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: 
3 
Date: 
03 Feb 2023
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 minor 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 major 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: The authors have responded to several of the
comments and questions raised and they have reflected that in the manuscript.
However, there are still a major problem, from my point of view, with the
definition of cases and controls.
REQUESTED REVISIONS: 
It is my understanding that there is still a major problem with definition of cases
and controls. First, authors define "25 non-lifestyle liver disease patients" which
they explain (although not added to the manuscript) that "In essence the make-up
of this group is focussed mainly on the 'type' of disease rather than the specific
disease, in all of the participants in this group, none had a disease due to their
own actions or lifestyle." Surprisingly, patients with hepatitis B virus are
included in this group which could be clearly derive from certain actions or
lifestyle. So I think this is a methodological flaw. 
In addition, I had stated in the first revision form that "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.".
Authors have answered that this is not needed for this comparison. But I have to
disagree. Authors have controlled for alcohol use because it could be clearly
related both with results in questionnaires and with liver disease (and, as such, to
be a confusion factor). In this line, they should have be done the same with -at
least- obesity (to control it or to adjust it in the multivariable analysis). If patients
with NAFLD are obese and controls are not, factors found in the different
questionnaires may be related with obesity and not with NAFLD itself.
Declaration of competing interests
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paper?
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interests' below. If your reply is yes to any, please give details below.
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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