Review for 10.1186/s12876-025-04117-1 (2025)

Title: Prognostic Value of ALBI Score for All-Cause Mortality in Metabolic Associated Fatty
Liver Disease Patients: A Cohort Study from NHANES 2003-2018
Version: 1 Date: 29 Mar 2025
Reviewer:  Amira A. A. Othman
Reviewer's report:
First of all
I want to congratulate the authors on their work. In this study, Zhou et al. aimed to summarize
the key objective, e.g., investigate a specific disease, analyze treatment effectiveness, perform
a meta-analysis, etc.. The authors want to fill a specific research gap by providing new data, a
novel approach, or a comparison of existing findings. However, the study’s purpose should be
stated more clearly in both the introduction and abstract. It’s important to emphasize why this
study matters and what practical or scientific impact it has.
Non-alcoholic fatty liver disease (NAFLD) is recognized as the most prevalent chronic liver
disease, impacting about 30% of global individuals, with the potential to progress to advanced
hepatic fibrosis and end-stage liver diseases eventually [*]. In June 2023, a multi-society
committee of international experts was gathered, and new terminology was adopted to reduce
stigma and increase disease awareness [**]. A new terminology, Steatotic liver disease (SLD),
replaces “fatty liver disease” as the umbrella term. Under subgroups of SLD, NAFLD has been
renamed as metabolic dysfunction-associated Steatotic liver disease (MASLD) [**]. NAFLD/
MASLD is closely related to metabolic syndrome (MetS) and its associated components of
hypertension, type 2 diabetes mellitus, dyslipidemia, and obesity[***].
(*:doi: 10.1097/HEP.0000000000000004, **: doi: 10.1016/j.jhep.2023.06.003, ***  doi:
10.1111/apt.17308).
The authors handled the reviewer comments satisfactorily, nevertheless, there is an observation
for which sufficient justification must be obtained.
In general:
1. The language is generally clear, but some minor grammatical errors and awkward phrasings
could be improved. Consider having the manuscript proofread by a native English speaker or
a professional editing service.
2. Abbreviations must be fully written at their first appearance.
In Title:
1. Make the title more specific by including the main variable, study type, or key finding. Ensure
it contains searchable keywords.
In the Abstract section
2. The background subsection in the abstract :
-  Should be the shortest part of the abstract. It should briefly outline the following information:
What is already known about the subject, related to the paper in question. What is not known
about the subject, and hence what the study intended to examine (or what the paper seeks to
present)? Please reconstruct it properly.
3.  The type of study: a population-based study.
4. In the method subsection in the abstract :
- It would help if you described the aim of your statistical analysis.
- Clarify study design and analysis techniques: “This cross-sectional study analyzed NHANES
data (2003–2018) using weighted logistic regression, etc.”
5. In the results subsection in the abstract :
6.   Add key data points in the results section (e.g., sample size, statistical significance). In the
conclusion subsection in the abstract :
- Emphasize the clinical significance of your study: Make the conclusion more specific and
avoid general statements.
In the Introduction section:
7. Try to provide a summarized description of the National Health and Nutrition Examination
Survey (NHANES) in the background section. You may use the following: “NHANES
(www.cdc.gov/nchs/nhanes) is designed to assess the health and nutritional status of adults
and children in the United States. The survey is distinctive in that it incorporates both
physical examinations and interviews. Several cross-sectional, nationally representative health
examination surveys are part of the NHANES program. Questions about demographics,
health insurance status, dietary habits, acute and chronic medical issues, mental health, and
prescription drug use are all included in the health interview. Exam components can change
between survey cycles but typically include blood pressure, dental exams, vision, hearing,
dermatology, fitness, balance and strength testing, respiratory testing, taste and smell, and
body measurements (weight, height, skin folds, body composition scans). Hematology, organ
and endocrine function (e.g., thyroid, kidney), environmental exposure, dietary biomarkers,
metabolic and cardiovascular health, and infectious disease are a few examples of laboratory
components.
8. MAFLD must replace NAFLD:
“In contrast to NAFLD, MAFLD does not necessitate ruling out other liver disease causes, such
as viral hepatitis or heavy alcohol use*. The new name chosen to replace NAFLD reflected the
disease etiology better and conveyed a more practical approach in daily clinical practice than
NAFLD, considering its close association with metabolic syndrome**. Please discuss the new
nomenclature in more detail.
(*: Doi: 10.1016/j.jhep.2020.03.039, **: doi: 10.1097/HEP.0000000000000520).
9. End the introduction with a clear research question or hypothesis.
10. Clearly define the research gap: why is this study necessary? Add recent references to support
the study’s importance.
In the Methods section:
11. Please move the sentences defining the NHANES to the introduction section rather than the
methodology section.
12. The study utilized the 2003-2018 NHANES survey cycle. Why did you choose the study
survey cycle? The survey includes study cycles from 2001 to 2023.
13. Please provide the participants' sociodemographic data.
14.  Provide clear inclusion and exclusion criteria.
15. Explain how participants or studies were selected.
16. Add more details on the statistical methods, including any adjustments for bias.
17. How the sample size was calculated.
18. Mention ethical approval earlier in the methodology to emphasize compliance.
19. Provide more details on the exclusion criteria to ensure reproducibility (e.g., specific
thresholds for "missing data").
In the Results section:
20. In all tables, please explain the abbreviations in tables.
21. You can title the statistical test column as “Test of significance” and use U= for the Mann–
Whitney U test, T= for the T-test, and #2 = for the Chi-square test, etc.. Although the Chi-square
test was used to compare observed and expected results, nothing was mentioned in the statistical
analysis section.
22. Ensure that table captions succinctly describe the content for standalone clarity.
23. Make key findings stand out more clearly.
24. Ensure tables and figures are labeled properly.
In the Discussion section:
25. The discussion section is one of the final parts of a research paper, in which an author
describes, analyzes, and interprets their findings. They explain the significance of those results
and tie everything back to the research question(s). In this manuscript, there is confusion
between what should be written in the introduction and discussion sections. Please reconstruct
the discussion section.
26. Add a discussion of the study’s limitations.
27. Critically analyze how these findings compare to previous studies.
28. Cite recent literature (such as [DOI: 10.1007/s12011-025-04544-x]) to strengthen your
argument.
In the Conclusion section:
29. "Make the conclusion more specific; summarize the key findings without overgeneralizing.
30. Avoid speculation and suggest future research areas if relevant.