Reviewer’s report
Title: 
Prevalence of and risk factors for Metabolic associated fatty liver disease
in an urban population in China: a cross-sectional comparative study
Version: 
0 
Date: 
28 Feb 2021
Reviewer's report:
This is a cross-sectional study in evaluating the prevalence of metabolic
associated fatty liver disease in China in a health examination population. The
population size was large, but whether it can represent the population of China
wasn't evident. Many wrong grammar or words use were frequently noted in
abstract and article. The English grammar and words use may be further edited
by native-English advisors. Some results are duplicated mentioned in table and
the result text, and again in discussion. In discussion, some cited literature were
based on NAFLD, not MAFLD which may need further correction and
condensed. 
Major issues: 
1. This study is a hospital based study rather than a territory-cohort study, or a
country-wide random sampling study. How this population represented the
population of China? In a previous study, the prevalence of MAFLD in China
had been reported.(Su Lin et al. Liver Int . 2020 Sep;40(9):2082-2089.) What's
new finding in this study compared with previous China studies?
2. What is the proportion of patients of different age in this study? Is it the same
with the age distribution in China?
2. Evaluation of hepatic steatosis is the key component in diagnosis of MAFLD,
please make detailed and clear definition about it. Is elastography used, or sono-
guided liver histology evaluation? or other blood biomarkers/scores used? If only
by sonography, may the prevalence of MAFLD underestimated in this study?
3.Is there any difference between patients different subgroups of MAFLD
patients, overweight or obesity, normal/lean weight and Type 2 DM?
4. About the measurement of blood pressure, did patients with hypertension
allowed to receive medication at the exam date, if not, how long were they asked
to stop the medication. If not stopped, how much patients had taking HTN
specific medication already? Similar condition and question on patients taking
DM, hyperlipidemia medication treatment. If not stopped, what is the size of
population, since this may influence the value of blood pressure and lab data in
this study. 
5. Since viral hepatitis is an important issue in Asia, how many patients have
coexisting HBV and HCV disease.
6. How many patients having MAFLD related cirrhosis? The drop of prevalence
in patients older than 55 years old may be due to MAFLD related cirrhosis
causing disappearance of metabolic disorders parameters. 
7. How many patients found with liver steatosis by ultrasound not fulfilling the
criteria of MAFLD in this study? If only <1% of patients didn't fulfill the
criteria, may ultrasound only be used for the diagnostic criteria of MAFLD? If
much patients didn't fulfill the criteria, what is their cause of liver steatosis? Did
they differ from those with MAFLD related liver steatosis?
8. Since the authors found may risk factors of MAFLD, will there be a set of
parameters score that had highest prediction ability of MAFLD in China? 
Minor issues:
1. Did the participants sign informed consent?
2. May male and female have different normal range of Liver function tests?
3. Did the staff doing ultrasound blind to the laboratory data or history of the
patient?
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Yes
Declaration of competing interests
Please complete a declaration of competing
interests, considering the following questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the
content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an
organization that holds or has applied for patents relating to the content of
the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this
paper?
If you can answer no to all of the above, write 'I declare that I have no competing
interests' below. If your reply is yes to any, please give details below.
I declare that I have no competing interests.
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Reviewer’s report
Title: 
Prevalence of and risk factors for Metabolic associated fatty liver disease
in an urban population in China: a cross-sectional comparative study
Version: 
0 
Date: 
28 Feb 2021
Reviewer's report:
This is a cross-sectional study in evaluating the prevalence of metabolic
associated fatty liver disease in China in a health examination population. The
population size was large, but whether it can represent the population of China
wasn't evident. Many wrong grammar or words use were frequently noted in
abstract and article. The English grammar and words use may be further edited
by native-English advisors. Some results are duplicated mentioned in table and
the result text, and again in discussion. In discussion, some cited literature were
based on NAFLD, not MAFLD which may need further correction and
condensed. 
Major issues: 
1. This study is a hospital based study rather than a territory-cohort study, or a
country-wide random sampling study. How this population represented the
population of China? In a previous study, the prevalence of MAFLD in China
had been reported.(Su Lin et al. Liver Int . 2020 Sep;40(9):2082-2089.) What's
new finding in this study compared with previous China studies?
2. What is the proportion of patients of different age in this study? Is it the same
with the age distribution in China?
2. Evaluation of hepatic steatosis is the key component in diagnosis of MAFLD,
please make detailed and clear definition about it. Is elastography used, or sono-
guided liver histology evaluation? or other blood biomarkers/scores used? If only
by sonography, may the prevalence of MAFLD underestimated in this study?
3.Is there any difference between patients different subgroups of MAFLD
patients, overweight or obesity, normal/lean weight and Type 2 DM?
4. About the measurement of blood pressure, did patients with hypertension
allowed to receive medication at the exam date, if not, how long were they asked
to stop the medication. If not stopped, how much patients had taking HTN
specific medication already? Similar condition and question on patients taking
DM, hyperlipidemia medication treatment. If not stopped, what is the size of
population, since this may influence the value of blood pressure and lab data in
this study. 
5. Since viral hepatitis is an important issue in Asia, how many patients have
coexisting HBV and HCV disease.
6. How many patients having MAFLD related cirrhosis? The drop of prevalence
in patients older than 55 years old may be due to MAFLD related cirrhosis
causing disappearance of metabolic disorders parameters. 
7. How many patients found with liver steatosis by ultrasound not fulfilling the
criteria of MAFLD in this study? If only <1% of patients didn't fulfill the
criteria, may ultrasound only be used for the diagnostic criteria of MAFLD? If
much patients didn't fulfill the criteria, what is their cause of liver steatosis? Did
they differ from those with MAFLD related liver steatosis?
8. Since the authors found may risk factors of MAFLD, will there be a set of
parameters score that had highest prediction ability of MAFLD in China? 
Minor issues:
1. Did the participants sign informed consent?
2. May male and female have different normal range of Liver function tests?
3. Did the staff doing ultrasound blind to the laboratory data or history of the
patient?
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons after the final decision on the manuscript has been made. If you have
already registered at Publons, they will notify you of the receipt of this review
and update your profile 
as per your settings and their policy. If you are not
registered with Publons, you will receive an email from them asking you to
register in order for them to be able to recognize your review on your new
profile page. Publons may use the Review Data to generate derivative metadata
for the benefit of Publons and you as a reviewer, carefully considering the
sensitivity of such information. For example, Publons may verify your record as
a reviewer by updating your profile published on its webservice if you have
registered for such service or help editors to identify candidate reviewers. Please
find the details of processing in Publons’ privacy policy
https://publons.com/about/terms
Yes
Declaration of competing interests
Please complete a declaration of competing
interests, considering the following questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the
content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an
organization that holds or has applied for patents relating to the content of
the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this
paper?
If you can answer no to all of the above, write 'I declare that I have no competing
interests' below. If your reply is yes to any, please give details below.
I declare that I have no competing interests.
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Please review this paper.
user
Reviewer’s report
Title: 
Prevalence of and risk factors for Metabolic associated fatty liver disease
in an urban population in China: a cross-sectional comparative study
Version: 
0 
Date: 
28 Feb 2021
Reviewer's report:
This is a cross-sectional study in evaluating the prevalence of metabolic
associated fatty liver disease in China in a health examination population. The
population size was large, but whether it can represent the population of China
wasn't evident. Many wrong grammar or words use were frequently noted in
abstract and article. The English grammar and words use may be further edited
by native-English advisors. Some results are duplicated mentioned in table and
the result text, and again in discussion. In discussion, some cited literature were
based on NAFLD, not MAFLD which may need further correction and
condensed. 
Major issues: 
1. This study is a hospital based study rather than a territory-cohort study, or a
country-wide random sampling study. How this population represented the
population of China? In a previous study, the prevalence of MAFLD in China
had been reported.(Su Lin et al. Liver Int . 2020 Sep;40(9):2082-2089.) What's
new finding in this study compared with previous China studies?
2. What is the proportion of patients of different age in this study? Is it the same
with the age distribution in China?
2. Evaluation of hepatic steatosis is the key component in diagnosis of MAFLD,
please make detailed and clear definition about it. Is elastography used, or sono-
guided liver histology evaluation? or other blood biomarkers/scores used? If only
by sonography, may the prevalence of MAFLD underestimated in this study?
3.Is there any difference between patients different subgroups of MAFLD
patients, overweight or obesity, normal/lean weight and Type 2 DM?
4. About the measurement of blood pressure, did patients with hypertension
allowed to receive medication at the exam date, if not, how long were they asked
to stop the medication. If not stopped, how much patients had taking HTN
specific medication already? Similar condition and question on patients taking
DM, hyperlipidemia medication treatment. If not stopped, what is the size of
population, since this may influence the value of blood pressure and lab data in
this study. 
5. Since viral hepatitis is an important issue in Asia, how many patients have
coexisting HBV and HCV disease.
6. How many patients having MAFLD related cirrhosis? The drop of prevalence
in patients older than 55 years old may be due to MAFLD related cirrhosis
causing disappearance of metabolic disorders parameters. 
7. How many patients found with liver steatosis by ultrasound not fulfilling the
criteria of MAFLD in this study? If only <1% of patients didn't fulfill the
criteria, may ultrasound only be used for the diagnostic criteria of MAFLD? If
much patients didn't fulfill the criteria, what is their cause of liver steatosis? Did
they differ from those with MAFLD related liver steatosis?
8. Since the authors found may risk factors of MAFLD, will there be a set of
parameters score that had highest prediction ability of MAFLD in China? 
Minor issues:
1. Did the participants sign informed consent?
2. May male and female have different normal range of Liver function tests?
3. Did the staff doing ultrasound blind to the laboratory data or history of the
patient?
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons after the final decision on the manuscript has been made. If you have
already registered at Publons, they will notify you of the receipt of this review
and update your profile 
as per your settings and their policy. If you are not
registered with Publons, you will receive an email from them asking you to
register in order for them to be able to recognize your review on your new
profile page. Publons may use the Review Data to generate derivative metadata
for the benefit of Publons and you as a reviewer, carefully considering the
sensitivity of such information. For example, Publons may verify your record as
a reviewer by updating your profile published on its webservice if you have
registered for such service or help editors to identify candidate reviewers. Please
find the details of processing in Publons’ privacy policy
https://publons.com/about/terms
Yes
Declaration of competing interests
Please complete a declaration of competing
interests, considering the following questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the
content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an
organization that holds or has applied for patents relating to the content of
the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this
paper?
If you can answer no to all of the above, write 'I declare that I have no competing
interests' below. If your reply is yes to any, please give details below.
I declare that I have no competing interests.
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
assistant