Review for 10.1186/s12876-023-02941-x (2023)

Reviewer’s report
Title: 
BEHAVIOUR REGULATION AND THE ROLE OF MENTAL
HEALTH IN NON-ALCOHOLIC FATTY LIVER DISEASE
Version: 
1 
Date: 
30 Nov 2022
Reviewer's report:
"PEER REVIEWER ASSESSMENTS: 
OBJECTIVE - Full research articles: is there a clear objective that addresses one
or several testable research questions? (Brief or other article types: is there a
clear objective?)
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols)
appropriate for the objective?
No - there are major issues
EXECUTION - Are the experiments and analyses performed with sufficient
technical rigor to allow confidence in the results?
No - there are major issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results
reasonable and not overstated?
No - there are minor issues
OVERALL MANUSCRIPT POTENTIAL - Has the author addressed your
concerns sufficiently for you to now recommend the work as a technically sound
contribution? If not, can further revisions be made to make the work technically
sound?
No - manuscript has some fundamental flaw(s)
PEER REVIEWER COMMENTS: 
GENERAL COMMENTS: My overall impression is that the manuscript is
limited by sample size and sample selection. The authors have performed an
interesting study with six different questionnaires but the definition of ""non-
lifestyle liver disease patients"" is lacking and the selection of healthy controls is
quite prone to bias so it is very difficult to reach any conclusion after comparing
these three groups.
REQUESTED REVISIONS: 
The main limitation of this manuscript is the selection of the sample. Criteria for
NAFLD patients are unclear apart from this diagnosis (which encompasses a
potentially wide range of patients that should be clearly defined) but the group of
""25 non-lifestyle liver disease patients"" really needs to be more specific. The
authors could have included in this group patients with hepatitis C virus or with
hemochromatosis or autoimmune hepatitis and these diseases are quite different
and may be associated with different behaviors and potential risk factors for
mental health issues. In addition, the healthy control group is a convenience
sample (e.g. hospital staff), which clearly can be biased. Authors should compare
patients with NAFLD and clearly defined criteria (with or without
steatohepatitis, degree of fibrosis, obesity and so on) with healthy controls with
similar variables (e.g., obesity). Indeed, authors controlled the presence of
alcohol use disorders but they should have also controlled other variables. This is
a major limitation of this article.
Introduction is too long and should be clearly shortened."
Declaration of competing interests
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recommendation.
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
No
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
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No