Review for 10.1186/s12876-020-01270-7 (2020)

Reviewer ’s report  
 
Title: Combined Effects of Lifestyle Risk Factors  on Fatty Liver Index  
 
Version: 2 Date: 24 Feb 2020  
 
Reviewer: Ludovico Abenavoli  
 
Reviewer's report:  
 
- Introduction section:  fatty liver is the main liver disease wo rldwide and it encompasses a 
spectrum from simple steatosis to steatohepatitis, fibrosis, or cirrhosis. The mechanisms involved 
in its occurrence and its progression to fibrosis, are probably due to a metabolic profile expressed 
within the context of a gen etic predisposition and is associated with a higher energy food intake. 
Several scientific advances have identified insulin resistance as the key aspect in the 
pathophysiology of  this condition (PMID:27610012). Also is important to highlight the role of 
junk food and western life style (PMID:32077594)  
 
- Discussion section: is pivotal for the Author, to highlight the role of healthy diet, as a 
Mediterranean diet. In fact, lifestyle interventions remain the first -line treatment for fatty liver. 
The interest  in antioxidants has increased over time, and literature reports an inverse association 
between nutrients rich in antioxidants and the risk of mortality due to non -communicable 
diseases, including liver steatosis. Mediterranean diet is a model characterize d by main 
consumption of plant -based foods and fish and reduced consumption of meat and dairy products. 
This diet represents the gold standard in preventive medicine, probably due to the harmonic 
combination of many foods with antioxidant and anti -inflamma tory properties. It contributes 
substantially to the reduction of the onset of many chronic diseases (PMID:31438482)  
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
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Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
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Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
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assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
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Acceptable  
 
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