Review for 10.1186/s12876-019-1145-3 (2019)

Reviewer ’s report  
 
Title: Anthropometric, Biochemical and Clinical Assessment of Ma lnutrition among Egyptian 
Children with Chronic Liver Diseases: A Single Institutional Cross -sectional Study  
 
Version: 0 Date: 19 Feb 2019  
 
Reviewer: Alfredo Larrosa -Haro  
 
Reviewer's report:  
 
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-This work proposes to evaluate the nutritional status of children with CLD and make 
anthropometric associations and with some biochemical indicators; the number of cases studied 
is one of the relevant aspects. Regarding the design, an analytical cross -sectional study is 
proposed and a control group is included,which does not seem correct since the group with CLD 
seemed to correspond to its universe and the control group is selected. The evaluation of the 
nutritional status with z -score was already made against a parameter, so the use of a control 
group is debatable. The z values of the control group are on the positive side of the distrubution 
curve and in a lmost all cases when observing the SD they exceed + 2SD which makes it 
questionable if it can be considered as a nutritionally "healthy" group. Another aspect related to 
the control group are ethical aspects in particular with blood samples which would at least 
require a particular mention.  
 
-There is no justification for the evaluation of 2 biomarkers and it seems that the authors taken 
them because they had availability more than for being part of the research question.  
 
-A table of correlation of anthropom etric indices with a number of significant correlations is 
presented. It is not clear what is the reason for including this large number of anthropometric 
indicators, which makes it difficult to explain what these significant relationships mean and 
makes t his large amount of data on one hand difficult to interpret and on the other does not 
establish which of them responds to the objective raised. It is a known fact that when studying 
sample of healthy or malnourished pediatric subjects these significant cor relations are observed 
in what it has been called "anthropometric harmony".  
 
-It is known that the presence of edema associated with hypoalbuminemia - which frequently 
occurs in this type of patients - introduces an important bias in the interpretation of in dicators that 
include weight as a variable as it suebestimates deficit. The authors do not report the presence of 
edema or the albumin values; only correlation coefficients and value of p are presented. Albumin 
is a difficult marker to interpret since on t he one hand it can express liver failure in the synthesis 
of proteins and on the other hand malnutrition.  
-In summary, this is a valuable series due to the number of patients and the large amount of 
related data that, although it is proposed as an analytic al study, does not propose a hypothesis 
and stays in the descriptive field despite carrying out statistical tests of the relational level.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls ? 
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any s tatistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
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that holds or has applied for patents relating to the content of the manuscript?  
 
5.  Do you have any other financial competing interests?  
 
6.  Do you have any non -financial competing i nterests in relation to this paper?  
 
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below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
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