Title: Low geriatric nutritional risk index is associated with osteoporosis and fracture risk in
patients with chronic liver disease: a cross-sectional study
Version: 0 Date: 24 Sep 2024
Reviewer's report:
This study investigates the relationship between the geriatric nutritional risk index (GNRI),
osteoporosis, and FRAX in patients with chronic liver disease, and is considered to be a useful
study. However, there are clearly insufficient explanations and some concerns.
Major
1.      Background p4#Line87-88
The aim of this study was to investigate the relationship between GNRI, osteoporosis, and
FRAX-derived fracture risk in patients with CLD. However, the current background does not
fully explain why it is necessary to investigate the relationship between GNRI, osteoporosis,
and FRAX.
2.      Methods p4, Line92-94
The subjects of this study were 209 patients with CLD recruited from two hospitals. Subject
characteristics should be described in detail, such as whether they were inpatients or outpatients.
The goal of osteoporosis treatment is to reduce fractures. Also, FRAX is a risk predictor of
fracture. Therefore, the presence or absence of fractures and history of fractures is extremely
important in this study. It should be detailed in the patient background. Furthermore, it is
advisable to investigate not only history of fracture but also morphological fracture with respect
to the spine.
3.      Methods p4, Line96-99
The present study, the exclusion criteria were as follows: (1) alcoholic liver disease resulting
from heavy alcohol intake (>3 units/day), which causes severe The exclusion criteria were
as follows: (1) alcoholic liver disease resulting from heavy alcohol intake (>3 units/day),
which causes severe malnutrition and (2) patients with ascites, which causes weight gain
and overestimation of GNRI scores. The exclusion of 1 and 2 from the present study is
understandable. On the other hand, the relationship between 1 and 2 above and FRAX is also
interesting. It would be useful to know how much each increases the risk of fracture.
4.      P8, Line197-201
The authors' statistical analysis explained that the cutoff value of the GNRI for predicting
osteoporosis was 104.9. As described in the Methods, Bouillanne O et al.[15] classified the
GNRI risk categories into four: no risk (> 98), low risk (92 to # 98), intermediate risk (82 to <
92), and severe risk (< 82). Considering previous research, it is expected that there will be a very
large number of people with a GNRI below 104.9. What percentage of the subjects in this study
had a GNRI below 104.9 ? In addition, there was no discussion of the cutoff value calculated
from the ROC curve, and the authors should provide a detailed explanation of these results.
#. p8, Line210-222
Does a high FRAX mean a high history of fractures? Factors contributing to high FRAX should
be investigated. We believe that each of the survey items should be investigated and discussed.
In particular, a history of bone fractures should be investigated.
Minor
1.      Please indicate the units of the horizontal axis in Figure 3.
Title: Low geriatric nutritional risk index is associated with osteoporosis and fracture risk in
patients with chronic liver disease: a cross-sectional study
Version: 0 Date: 24 Sep 2024
Reviewer's report:
This study investigates the relationship between the geriatric nutritional risk index (GNRI),
osteoporosis, and FRAX in patients with chronic liver disease, and is considered to be a useful
study. However, there are clearly insufficient explanations and some concerns.
Major
1.      Background p4#Line87-88
The aim of this study was to investigate the relationship between GNRI, osteoporosis, and
FRAX-derived fracture risk in patients with CLD. However, the current background does not
fully explain why it is necessary to investigate the relationship between GNRI, osteoporosis,
and FRAX.
2.      Methods p4, Line92-94
The subjects of this study were 209 patients with CLD recruited from two hospitals. Subject
characteristics should be described in detail, such as whether they were inpatients or outpatients.
The goal of osteoporosis treatment is to reduce fractures. Also, FRAX is a risk predictor of
fracture. Therefore, the presence or absence of fractures and history of fractures is extremely
important in this study. It should be detailed in the patient background. Furthermore, it is
advisable to investigate not only history of fracture but also morphological fracture with respect
to the spine.
3.      Methods p4, Line96-99
The present study, the exclusion criteria were as follows: (1) alcoholic liver disease resulting
from heavy alcohol intake (>3 units/day), which causes severe The exclusion criteria were
as follows: (1) alcoholic liver disease resulting from heavy alcohol intake (>3 units/day),
which causes severe malnutrition and (2) patients with ascites, which causes weight gain
and overestimation of GNRI scores. The exclusion of 1 and 2 from the present study is
understandable. On the other hand, the relationship between 1 and 2 above and FRAX is also
interesting. It would be useful to know how much each increases the risk of fracture.
4.      P8, Line197-201
The authors' statistical analysis explained that the cutoff value of the GNRI for predicting
osteoporosis was 104.9. As described in the Methods, Bouillanne O et al.[15] classified the
GNRI risk categories into four: no risk (> 98), low risk (92 to # 98), intermediate risk (82 to <
92), and severe risk (< 82). Considering previous research, it is expected that there will be a very
large number of people with a GNRI below 104.9. What percentage of the subjects in this study
had a GNRI below 104.9 ? In addition, there was no discussion of the cutoff value calculated
from the ROC curve, and the authors should provide a detailed explanation of these results.
#. p8, Line210-222
Does a high FRAX mean a high history of fractures? Factors contributing to high FRAX should
be investigated. We believe that each of the survey items should be investigated and discussed.
In particular, a history of bone fractures should be investigated.
Minor
1.      Please indicate the units of the horizontal axis in Figure 3.
Please review this paper.
user
Title: Low geriatric nutritional risk index is associated with osteoporosis and fracture risk in
patients with chronic liver disease: a cross-sectional study
Version: 0 Date: 24 Sep 2024
Reviewer's report:
This study investigates the relationship between the geriatric nutritional risk index (GNRI),
osteoporosis, and FRAX in patients with chronic liver disease, and is considered to be a useful
study. However, there are clearly insufficient explanations and some concerns.
Major
1.      Background p4#Line87-88
The aim of this study was to investigate the relationship between GNRI, osteoporosis, and
FRAX-derived fracture risk in patients with CLD. However, the current background does not
fully explain why it is necessary to investigate the relationship between GNRI, osteoporosis,
and FRAX.
2.      Methods p4, Line92-94
The subjects of this study were 209 patients with CLD recruited from two hospitals. Subject
characteristics should be described in detail, such as whether they were inpatients or outpatients.
The goal of osteoporosis treatment is to reduce fractures. Also, FRAX is a risk predictor of
fracture. Therefore, the presence or absence of fractures and history of fractures is extremely
important in this study. It should be detailed in the patient background. Furthermore, it is
advisable to investigate not only history of fracture but also morphological fracture with respect
to the spine.
3.      Methods p4, Line96-99
The present study, the exclusion criteria were as follows: (1) alcoholic liver disease resulting
from heavy alcohol intake (>3 units/day), which causes severe The exclusion criteria were
as follows: (1) alcoholic liver disease resulting from heavy alcohol intake (>3 units/day),
which causes severe malnutrition and (2) patients with ascites, which causes weight gain
and overestimation of GNRI scores. The exclusion of 1 and 2 from the present study is
understandable. On the other hand, the relationship between 1 and 2 above and FRAX is also
interesting. It would be useful to know how much each increases the risk of fracture.
4.      P8, Line197-201
The authors' statistical analysis explained that the cutoff value of the GNRI for predicting
osteoporosis was 104.9. As described in the Methods, Bouillanne O et al.[15] classified the
GNRI risk categories into four: no risk (> 98), low risk (92 to # 98), intermediate risk (82 to <
92), and severe risk (< 82). Considering previous research, it is expected that there will be a very
large number of people with a GNRI below 104.9. What percentage of the subjects in this study
had a GNRI below 104.9 ? In addition, there was no discussion of the cutoff value calculated
from the ROC curve, and the authors should provide a detailed explanation of these results.
#. p8, Line210-222
Does a high FRAX mean a high history of fractures? Factors contributing to high FRAX should
be investigated. We believe that each of the survey items should be investigated and discussed.
In particular, a history of bone fractures should be investigated.
Minor
1.      Please indicate the units of the horizontal axis in Figure 3.
assistant