Title: Modified Triglyceride-Glucose Indices as Novel Predictors of Metabolic Dysfunction-
associated Fatty Liver Disease in US Adolescents: A Nationally Representative Study from
NHANES 2017-2020
Version: 1 Date: 14 Mar 2025
Reviewer's report:
Thank you for  involved me in the revision process of the present manuscript. This manuscript
is well written, but lacks of a true novelty and suffer of many issues:
1. The study population consists of a relatively small sample size, which may not be
representative of the broader adolescent population. At the same time, the demographic
composition, with a predominance of Non-Hispanic White participants, limits the
generalizability of the findings to diverse racial and ethnic groups.
2. The confounding factors were insufficiently adjusted in the final model, raising concerns
about potential residual confounding in the observed associations.
3. The manuscript highlights a significant association between TyG indices and CAP; however,
the disappearance of significance for the TyG index and TyG-BMI in Model 3 contradicts the
earlier conclusions.
4. While the association between TyG-related indices and NAFLD has been explored in previous
studies, this manuscript does not provide substantial novel insights beyond existing literature.
The clinical implications of the findings are not well-articulated, and the practical utility of
modified TyG indices in adolescent NAFLD risk stratification remains unclear.
5. The new MASLD nomenclature was not adopted. NAFLD nomenclature has been changed
at the end of 2023.
Title: Modified Triglyceride-Glucose Indices as Novel Predictors of Metabolic Dysfunction-
associated Fatty Liver Disease in US Adolescents: A Nationally Representative Study from
NHANES 2017-2020
Version: 1 Date: 14 Mar 2025
Reviewer's report:
Thank you for  involved me in the revision process of the present manuscript. This manuscript
is well written, but lacks of a true novelty and suffer of many issues:
1. The study population consists of a relatively small sample size, which may not be
representative of the broader adolescent population. At the same time, the demographic
composition, with a predominance of Non-Hispanic White participants, limits the
generalizability of the findings to diverse racial and ethnic groups.
2. The confounding factors were insufficiently adjusted in the final model, raising concerns
about potential residual confounding in the observed associations.
3. The manuscript highlights a significant association between TyG indices and CAP; however,
the disappearance of significance for the TyG index and TyG-BMI in Model 3 contradicts the
earlier conclusions.
4. While the association between TyG-related indices and NAFLD has been explored in previous
studies, this manuscript does not provide substantial novel insights beyond existing literature.
The clinical implications of the findings are not well-articulated, and the practical utility of
modified TyG indices in adolescent NAFLD risk stratification remains unclear.
5. The new MASLD nomenclature was not adopted. NAFLD nomenclature has been changed
at the end of 2023.
Please review this paper.
user
Title: Modified Triglyceride-Glucose Indices as Novel Predictors of Metabolic Dysfunction-
associated Fatty Liver Disease in US Adolescents: A Nationally Representative Study from
NHANES 2017-2020
Version: 1 Date: 14 Mar 2025
Reviewer's report:
Thank you for  involved me in the revision process of the present manuscript. This manuscript
is well written, but lacks of a true novelty and suffer of many issues:
1. The study population consists of a relatively small sample size, which may not be
representative of the broader adolescent population. At the same time, the demographic
composition, with a predominance of Non-Hispanic White participants, limits the
generalizability of the findings to diverse racial and ethnic groups.
2. The confounding factors were insufficiently adjusted in the final model, raising concerns
about potential residual confounding in the observed associations.
3. The manuscript highlights a significant association between TyG indices and CAP; however,
the disappearance of significance for the TyG index and TyG-BMI in Model 3 contradicts the
earlier conclusions.
4. While the association between TyG-related indices and NAFLD has been explored in previous
studies, this manuscript does not provide substantial novel insights beyond existing literature.
The clinical implications of the findings are not well-articulated, and the practical utility of
modified TyG indices in adolescent NAFLD risk stratification remains unclear.
5. The new MASLD nomenclature was not adopted. NAFLD nomenclature has been changed
at the end of 2023.
assistant