Review for 10.1186/s12876-025-03641-4 (2025)

Title: TITLE: The Association Between Blood Pressure and Gallstones and the Age of First
Cholecystectomy in U.S. Adults: Results from a Cross-Sectional Study
Version: 0 Date: 18 Nov 2024
Reviewer:  Yüksel Do#an
Reviewer's report:
The manuscript presents an interesting and relevant investigation into the association between
hypertension (HTN), gallstone disease, and cholecystectomy, using a robust dataset from
NHANES.
Strengths:
The study addresses an important public health issue by linking two prevalent conditions, HTN
and gallstone disease.
The use of NHANES, a well-established, nationally representative dataset, strengthens the
validity and generalizability of the findings.
The inclusion of logistic regression models, subgroup analyses, and nonlinear relationships adds
depth to the study.
Critiques:
1. Introduction:
• The introduction is overly dense, covering various aspects of gallstones, cholecystectomy, and
HTN. It could be streamlined to focus more on the specific knowledge gap and objectives of
the study.
•  The discussion on gallstone classification and worldwide prevalence statistics might not
directly contribute to the study's hypothesis.
2. Methods:
• The exclusion criteria are mentioned but not clearly defined. A more explicit explanation of
why certain participants were excluded would improve transparency.
• While the authors note that NHANES data is freely available, they should emphasize
compliance with ethical guidelines
•  While covariates are listed, it is unclear if all potential confounders (e.g., diet, physical activity)
were adequately considered or adjusted for.
3. Results:
•  Table 1 contains excessive detail, making it difficult for readers to identify key findings.
•  Figures, especially the smoothed curve fitting (Figure 2) and subgroup analysis (Figure 3),
are referenced but not adequately described in the text
4. Discussion:
The discussion mainly reiterates the results without deeply exploring their implications or
comparing findings to existing literature.
The authors do not sufficiently discuss potential limitations, such as the cross-sectional nature
of NHANES data, recall bias from self-reported variables, and unmeasured confounders.
The association between SBP and the age at first cholecystectomy is presented without sufficient
biological plausibility or evidence to support the claim.
5. Language and Style:
The manuscript has grammatical errors and awkward phrasing (e.g., "solid formations of bile").
A thorough language edit is needed.
Many sentences repeat information unnecessarily, making the manuscript verbose.
6. References:
Some references lack sufficient detail or are inconsistently formatted.
Suggestions for Improvement:
Please Focus on the research gap and study objectives without unnecessary background details.
Please  Provide explicit exclusion criteria and ensure that covariates and statistical methods are
clearly justified.
Please Summarize key findings in tables and figures,
implications, limitations,
Please Revise the language
I TH#NK ,with these improvements, the manuscript could make a significant contribution to the
understanding of HTN and gallstone disease.
REV#SE