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: 19 May 2025
Reviewer's report:
This manuscript presents a well-conducted, large-scale cohort study exploring the non-linear
relationship between the Hepatic Steatosis Index (HSI) and glycemic progression in a Chinese
population. The authors have responded comprehensively and thoughtfully to all reviewer
comments, including clarifying the study’s novelty, redefining the outcome to “glycemic
progression,” performing sensitivity analyses to address missing data, and expanding the
discussion on sex-specific patterns and clinical implications. The limitations, including reliance
on fasting glucose, high missingness in lifestyle variables, and the use of HSI as a surrogate for
hepatic steatosis, are transparently acknowledged and appropriately discussed.  I believe it is
suitable for acceptance.
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: 19 May 2025
Reviewer's report:
This manuscript presents a well-conducted, large-scale cohort study exploring the non-linear
relationship between the Hepatic Steatosis Index (HSI) and glycemic progression in a Chinese
population. The authors have responded comprehensively and thoughtfully to all reviewer
comments, including clarifying the study’s novelty, redefining the outcome to “glycemic
progression,” performing sensitivity analyses to address missing data, and expanding the
discussion on sex-specific patterns and clinical implications. The limitations, including reliance
on fasting glucose, high missingness in lifestyle variables, and the use of HSI as a surrogate for
hepatic steatosis, are transparently acknowledged and appropriately discussed.  I believe it is
suitable for acceptance.
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: 19 May 2025
Reviewer's report:
This manuscript presents a well-conducted, large-scale cohort study exploring the non-linear
relationship between the Hepatic Steatosis Index (HSI) and glycemic progression in a Chinese
population. The authors have responded comprehensively and thoughtfully to all reviewer
comments, including clarifying the study’s novelty, redefining the outcome to “glycemic
progression,” performing sensitivity analyses to address missing data, and expanding the
discussion on sex-specific patterns and clinical implications. The limitations, including reliance
on fasting glucose, high missingness in lifestyle variables, and the use of HSI as a surrogate for
hepatic steatosis, are transparently acknowledged and appropriately discussed.  I believe it is
suitable for acceptance.
assistant