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: 27 Mar 2025
Reviewer's report:
This manuscript presents an insightful study investigating the predictive value of modified
triglyceride-glucose (TyG) indices for non-alcoholic fatty liver disease (NAFLD) in adolescents
using NHANES data. The study is well-structured and addresses a clinically relevant topic.
However, several aspects require revision and clarification to enhance the manuscript's scientific
rigor and overall quality.
- The terminology for NAFLD has recently been updated to metabolic dysfunction-associated
steatotic liver disease (MASLD). It is recommended that the authors adopt this revised
nomenclature while considering a subgroup analysis to compare findings between MASLD and
the previous NAFLD definition.
Methodological Considerations:
- The methods section mentions liver stiffness measurement, yet the manuscript does not report
these results. Please include the liver fibrosis data and analyze the association between TyG
indices and fibrosis severity.
- To comprehensively assess the predictive accuracy of the TyG indices for identifying NAFLD/
MASLD, the area under the receiver operating characteristic curve (AUROC) should be
calculated. Please incorporate AUROC analysis into the statistical methodology and report these
findings.
- Clarify the time interval between the CAP/LSM assessments and blood sample collection used
for calculating the TyG indices. If there is a significant delay between these assessments, discuss
its potential impact on the study findings.
Discussion:
- Compare the study results with previous literature utilizing NAFLD, MAFLD, and MASLD
diagnostic criteria, and discuss any discrepancies arising from the different classification
systems.
- Contextualize the AUROC values obtained in this study by comparing them with other
commonly used non-invasive biomarkers and scoring systems.
- Discuss whether there are age-related differences in the diagnostic performance of these indices
between adolescents and adults.
- Elaborate on the clinical implications of the findings, particularly their potential utility in
screening or early identification of NAFLD/MASLD in adolescents.
By addressing these points, the manuscript will be significantly strengthened, providing greater
clarity and impact.
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: 27 Mar 2025
Reviewer's report:
This manuscript presents an insightful study investigating the predictive value of modified
triglyceride-glucose (TyG) indices for non-alcoholic fatty liver disease (NAFLD) in adolescents
using NHANES data. The study is well-structured and addresses a clinically relevant topic.
However, several aspects require revision and clarification to enhance the manuscript's scientific
rigor and overall quality.
- The terminology for NAFLD has recently been updated to metabolic dysfunction-associated
steatotic liver disease (MASLD). It is recommended that the authors adopt this revised
nomenclature while considering a subgroup analysis to compare findings between MASLD and
the previous NAFLD definition.
Methodological Considerations:
- The methods section mentions liver stiffness measurement, yet the manuscript does not report
these results. Please include the liver fibrosis data and analyze the association between TyG
indices and fibrosis severity.
- To comprehensively assess the predictive accuracy of the TyG indices for identifying NAFLD/
MASLD, the area under the receiver operating characteristic curve (AUROC) should be
calculated. Please incorporate AUROC analysis into the statistical methodology and report these
findings.
- Clarify the time interval between the CAP/LSM assessments and blood sample collection used
for calculating the TyG indices. If there is a significant delay between these assessments, discuss
its potential impact on the study findings.
Discussion:
- Compare the study results with previous literature utilizing NAFLD, MAFLD, and MASLD
diagnostic criteria, and discuss any discrepancies arising from the different classification
systems.
- Contextualize the AUROC values obtained in this study by comparing them with other
commonly used non-invasive biomarkers and scoring systems.
- Discuss whether there are age-related differences in the diagnostic performance of these indices
between adolescents and adults.
- Elaborate on the clinical implications of the findings, particularly their potential utility in
screening or early identification of NAFLD/MASLD in adolescents.
By addressing these points, the manuscript will be significantly strengthened, providing greater
clarity and impact.
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: 27 Mar 2025
Reviewer's report:
This manuscript presents an insightful study investigating the predictive value of modified
triglyceride-glucose (TyG) indices for non-alcoholic fatty liver disease (NAFLD) in adolescents
using NHANES data. The study is well-structured and addresses a clinically relevant topic.
However, several aspects require revision and clarification to enhance the manuscript's scientific
rigor and overall quality.
- The terminology for NAFLD has recently been updated to metabolic dysfunction-associated
steatotic liver disease (MASLD). It is recommended that the authors adopt this revised
nomenclature while considering a subgroup analysis to compare findings between MASLD and
the previous NAFLD definition.
Methodological Considerations:
- The methods section mentions liver stiffness measurement, yet the manuscript does not report
these results. Please include the liver fibrosis data and analyze the association between TyG
indices and fibrosis severity.
- To comprehensively assess the predictive accuracy of the TyG indices for identifying NAFLD/
MASLD, the area under the receiver operating characteristic curve (AUROC) should be
calculated. Please incorporate AUROC analysis into the statistical methodology and report these
findings.
- Clarify the time interval between the CAP/LSM assessments and blood sample collection used
for calculating the TyG indices. If there is a significant delay between these assessments, discuss
its potential impact on the study findings.
Discussion:
- Compare the study results with previous literature utilizing NAFLD, MAFLD, and MASLD
diagnostic criteria, and discuss any discrepancies arising from the different classification
systems.
- Contextualize the AUROC values obtained in this study by comparing them with other
commonly used non-invasive biomarkers and scoring systems.
- Discuss whether there are age-related differences in the diagnostic performance of these indices
between adolescents and adults.
- Elaborate on the clinical implications of the findings, particularly their potential utility in
screening or early identification of NAFLD/MASLD in adolescents.
By addressing these points, the manuscript will be significantly strengthened, providing greater
clarity and impact.
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