Title: The Influence of a Gluten-free Diet on Health-related Quality of Life in Individuals with
Celiac Disease
Version: 1 Date: 09 May 2021
Reviewer's report:
1) Please check the format for your references. They are not in consistent complete form and
frequently don’t include the year of publication. Please correct.
2) I suggest using a different first reference since you are discussing the definition of celiac
disease the first reference is less appropriate.  I suggest using a reference such as Celiac Disease,
New England Journal of medicine 2007; 357: 1731-43 by Green , and Cellier, or any other
similar paper describing overview of celiac disease.
3) Your second reference is a paper on HLA associated with Celiac disease and if citing this
it would be better if you mention the permissive HLA associated with celiac disease in your
description of celiac disease.
4) Do you have the range of time on a gluten free diet 6months-? Years. Your sample size is
small but it would be interesting to see if time on a gluten free diet was an important factor
5) Line 168 Reference 19, the Biagi GFD questionnaire consists of 4 questions.
6) Line 223 Comment- It is also notable that 43% of participants were overweight.
7) Lines 316-320 it is confusing what the 3 categories of scores are for. It would help to indicate
it is for the 3 levels of income at the beginning of the score comparisons for income.
8) Overall 62% were FI, of these 35% Nonadherent and 65% adherent, Most nonadherent were
FI. It is interesting that the overall rate is that high.  Is there data on FI in the general population
in Saudi Arabia – it would be interesting to compare.
9) Line 413 A significant limitation of the study is that most of your study group (75%) only
had a serology test for diagnosis. This means you could have included people without celiac
disease. Do you have other supportive info you could include such as a medical diagnosis or
recommendation by a physician to follow a lifelong gluten free diet in these pts? Some of the
studies you site such as reference #18, only 11% were serology only, others such as in the
Canadian study reference they  only included biopsy proven celiac disease or DH. Your first
reference #1, was conducted in Saudi Arabia and that study was vague as to the criteria for
inclusion for celiac disease. It is stronger data if the study can identify adult celiac disease
patients with biopsy and serology.
Congratulations on your interest and work on this important aspect in celiac disease treatment
and how it affects the lives of celiac patients around the world.
Title: The Influence of a Gluten-free Diet on Health-related Quality of Life in Individuals with
Celiac Disease
Version: 1 Date: 09 May 2021
Reviewer's report:
1) Please check the format for your references. They are not in consistent complete form and
frequently don’t include the year of publication. Please correct.
2) I suggest using a different first reference since you are discussing the definition of celiac
disease the first reference is less appropriate.  I suggest using a reference such as Celiac Disease,
New England Journal of medicine 2007; 357: 1731-43 by Green , and Cellier, or any other
similar paper describing overview of celiac disease.
3) Your second reference is a paper on HLA associated with Celiac disease and if citing this
it would be better if you mention the permissive HLA associated with celiac disease in your
description of celiac disease.
4) Do you have the range of time on a gluten free diet 6months-? Years. Your sample size is
small but it would be interesting to see if time on a gluten free diet was an important factor
5) Line 168 Reference 19, the Biagi GFD questionnaire consists of 4 questions.
6) Line 223 Comment- It is also notable that 43% of participants were overweight.
7) Lines 316-320 it is confusing what the 3 categories of scores are for. It would help to indicate
it is for the 3 levels of income at the beginning of the score comparisons for income.
8) Overall 62% were FI, of these 35% Nonadherent and 65% adherent, Most nonadherent were
FI. It is interesting that the overall rate is that high.  Is there data on FI in the general population
in Saudi Arabia – it would be interesting to compare.
9) Line 413 A significant limitation of the study is that most of your study group (75%) only
had a serology test for diagnosis. This means you could have included people without celiac
disease. Do you have other supportive info you could include such as a medical diagnosis or
recommendation by a physician to follow a lifelong gluten free diet in these pts? Some of the
studies you site such as reference #18, only 11% were serology only, others such as in the
Canadian study reference they  only included biopsy proven celiac disease or DH. Your first
reference #1, was conducted in Saudi Arabia and that study was vague as to the criteria for
inclusion for celiac disease. It is stronger data if the study can identify adult celiac disease
patients with biopsy and serology.
Congratulations on your interest and work on this important aspect in celiac disease treatment
and how it affects the lives of celiac patients around the world.
Please review this paper.
user
Title: The Influence of a Gluten-free Diet on Health-related Quality of Life in Individuals with
Celiac Disease
Version: 1 Date: 09 May 2021
Reviewer's report:
1) Please check the format for your references. They are not in consistent complete form and
frequently don’t include the year of publication. Please correct.
2) I suggest using a different first reference since you are discussing the definition of celiac
disease the first reference is less appropriate.  I suggest using a reference such as Celiac Disease,
New England Journal of medicine 2007; 357: 1731-43 by Green , and Cellier, or any other
similar paper describing overview of celiac disease.
3) Your second reference is a paper on HLA associated with Celiac disease and if citing this
it would be better if you mention the permissive HLA associated with celiac disease in your
description of celiac disease.
4) Do you have the range of time on a gluten free diet 6months-? Years. Your sample size is
small but it would be interesting to see if time on a gluten free diet was an important factor
5) Line 168 Reference 19, the Biagi GFD questionnaire consists of 4 questions.
6) Line 223 Comment- It is also notable that 43% of participants were overweight.
7) Lines 316-320 it is confusing what the 3 categories of scores are for. It would help to indicate
it is for the 3 levels of income at the beginning of the score comparisons for income.
8) Overall 62% were FI, of these 35% Nonadherent and 65% adherent, Most nonadherent were
FI. It is interesting that the overall rate is that high.  Is there data on FI in the general population
in Saudi Arabia – it would be interesting to compare.
9) Line 413 A significant limitation of the study is that most of your study group (75%) only
had a serology test for diagnosis. This means you could have included people without celiac
disease. Do you have other supportive info you could include such as a medical diagnosis or
recommendation by a physician to follow a lifelong gluten free diet in these pts? Some of the
studies you site such as reference #18, only 11% were serology only, others such as in the
Canadian study reference they  only included biopsy proven celiac disease or DH. Your first
reference #1, was conducted in Saudi Arabia and that study was vague as to the criteria for
inclusion for celiac disease. It is stronger data if the study can identify adult celiac disease
patients with biopsy and serology.
Congratulations on your interest and work on this important aspect in celiac disease treatment
and how it affects the lives of celiac patients around the world.
assistant