Historical Changes in Weight Classes and the Influence of NAFLD Prevalence: A Population Analysis of 34,486 Individuals
, Kai En Chan 2, Caitlyn Tan 2, Manik Aggarwal 3, Rebecca Wenling Zeng 2, Jieling Xiao 2, Yip Han Chin 2, Eunice X. X. Tan 1,2,4, Yi Ping Ren 5, Douglas Chee 5, Jonathan Neo 5, Nicholas W. S. Chew 6, Michael Tseng 7, Mohammad Shadab Siddiqui 7, Arun J. Sanyal 7, Yock Young Dan 1,2,4,‡ and Mark Muthiah 1,2,4,*,‡
Round 1
Reviewer 1 Report
The paper addresses a fundamental and overlooked issue-whether weight reduction means improvement in liver patients with NAFLD.
The paper shows the very difficult to accept result that patients who reduced their body weight to the correct BMI values, still had an increased risk of developing NAFLD compared to those who were thin at both time points.
This result - if accepted by hepatologists - will turn nutrition counseling into this area. Because it's not just about reducing fat mass, but that this fat mass involves visceral fat tissue
The work has its methodological limitations - for example, the lack of results of measurements of lean body mass (LBM) especially muscle mass (MM). This parameter can be a predictor of "healthy" weight reduction.
It seems that only such a plan of work with the patient that includes caloric deficits and physical activity (preventing loss of muscle mass) can be effective for patients
Looking at the cholesterol results, it is apparent that the patients were treated - shouldn't this factor be considered in the analysis?
Author Response
Please see the attachment.
Author Response File: 
Author Response.pdf
Reviewer 2 Report
The Authors should integrate the analysis of data with a new chapter dedicated to the behaviour of endotoxin and oxidant stress, previously shown to influence the physiopathology of NAFLD. Finally the conclusions are not fully supported by rhe results
Author Response
Please see the attachment.
Author Response File: Author Response.pdf
Reviewer 3 Report
After reviewing the paper titled “Historical Changes in Weight Classes and the Influence of NAFLD Prevalence. A Population Analysis of 34,486 Individuals'', a retrospective study that aims to understand the relationship between weight class changes overtime and the prevalence of NAFLD.
We first would like to congratulate the authors on a great research question that furthers the knowledge on a very common healthcare problem, that hasn’t been researched before.
We have the following observations and suggestions:
- Title and abstract: they cover the main aspects of the submitted work in a clear and concise manner.
- Introduction: It accurately emphasizes the importance of NAFLD and its relationship with weight class, and the fact that this relationship is poorly understood.
- Methods and materials:
- It is not clear in this section when or using what data, did you calculate de FLI or US-FLI, and therefore made the diagnosis of NAFLD. You do comment on it in the limitations section, but it should be made clear in this section as well.
- In the first paragraph of the third page it says: “ individuals who had improvement in their BMI category…”. I believe the word improvement shouldn’t be used in this context as it denotes a sense of bettering. Maybe, raise, increase or augment are better words to use.
- Results:
- I find table 1 brings little transcendent information to the paper. If it is important to keep it, maybe explain its importance a little further in the text.
- I particularly enjoyed figure 1. It is simple, and it conveys a lot of information in an understandable and graphic way.
- Discussion:
- The third paragraph in the discussion says: “ Amongst individuals with NAFLD however, only 5.35% of NAFLD individuals…”. Individuals with NAFLD is repeated, leave one of the 2, not both.
- Limitations: The study clearly accounts for the weight of patients at 2 points in time. Nevertheless, what happens with the weight of the patient in between these 2 recollections is not discussed and it might be central to the risk of developing NAFLD. Measuring it is not part of the study aim, but it should be accounted for as a limitation
- Conclusion: it is clear, concise and simple, and it summarizes the most important findings within this research.
Author Response
Please see the attachment.
Author Response File: Author Response.pdf
Round 2
Reviewer 1 Report
I am ok . Congratulations
Reviewer 2 Report
The paper was significantly improved. The Authors answered correctly to all my queries.
