Title: The association between modified cardiometabolic index with non-alcoholic fatty liver
disease and liver fibrosis: A cross-sectional study
Version: 0 Date: 19 Feb 2025
Reviewer's report:
Dear Authors,
Thank you to the authors for their efforts in exploring this important topic. I appreciate their
efforts.
Generally, this paper presents valuable findings. However, it requires revisions to address the
concerns.
1. While the authors excluded and removed heavy drinkers and individuals with hepatitis B and/
or C virus infection, the diagnostic approach described in the manuscript does not fully align with
established guidelines for NAFLD diagnosis. The diagnosis of NAFLD appears to rely solely
on CAP #248 dB/m without addressing other key criteria, such as the exclusion of secondary
causes of liver fat accumulation (e.g., medications). Please clarify whether these exclusions were
performed and how they were handled.
2. To the best of my knowledge, this modified version of the CMI has not been proposed or
validated in any previous studies. While innovation is encouraged, the introduction of a new
metric should ideally build upon existing literature or established methodologies. The absence
of prior evidence or precedent makes it difficult to assess the novelty and appropriateness of
this approach.
3. A major limitation of this study is the lack of separate validation and testing groups to evaluate
the performance of the newly proposed MCMI. Introducing a new metric without proper
validation raises concerns about its reliability and generalizability. Was the modified index
calibrated to ensure it provides reliable predictions across different populations or datasets?
Authors could explain whether: (1) They consider splitting their dataset into training and
validation cohorts to assess the robustness of the MCMI. (2) Alternatively, the MCMI should
be tested on an independent external dataset to confirm its diagnostic accuracy and utility.
To address these concerns, I recommend the following:
1. Provide a detailed diagnostic criteria for subjects with NAFLD.
2. Provide a clear and detailed rationale for the modification of the CMI formula, including
references to prior studies or theoretical frameworks that support this approach.
3. Validate the MCMI using appropriate statistical methods, such as splitting the dataset into
training and validation cohorts or testing it on an independent external dataset.
Title: The association between modified cardiometabolic index with non-alcoholic fatty liver
disease and liver fibrosis: A cross-sectional study
Version: 0 Date: 19 Feb 2025
Reviewer's report:
Dear Authors,
Thank you to the authors for their efforts in exploring this important topic. I appreciate their
efforts.
Generally, this paper presents valuable findings. However, it requires revisions to address the
concerns.
1. While the authors excluded and removed heavy drinkers and individuals with hepatitis B and/
or C virus infection, the diagnostic approach described in the manuscript does not fully align with
established guidelines for NAFLD diagnosis. The diagnosis of NAFLD appears to rely solely
on CAP #248 dB/m without addressing other key criteria, such as the exclusion of secondary
causes of liver fat accumulation (e.g., medications). Please clarify whether these exclusions were
performed and how they were handled.
2. To the best of my knowledge, this modified version of the CMI has not been proposed or
validated in any previous studies. While innovation is encouraged, the introduction of a new
metric should ideally build upon existing literature or established methodologies. The absence
of prior evidence or precedent makes it difficult to assess the novelty and appropriateness of
this approach.
3. A major limitation of this study is the lack of separate validation and testing groups to evaluate
the performance of the newly proposed MCMI. Introducing a new metric without proper
validation raises concerns about its reliability and generalizability. Was the modified index
calibrated to ensure it provides reliable predictions across different populations or datasets?
Authors could explain whether: (1) They consider splitting their dataset into training and
validation cohorts to assess the robustness of the MCMI. (2) Alternatively, the MCMI should
be tested on an independent external dataset to confirm its diagnostic accuracy and utility.
To address these concerns, I recommend the following:
1. Provide a detailed diagnostic criteria for subjects with NAFLD.
2. Provide a clear and detailed rationale for the modification of the CMI formula, including
references to prior studies or theoretical frameworks that support this approach.
3. Validate the MCMI using appropriate statistical methods, such as splitting the dataset into
training and validation cohorts or testing it on an independent external dataset.
Please review this paper.
user
Title: The association between modified cardiometabolic index with non-alcoholic fatty liver
disease and liver fibrosis: A cross-sectional study
Version: 0 Date: 19 Feb 2025
Reviewer's report:
Dear Authors,
Thank you to the authors for their efforts in exploring this important topic. I appreciate their
efforts.
Generally, this paper presents valuable findings. However, it requires revisions to address the
concerns.
1. While the authors excluded and removed heavy drinkers and individuals with hepatitis B and/
or C virus infection, the diagnostic approach described in the manuscript does not fully align with
established guidelines for NAFLD diagnosis. The diagnosis of NAFLD appears to rely solely
on CAP #248 dB/m without addressing other key criteria, such as the exclusion of secondary
causes of liver fat accumulation (e.g., medications). Please clarify whether these exclusions were
performed and how they were handled.
2. To the best of my knowledge, this modified version of the CMI has not been proposed or
validated in any previous studies. While innovation is encouraged, the introduction of a new
metric should ideally build upon existing literature or established methodologies. The absence
of prior evidence or precedent makes it difficult to assess the novelty and appropriateness of
this approach.
3. A major limitation of this study is the lack of separate validation and testing groups to evaluate
the performance of the newly proposed MCMI. Introducing a new metric without proper
validation raises concerns about its reliability and generalizability. Was the modified index
calibrated to ensure it provides reliable predictions across different populations or datasets?
Authors could explain whether: (1) They consider splitting their dataset into training and
validation cohorts to assess the robustness of the MCMI. (2) Alternatively, the MCMI should
be tested on an independent external dataset to confirm its diagnostic accuracy and utility.
To address these concerns, I recommend the following:
1. Provide a detailed diagnostic criteria for subjects with NAFLD.
2. Provide a clear and detailed rationale for the modification of the CMI formula, including
references to prior studies or theoretical frameworks that support this approach.
3. Validate the MCMI using appropriate statistical methods, such as splitting the dataset into
training and validation cohorts or testing it on an independent external dataset.
assistant