Title: Non-linear Relationship Between the Hepatic Steatosis Index and Glycemic Progression:
Evidence from a Large-Scale Retrospective Cohort Study in a Chinese Population
Version: 1 Date: 20 May 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
1. Introduction
Overloaded with statistical prevalence data that can distract from the research objective.
The knowledge gap regarding HSI’s role in glycemic progression is not clearly articulated.
Lack of a compelling rationale for why this study is needed now.
2. Methods
The exclusion criteria paragraph is overly long and disrupts the flow of the section.
The rationale for using piecewise Cox regression is not provided in the Methods section.
Key variable definitions (e.g., smoking, alcohol use, family history) are not clearly defined.
Limited discussion of why certain confounding variables (e.g., diet, physical activity) were not
included.
3. Discussion
Repetition of numerical results that were already stated earlier.
The discussion of causality is insufficient—does not clearly state that the study is observational
and cannot infer causal relationships.
Important potential confounders such as diet, exercise, and medication use are not
acknowledged.
The biological mechanisms behind the stronger association between men and lean individuals
are mentioned but not thoroughly explored.
Clinical implications are mentioned but not detailed (i.e., how HSI could be used in screening
or practice).
4. Structural and Style Issues
Absence of a distinct Conclusion section summarizing the main findings and their implications.
Overuse of acronyms without periodic redefinition (e.g., HSI, NAFLD, Pre-DM, FPG, DM,
BMI, ALT, AST, etc.).
Overly dense text in some paragraphs reduces readability and comprehension.
Title: Non-linear Relationship Between the Hepatic Steatosis Index and Glycemic Progression:
Evidence from a Large-Scale Retrospective Cohort Study in a Chinese Population
Version: 1 Date: 20 May 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
1. Introduction
Overloaded with statistical prevalence data that can distract from the research objective.
The knowledge gap regarding HSI’s role in glycemic progression is not clearly articulated.
Lack of a compelling rationale for why this study is needed now.
2. Methods
The exclusion criteria paragraph is overly long and disrupts the flow of the section.
The rationale for using piecewise Cox regression is not provided in the Methods section.
Key variable definitions (e.g., smoking, alcohol use, family history) are not clearly defined.
Limited discussion of why certain confounding variables (e.g., diet, physical activity) were not
included.
3. Discussion
Repetition of numerical results that were already stated earlier.
The discussion of causality is insufficient—does not clearly state that the study is observational
and cannot infer causal relationships.
Important potential confounders such as diet, exercise, and medication use are not
acknowledged.
The biological mechanisms behind the stronger association between men and lean individuals
are mentioned but not thoroughly explored.
Clinical implications are mentioned but not detailed (i.e., how HSI could be used in screening
or practice).
4. Structural and Style Issues
Absence of a distinct Conclusion section summarizing the main findings and their implications.
Overuse of acronyms without periodic redefinition (e.g., HSI, NAFLD, Pre-DM, FPG, DM,
BMI, ALT, AST, etc.).
Overly dense text in some paragraphs reduces readability and comprehension.
Please review this paper.
user
Title: Non-linear Relationship Between the Hepatic Steatosis Index and Glycemic Progression:
Evidence from a Large-Scale Retrospective Cohort Study in a Chinese Population
Version: 1 Date: 20 May 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
1. Introduction
Overloaded with statistical prevalence data that can distract from the research objective.
The knowledge gap regarding HSI’s role in glycemic progression is not clearly articulated.
Lack of a compelling rationale for why this study is needed now.
2. Methods
The exclusion criteria paragraph is overly long and disrupts the flow of the section.
The rationale for using piecewise Cox regression is not provided in the Methods section.
Key variable definitions (e.g., smoking, alcohol use, family history) are not clearly defined.
Limited discussion of why certain confounding variables (e.g., diet, physical activity) were not
included.
3. Discussion
Repetition of numerical results that were already stated earlier.
The discussion of causality is insufficient—does not clearly state that the study is observational
and cannot infer causal relationships.
Important potential confounders such as diet, exercise, and medication use are not
acknowledged.
The biological mechanisms behind the stronger association between men and lean individuals
are mentioned but not thoroughly explored.
Clinical implications are mentioned but not detailed (i.e., how HSI could be used in screening
or practice).
4. Structural and Style Issues
Absence of a distinct Conclusion section summarizing the main findings and their implications.
Overuse of acronyms without periodic redefinition (e.g., HSI, NAFLD, Pre-DM, FPG, DM,
BMI, ALT, AST, etc.).
Overly dense text in some paragraphs reduces readability and comprehension.
assistant