Review for 10.1186/s12876-025-04099-0 (2025)

Title: Sex-Specific Adverse Effects of Lipid Accumulation Products and Cardiometabolic
Indices on the Prevalence of Gallstones: Insights from the 2017-2020 National Health and
Nutrition Examination Survey
Version: 0 Date: 20 May 2025
Reviewer:  Bryan Adrian Priego-Parra
Reviewer's report:
Thank you for the invitation to review this manuscript. In this study, the authors examined the
relationship between lipid accumulation product (LAP), cardiometabolic index (CMI), and the
prevalence of gallstones using data from the 2017-2020 NHANES survey, with a focus on sex
differences. The study found a positive association between LAP, CMI, and the presence of
gallstones exclusively in women. The article benefits from utilizing a transparent and publicly
accessible database, incorporating data from 15,560 individuals.
Overall, it is a well-written and engaging article. I have some suggestions for improvement,
which I have listed below:
Major Comments:
• Terminology on Gallstones:
Since the question used to assess gallstones is retrospective and based on a previously
confirmed diagnosis (“Has a doctor or other healthcare professional ever told you that you have
gallstones?”), the term “gallstone risk” is inappropriate. To more accurately reflect the data,
consider using “Prevalence of gallstones,” “History of gallstones” for prior diagnoses, or “Self-
reported gallstones” to emphasize the self-reported nature. Consequently, the term “gallstone
risk” should be revised throughout the manuscript, including the title. Discussing risk would
require a distinct study design and a more objective assessment of gallstone risk.
• Sex vs. Gender Terminology:
According to the latest medical writing guidelines, it is essential to distinguish biological sex
from gender. Therefore, I suggest replacing “gender” with “sex,” and using “women” and “men”
instead of “female” and “male” throughout the text, including the title.
General Comments:
• Include Spearman correlation and DeLong’s test in the statistical methodology section.
• The statistical p-value should be presented in lowercase (“p”) throughout the text.
Specific Line-by-Line Recommendations:
• Line 45: Standardize the format after the CI with a dash. Example: “For each 1-point increase
in CMI, the multivariable-adjusted OR was 1.408 (95% CI: 1.098–1.806).”
• Line 52: Adjust to: “The study revealed a positive association between LAP, CMI, and the
prevalence of gallstones.”
• Line 129: Add a corresponding reference for each index in:
“In this study, we utilized previously published formulas to calculate participants' body mass
index (BMI), body roundness index (BRI), cardiometabolic index (CMI), lipid accumulation
product (LAP), visceral adiposity index (VAI), and waist-to-height ratio (WtHR).”
• Line 130: Add a space after “metabolic index”:
“body mass index (BMI), body roundness index (BRI), cardiometabolic index (CMI), …”
• Line 164: Adjust verb tense to past:
“The number and location of knots in the RCS were guided by the Akaike Information Criterion
to balance optimal fit and overfitting.”
• Line 197: It is not necessary to redefine “A multivariable-adjusted restricted cubic spline
(RCS)” as it was already defined in line 162. Use only the acronym. The same applies to line
208 for “corresponding areas under the curve (AUC), 95% confidence intervals (CI),” where
ROC and CI were previously defined.
• Line 203: Move this sentence to the discussion section:
“These findings underscore the potential sex-specific roles of LAP and CMI in gallstone
pathogenesis.”
• Line 210: Change to the past tense and adjust terminology:
“BMI, WC, VAI, and WtHR were effective predictors of gallstone prevalence.”
• Line 250: Use only the acronyms for CMI, as they have already been defined.
Overall, the statistical approach effectively explores the dataset. Congratulations on this
comprehensive analysis.
I hope my suggestions are helpful in enhancing your manuscript. Best of luck, and thank you
for the invitation.