Title: Weight-adjusted waist circumference index with hepatic steatosis and fibrosis in adult
females: a cross-sectional, nationally representative study (NHANES 2017–2020)
Version: 2 Date: 08 Oct 2024
Reviewer's report:
We had the honor to review the manuscript on weight-adjusted waist circumference index and its
associations with liver disease (steatosis and fibrosis based on FibroScan) amongst females from
the NHANES 2017-2020 database. Although the findings are interesting and the topic deserves
further investigation the enthusiasm is limited due to the complexity of the study and lack of a
single strong story aiding the reader through this information.
Major
1. Although some other markers were investigated, it remains unclear to me if the WWI is better
in assessing the risk of steatosis and fibrosis compared to the other tests mentioned in this study.
2. Although one should always consider impact of sex on body composition and the associated
risks, I miss the comparison to the male counterpart. Is the WWI also better in males? Are there
different associations? Or can we use WWI in both female and males?
3. I am intrigued by the U shaped correlation for WWI and LSM. This seems to be in
contradiction with Table 1, where the lowers LSM was reported for Q1 and highest for Q4.
Might this due to (over)adjusting? Among the Q1, were there also more patients with clinically
relevant increased LSM?
4. Although the data is interesting, I have difficulties extracting useful conclusions for further
research and/or clinical practice. I recommend the authors to assess carefully what the main
messages would be of this paper and how the tables and figures could contribute to this message.
Minor
1. Please check for style and grammar. Some sentences are duplicate or in contradiction. For
example, the first sentence is duplicated in the data analysis section and the table legends are
sometime duplicated, especially the models, however, they are not the same models which is
confusing.
Title: Weight-adjusted waist circumference index with hepatic steatosis and fibrosis in adult
females: a cross-sectional, nationally representative study (NHANES 2017–2020)
Version: 2 Date: 08 Oct 2024
Reviewer's report:
We had the honor to review the manuscript on weight-adjusted waist circumference index and its
associations with liver disease (steatosis and fibrosis based on FibroScan) amongst females from
the NHANES 2017-2020 database. Although the findings are interesting and the topic deserves
further investigation the enthusiasm is limited due to the complexity of the study and lack of a
single strong story aiding the reader through this information.
Major
1. Although some other markers were investigated, it remains unclear to me if the WWI is better
in assessing the risk of steatosis and fibrosis compared to the other tests mentioned in this study.
2. Although one should always consider impact of sex on body composition and the associated
risks, I miss the comparison to the male counterpart. Is the WWI also better in males? Are there
different associations? Or can we use WWI in both female and males?
3. I am intrigued by the U shaped correlation for WWI and LSM. This seems to be in
contradiction with Table 1, where the lowers LSM was reported for Q1 and highest for Q4.
Might this due to (over)adjusting? Among the Q1, were there also more patients with clinically
relevant increased LSM?
4. Although the data is interesting, I have difficulties extracting useful conclusions for further
research and/or clinical practice. I recommend the authors to assess carefully what the main
messages would be of this paper and how the tables and figures could contribute to this message.
Minor
1. Please check for style and grammar. Some sentences are duplicate or in contradiction. For
example, the first sentence is duplicated in the data analysis section and the table legends are
sometime duplicated, especially the models, however, they are not the same models which is
confusing.
Please review this paper.
user
Title: Weight-adjusted waist circumference index with hepatic steatosis and fibrosis in adult
females: a cross-sectional, nationally representative study (NHANES 2017–2020)
Version: 2 Date: 08 Oct 2024
Reviewer's report:
We had the honor to review the manuscript on weight-adjusted waist circumference index and its
associations with liver disease (steatosis and fibrosis based on FibroScan) amongst females from
the NHANES 2017-2020 database. Although the findings are interesting and the topic deserves
further investigation the enthusiasm is limited due to the complexity of the study and lack of a
single strong story aiding the reader through this information.
Major
1. Although some other markers were investigated, it remains unclear to me if the WWI is better
in assessing the risk of steatosis and fibrosis compared to the other tests mentioned in this study.
2. Although one should always consider impact of sex on body composition and the associated
risks, I miss the comparison to the male counterpart. Is the WWI also better in males? Are there
different associations? Or can we use WWI in both female and males?
3. I am intrigued by the U shaped correlation for WWI and LSM. This seems to be in
contradiction with Table 1, where the lowers LSM was reported for Q1 and highest for Q4.
Might this due to (over)adjusting? Among the Q1, were there also more patients with clinically
relevant increased LSM?
4. Although the data is interesting, I have difficulties extracting useful conclusions for further
research and/or clinical practice. I recommend the authors to assess carefully what the main
messages would be of this paper and how the tables and figures could contribute to this message.
Minor
1. Please check for style and grammar. Some sentences are duplicate or in contradiction. For
example, the first sentence is duplicated in the data analysis section and the table legends are
sometime duplicated, especially the models, however, they are not the same models which is
confusing.
assistant