Review for 10.1186/1471-230X-9-4 (2009)

Reviewer's report
Title:An association between colonic adenoma and abdominal obesity : A cross
sectional study.
Version: 4Date:29 August 2008
Reviewer: Suminori Kono
Reviewer's report:
The paper reported a positive relation between waist circuference and colon
(colorectal?) adenomas in a small cross-sectional study in Korea. It remains
uncertain whether abdominal obesity rather than overall adiposity is important in
colon carcinogenesis, and thus the findings are of much value. However, the
presentation is no good; discussion is rather superficial; and English is poor.
Specific comments are as follows:
1. Major Compulsory Revisions. Of 1187 persons undergoing the health
cheqk-up, 165 cases and 365 controls remained in the analysis. Please describe
details of the process of excluding subjects with reasons for exclusion and
numbers specified. Did all of the 1187 subjects receive total colonoscopy? What
was the number of subjects by colonoscopic findings and by histological
examination. Were the subjects with rectal adenomas excluded?
2. Major Compulsory Revisions. Table 1: Means should be sex- and
age-adjusted. I do not find the reason why serum lipids and blood pressure
should be presented. Smoking and parental history (if available) should be also
shown in Table 1 using proportions.
3. Major Compulsory Revisions. Table 3: The authors used a dichotomous
variable for waist circumference and continuous variable for BMI, and these
highly inter-correlated factors were included in the model simultaneously. In
Table 3, adjusted odds ratios should be shown for tertile or preferably quartile
categories of waist circumference and BMI without and with mutual adjustment
for each other. Sex, age, smoking, calorie, fat intake should be included in the
model as done, but their odds ratios are unnecessary. Smoking is also better to
be categorized into null, low and high exposure.
4. Minor Essential Revisions. Abdominal obesity is defined differently for men
and women, and it is better to show odds ratios for abdominal obesity in men and
women separately. Overweight (BMI >= 25) is a common definition, and it is
desirable to present odds ratios for overweight, again for men and women
separately. Another table may be created, but these odds ratios and 95% CI can
be described in text.
5. Major Compulsory Revisions. The authors should be more specific in writing.
1) Line 3 on the Background page: What sort of dietary factors are known as risk
factors. Specify vegetables, red meat and whatsoever.
2) Lines 1-3 from the bottom: More references are needed. Please refer to IARC
Handbooks of Cancer Prevention, vol 6 Weight control and physical activity
(IARC, 2002). References 10-12 are to be cited here.
3) Line 3 from the bottom on the Discussion page: “Sayaka et al” should be
“Otake et al.”
4) At the middle of the second page of the Discussion, there is a sentence to the
effect that the relation between central obesity and colon adenomas remains
controversial. Please describe how controversial the findings are in the
Introduction. This paragraph is duplicate with a text in the Introduction.
6. Major Compulsory Revisions. It is strongly recommended to consult with a
person with good knowledge of writing in English. There are lots of eccentric
words and phrases. Examples in the Abstract pages are “predictor as (=> a
measure of ) central obesity”, “Subject were undergone (=> underwent)
screening”, “Demographic data (=> Demographic and lifestyle factors) such as
smoking”, “measurements were examined (=> determined or recorded)”, and “
analysis (was) obtained.”
Level of interest: An article of outstanding merit and interest in its field
Quality of written English: Not suitable for publication unless extensively edited
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.