Review for 10.1186/s12876-024-03585-1 (2025)

Title: Dietary Inflammatory Index and Its Association with Fatty Liver Disease: A Study in
Obese and Non-Obese Populations
Version: 4 Date: 26 Nov 2024
Reviewer's report:
This is a retrospective study assessing the DII in NAFLD patients, being divided according
to the BMI status. Although the manuscript evaluates an interesting topic, several important
factors are lacking and require addressing them by the authors. The current literature
includes several published articles that evaluated the same topic, including on the same study
population NHANES and other populations (doi: 10.1186/s12944-024-02082-4; doi: 10.1016/
j.clnesp.2024.01.017; doi: 10.1016/j.heliyon.2023.e13983; doi: 10.1186/s40795-023-00738-5),
as well as systematic review and meta-analysis (https://doi.org/10.3389/fnut.2024.1388557).
Therefore, I believe the current study doesn’t add much to the current literature.
Several comments that need to be addressed by the authors:
- I suggest using the currently proposed MASLD criteria instead. Nevertheless, the NAFLD
analyses can remain as a subgroup, comparing whether different findings are obtained between
MASLD and NAFLD groups.
- Terms should be mentioned fully upon first appearance in the text along with the abbreviation,
followed by the abbreviation only when referred to again in the text. Please check all used
abbreviations and correct accordingly.
- Introduction: "Shivappa et al. devised an innovative tool known as the Dietary Inflammatory
Index (DII) for evaluating the inflammatory potential of foods to further elucidate the association
between diet and inflammation." Please add a citation.
- Methods:
"The Institutional Review Board determined this study to be "non-human subjects"
research[24]." Do you mean that the ethical committee decided to waive the need for obtaining
their approval? If so, please clarify this clearly in the text.
"Participants in the 1999–2000 period were included in this study. Adults with complete 24-
hour dietary data were considered. Participants under the age of 20 were excluded, resulting
in the exclusion of 5085 individuals. The number of participants lacking DII data was further
reduced by 641. Similarly, 129 individuals lacking BMI and Waist circumference data were
excluded. Additionally, participants lacking data on other covariates were excluded, leading to
the exclusion of 640 individuals. Finally, individuals without obesity but with fatty liver disease
were also discarded, excluding 14 individuals. The final number of participants included in the
study was reduced to 3456." All these details should go into the results section.
2.4 Definition of fatty liver and obesity: It would also be very interesting if you add the FIB-4
score in order to assess the association between DII and liver fibrosis.
- Results: "A total of 9965 eligible participants were included in this study." This sentence needs
to be corrected as 9965 participants were evaluated for eligibility, as not all were eligible due
to the previously mentioned exclusion reasons.
- The word "obesity" from the title in figure 3 is misspelled.
- Discussion and conclusions: The conclusions should be mentioned separately as a different
paragraph. Also, the study limitations and strengths should be divided into 2 paragraphs.
- Although the authors mention that they used an English service for improving their manuscript,
it remains very hard to follow while reading and is full of typos and grammatical errors.