or absence of metabolic health and prediabetes and clusters of people at risk for diabetes or
with diabetes (e.g. see PMID: 37156256). The authors should perform such analyses or at least
discuss this important point.
assistant