A Body Shape Index (ABSI) as a Variant of Conicity Index Not Affected by the Obesity Paradox: A Cross-Sectional Study Using Arterial Stiffness Parameter

Round 1

Reviewer 1 Report

This cross-sectional study mainly focused on the correlation between body mass index (ABSI) and arterial stiffness. ABSI is an abdominal obesity index based on epidemic statistics. This manuscript analyzed the cross-sectional data of middle age Japanese urban residents. Body obesity index including BMI, waist circumference (WC), ABSI, taper index (CI), waist height ratio (WHtR) and WC/BMI ratio were examined. It was found that the correlation between ABSI and CI and age and arterial stiffness was stronger than other indicators. The authors concluded that ABSI could reflect the degree of body changes, and is the only abdominal obesity index that is not affected by the obesity paradox at present. The topic is interesting and the manuscript is well-written. I have a few concerns:

1. Arterial stiffness was recommended in the title to be more concrete. 

2.  Only cardio-ankle vascular index (CAVI) was employed, whether additional parameters could be added to better verify arterial stiffness. Please clarify it.

3. Add a diagram to show the design and main findings of this study.

Author Response

Reply to reviewer comments

We are grateful to the reviewers for the critical comments and useful suggestions that have helped us to improve our paper considerably. As indicated in the responses that follow, we have taken the comments and suggestion into account in the revised version of our paper.

Reviewer 1

• Comment 1. Arterial stiffness was recommended in the title to be more concrete.
• Response:

As the reviewer pointed out, incorporating "arterial stiffness" into the title would help clarify the content of this study. We therefore added the text "using arterial stiffness parameter” in the title as follows;

“A body shape index (ABSI) as a variant of conicity index not affected by the obesity paradox: a cross-sectional study using arterial stiffness parameter”

• Comment 2. Only cardio-ankle vascular index (CAVI) was employed, whether additional parameters could be added to better verify arterial stiffness. Please clarify it.
• Response:

As the reviewer pointed out, it may be meaningful to perform similar validation using other traditional vascular parameters. We have therefore added the following text as a limitation in the Discussion section.

“Although only CAVI was adopted in this study to determine the cutoff for the abdominal obesity indices, validation with other vascular parameters (i.e. Flow-mediated dilation, Pulse-wave velocity and Carotid intima-media thickness) is also desired.”

• Comment 3. Add a diagram to show the design and main findings of this study.
• Response:

In response to the reviewer's suggestion, we have revised the graphic abstract. The revised abstract includes the flow-diagram, study design and the main finding.

Corrections not related to reviewer comments:

We apologize that in the initial manuscript, the first paragraph of the Discussion section was inadvertently inserted, even though it is not relevant to this study. In the revised manuscript, the paragraph has been removed.

That’s All.

Daiji Nagayama, M.D., PhD.

Nagayama Clinic, 2-12-22, Tenjin-Cho, Oyama-City, Tochigi, 323-0032, Japan　　

Tel: +81-285-22-0219, Fax: +81-285-22-0219

E-mail: [email protected]

Reviewer 2 Report

Comments for author File: Comments.pdf

Author Response

Reply to reviewer comments

We are grateful to the reviewers for the critical comments and useful suggestions that have helped us to improve our paper considerably. As indicated in the responses that follow, we have taken the comments and suggestion into account in the revised version of our paper.

Reviewer 2

• Comment 1. How do the authors justify collecting data from males who had higher disease histories (Blood pressure, fasting blood glucose, triglycerides, HDL- Cholesterol) compared to females for the data collection? Would this not affect the data collection. Please explain the rationale behind this in the text.
• Response:

We appreciate the important suggestion. As the reviewer pointed out, there are clear gender differences in metabolic parameters (Table 1). In addition, several abdominal obesity indices also showed gender differences in their discriminatory power for high CAVI. However, since the power of ABSI was equal in both genders, WC calculator was established without considering gender difference. The following paragraph has therefore been added to the Discussion section.

“As shown in Table 1, the gender differences in metabolic parameters including blood pressure, FPG and lipid parameters were observed. Nevertheless, we determined that these differences do not affect the conclusion of the present study, because there is no gender difference in the discriminatory power of ABSI for high CAVI. Furthermore, as noted above, ABSI cutoff for increased arterial stiffness and renal impairment have been reported to be equal in both genders [12]. We therefore established the WC calculator that corresponds to the common ABSI cutoff for both genders (Fig. 2). On the other hand, since WC, conicity index and WHtR shows stronger discriminatory power for high CAVI in women, it may be desirable to set these cutoffs separately for men and women.”

• Comment 2. Out of the 24 references in the article, authors have cited 8 of their own work which makes the self-citations to dominate. Please provide references from others also working in the same field to avoid this.
• Response:

In response to the reviewer's suggestion, the two references (Ref.3 and 24) have been changed to other references with the same significances. However, the six remaining references we have reported (Ref.6, 9, 10, 12, 15 and 20) unfortunately could not be changed in order to maintain the structure of this manuscript.

Ref.3 (Vasc Health Risk Manag. 2016,13,1–9.) was changed to the paper: “Sugiura T, Dohi Y, Takagi Y, Yoshikane N, Ito M, Suzuki K, Nagami T, Iwase M, Seo Y, Ohte N. Relationships of Obesity-Related Indices and Metabolic Syndrome with Subclinical Atherosclerosis in Middle-Aged Untreated Japanese Workers. J Atheroscler Thromb. 2020;27,342-352. DOI: 10.5551/jat.50633.”

Ref.24 (Circ J. 2008,72,598–604.) was changed to the paper: “Tanaka A, Tomiyama H, Maruhashi T, Matsuzawa Y, Miyoshi T, Kabutoya T, Kario K, Sugiyama S, Munakata M, Ito H, Ueda S, Vlachopoulos C, Higashi Y, Inoue T, Node K; Physiological Diagnosis Criteria for Vascular Failure Committee: Physiological diagnostic criteria for vascular failure. Hypertension. 2018,72,1060-1071. DOI: 10.1161/HYPERTENSIONAHA.118.11554.”

• Comment 3. Please have a thorough grammar check to avoid awkward sentencing that affect the clarity of the ideas presented

Eg; Page 1 lines 42-43

Considering the soundness of the scientific approach and findings, I would enthusiastically recommend the manuscript for publication after authors addressing the suggested minor revisions. I believe addressing these comments will improve the manuscript and make the readers understand better.

• Response:

We agree with the reviewer's important remark. In addition to the reviewer's remark, several other grammatical problems have been corrected as much as possible. Please note that this manuscript has already been proofread by Medical Translation Services, Inc.

Corrections not related to reviewer comments:

We apologize that in the initial manuscript, the first paragraph of the Discussion section was inadvertently inserted, even though it is not relevant to this study. In the revised manuscript, the paragraph has been removed.

That’s All.

Daiji Nagayama, M.D., PhD.

Nagayama Clinic, 2-12-22, Tenjin-Cho, Oyama-City, Tochigi, 323-0032, Japan　　

Tel: +81-285-22-0219, Fax: +81-285-22-0219

E-mail: [email protected]