Title: Impact of Sociodemographic Disparities on Sarcopenia, Telomere Length, and Mortality
in Patients with Liver Disease in the US Population
Version: 2 Date: 10 Sep 2024
Reviewer's report:
The paper is well written and the statistical analysis is sound, following protocols recommended
for adjusting raw data.  There have been papers already evaluating either 1. sarcopenia on
outcomes in liver disease and 2. telomere length on outcomes in liver disease
The main issue with the current article is that age is a significant factor influencing both muscle
mass and telomere length.
The overall older mean age of those with sarcopenia illustrates this expected data.  It makes it
much more difficult to interpret data such as "Applying the ALM definition, sarcopenia was
present in 10.2% of patients with ALD, 20.5% of patients with VLD, 13.1% of patients with
NLD, 7.7% of patients with MASLD, and 12.8% of patients with OLD " without knowing the
mean age of each group.
The same would be notable for age and telomere length.  I am curious regarding the findings
of "Longer telomeres were generally associated with increased mortality at younger ages,
especially in those with sarcopenia. However, at older ages, longer telomeres were associated
with decreased mortality in those without sarcopenia. "  I would wonder what is the significance
of this data in a paper regarding liver disease?  The explanation in the discussion references a
higher rate of cancers with germline genetic variation.  I would also assume little mortality in
this group.  I am not sure what this data means.  Was this seen in the non-liver disease population
as well?  
Title: Impact of Sociodemographic Disparities on Sarcopenia, Telomere Length, and Mortality
in Patients with Liver Disease in the US Population
Version: 2 Date: 10 Sep 2024
Reviewer's report:
The paper is well written and the statistical analysis is sound, following protocols recommended
for adjusting raw data.  There have been papers already evaluating either 1. sarcopenia on
outcomes in liver disease and 2. telomere length on outcomes in liver disease
The main issue with the current article is that age is a significant factor influencing both muscle
mass and telomere length.
The overall older mean age of those with sarcopenia illustrates this expected data.  It makes it
much more difficult to interpret data such as "Applying the ALM definition, sarcopenia was
present in 10.2% of patients with ALD, 20.5% of patients with VLD, 13.1% of patients with
NLD, 7.7% of patients with MASLD, and 12.8% of patients with OLD " without knowing the
mean age of each group.
The same would be notable for age and telomere length.  I am curious regarding the findings
of "Longer telomeres were generally associated with increased mortality at younger ages,
especially in those with sarcopenia. However, at older ages, longer telomeres were associated
with decreased mortality in those without sarcopenia. "  I would wonder what is the significance
of this data in a paper regarding liver disease?  The explanation in the discussion references a
higher rate of cancers with germline genetic variation.  I would also assume little mortality in
this group.  I am not sure what this data means.  Was this seen in the non-liver disease population
as well?  
Please review this paper.
user
Title: Impact of Sociodemographic Disparities on Sarcopenia, Telomere Length, and Mortality
in Patients with Liver Disease in the US Population
Version: 2 Date: 10 Sep 2024
Reviewer's report:
The paper is well written and the statistical analysis is sound, following protocols recommended
for adjusting raw data.  There have been papers already evaluating either 1. sarcopenia on
outcomes in liver disease and 2. telomere length on outcomes in liver disease
The main issue with the current article is that age is a significant factor influencing both muscle
mass and telomere length.
The overall older mean age of those with sarcopenia illustrates this expected data.  It makes it
much more difficult to interpret data such as "Applying the ALM definition, sarcopenia was
present in 10.2% of patients with ALD, 20.5% of patients with VLD, 13.1% of patients with
NLD, 7.7% of patients with MASLD, and 12.8% of patients with OLD " without knowing the
mean age of each group.
The same would be notable for age and telomere length.  I am curious regarding the findings
of "Longer telomeres were generally associated with increased mortality at younger ages,
especially in those with sarcopenia. However, at older ages, longer telomeres were associated
with decreased mortality in those without sarcopenia. "  I would wonder what is the significance
of this data in a paper regarding liver disease?  The explanation in the discussion references a
higher rate of cancers with germline genetic variation.  I would also assume little mortality in
this group.  I am not sure what this data means.  Was this seen in the non-liver disease population
as well?  
assistant