Title: TyG-BMI as a Superior Predictor of MAFLD and Pre-MAFLD in Chinese Adults: A
Cross-Sectional Study
Version: 0 Date: 14 May 2025
Reviewer:  Mohamed H. Zidan
Reviewer's report:
Dear Authors,
Re: Predictive Value of Triglyceride Glucose-Related Indexes for MAFLD and Pre-MAFLD in
the Chinese Population
Thank you for the opportunity to review your manuscript exploring the diagnostic value of the
triglyceride-glucose (TyG) index and its related composite indices in identifying metabolic-
associated fatty liver disease (MAFLD) and pre-MAFLD within a large Chinese cohort.
However, several areas merit improvement. First, although the study design and statistical
approaches are sound, the manuscript would benefit from a clearer articulation of the rationale
behind defining "pre-MAFLD" as a distinct entity. As this is not an established clinical
category in current guidelines, you should further justify its use and implications, particularly
in the Introduction and Discussion sections. Additionally, while the ultrasound-based diagnosis
of steatosis is pragmatic for population studies, its limitations in sensitivity and specificity,
especially for early-stage or mild disease, should be acknowledged.
Second, although the abstract is concise and informative, it contains minor grammatical
inconsistencies (e.g., “Throw these findings” instead of “Through these findings” in an earlier
version; although corrected in this manuscript, such lapses should be monitored). In the main
text, a few sentences could be edited for improved clarity and flow. For example, the phrasing
“The ability of the TyG index to predict pre-MAFLD was inferior to that of anthropometric
indicators, while TyG-related indexes were stronger…” may benefit from rewording to reduce
ambiguity.
In the Discussion, you effectively position your findings within the existing literature, including
relevant comparisons to prior TyG-based studies. Nevertheless, while the conclusion that
TyG-BMI may serve as a practical, non-invasive screening tool is supported by your data,
further caution should be expressed regarding its generalizability. Your population is regionally
concentrated in the Yangtze River Delta, and the exclusion of individuals with viral hepatitis or
other chronic liver diseases, while methodologically sound, may limit applicability in broader
clinical settings.
Finally, your emphasis on defining pre-MAFLD and establishing a threshold (TyG-BMI cut-
off of 202.54) is novel and relevant. However, more discussion is warranted on the clinical
implications of such categorization, how it could inform preventive strategies, longitudinal risk
assessment, or lifestyle interventions. The term “pre-MAFLD” itself may benefit from a more
nuanced discussion regarding its diagnostic validity and potential for misclassification.
Good Luck
Title: TyG-BMI as a Superior Predictor of MAFLD and Pre-MAFLD in Chinese Adults: A
Cross-Sectional Study
Version: 0 Date: 14 May 2025
Reviewer:  Mohamed H. Zidan
Reviewer's report:
Dear Authors,
Re: Predictive Value of Triglyceride Glucose-Related Indexes for MAFLD and Pre-MAFLD in
the Chinese Population
Thank you for the opportunity to review your manuscript exploring the diagnostic value of the
triglyceride-glucose (TyG) index and its related composite indices in identifying metabolic-
associated fatty liver disease (MAFLD) and pre-MAFLD within a large Chinese cohort.
However, several areas merit improvement. First, although the study design and statistical
approaches are sound, the manuscript would benefit from a clearer articulation of the rationale
behind defining "pre-MAFLD" as a distinct entity. As this is not an established clinical
category in current guidelines, you should further justify its use and implications, particularly
in the Introduction and Discussion sections. Additionally, while the ultrasound-based diagnosis
of steatosis is pragmatic for population studies, its limitations in sensitivity and specificity,
especially for early-stage or mild disease, should be acknowledged.
Second, although the abstract is concise and informative, it contains minor grammatical
inconsistencies (e.g., “Throw these findings” instead of “Through these findings” in an earlier
version; although corrected in this manuscript, such lapses should be monitored). In the main
text, a few sentences could be edited for improved clarity and flow. For example, the phrasing
“The ability of the TyG index to predict pre-MAFLD was inferior to that of anthropometric
indicators, while TyG-related indexes were stronger…” may benefit from rewording to reduce
ambiguity.
In the Discussion, you effectively position your findings within the existing literature, including
relevant comparisons to prior TyG-based studies. Nevertheless, while the conclusion that
TyG-BMI may serve as a practical, non-invasive screening tool is supported by your data,
further caution should be expressed regarding its generalizability. Your population is regionally
concentrated in the Yangtze River Delta, and the exclusion of individuals with viral hepatitis or
other chronic liver diseases, while methodologically sound, may limit applicability in broader
clinical settings.
Finally, your emphasis on defining pre-MAFLD and establishing a threshold (TyG-BMI cut-
off of 202.54) is novel and relevant. However, more discussion is warranted on the clinical
implications of such categorization, how it could inform preventive strategies, longitudinal risk
assessment, or lifestyle interventions. The term “pre-MAFLD” itself may benefit from a more
nuanced discussion regarding its diagnostic validity and potential for misclassification.
Good Luck
Please review this paper.
user
Title: TyG-BMI as a Superior Predictor of MAFLD and Pre-MAFLD in Chinese Adults: A
Cross-Sectional Study
Version: 0 Date: 14 May 2025
Reviewer:  Mohamed H. Zidan
Reviewer's report:
Dear Authors,
Re: Predictive Value of Triglyceride Glucose-Related Indexes for MAFLD and Pre-MAFLD in
the Chinese Population
Thank you for the opportunity to review your manuscript exploring the diagnostic value of the
triglyceride-glucose (TyG) index and its related composite indices in identifying metabolic-
associated fatty liver disease (MAFLD) and pre-MAFLD within a large Chinese cohort.
However, several areas merit improvement. First, although the study design and statistical
approaches are sound, the manuscript would benefit from a clearer articulation of the rationale
behind defining "pre-MAFLD" as a distinct entity. As this is not an established clinical
category in current guidelines, you should further justify its use and implications, particularly
in the Introduction and Discussion sections. Additionally, while the ultrasound-based diagnosis
of steatosis is pragmatic for population studies, its limitations in sensitivity and specificity,
especially for early-stage or mild disease, should be acknowledged.
Second, although the abstract is concise and informative, it contains minor grammatical
inconsistencies (e.g., “Throw these findings” instead of “Through these findings” in an earlier
version; although corrected in this manuscript, such lapses should be monitored). In the main
text, a few sentences could be edited for improved clarity and flow. For example, the phrasing
“The ability of the TyG index to predict pre-MAFLD was inferior to that of anthropometric
indicators, while TyG-related indexes were stronger…” may benefit from rewording to reduce
ambiguity.
In the Discussion, you effectively position your findings within the existing literature, including
relevant comparisons to prior TyG-based studies. Nevertheless, while the conclusion that
TyG-BMI may serve as a practical, non-invasive screening tool is supported by your data,
further caution should be expressed regarding its generalizability. Your population is regionally
concentrated in the Yangtze River Delta, and the exclusion of individuals with viral hepatitis or
other chronic liver diseases, while methodologically sound, may limit applicability in broader
clinical settings.
Finally, your emphasis on defining pre-MAFLD and establishing a threshold (TyG-BMI cut-
off of 202.54) is novel and relevant. However, more discussion is warranted on the clinical
implications of such categorization, how it could inform preventive strategies, longitudinal risk
assessment, or lifestyle interventions. The term “pre-MAFLD” itself may benefit from a more
nuanced discussion regarding its diagnostic validity and potential for misclassification.
Good Luck
assistant