Review for 10.1186/s12876-025-03808-z (2025)

Title: Association between Sarcopenia and the Prevalence of Gallstone in US Adults: A Cross-
Sectional Analysis of NHANES
Version: 0 Date: 22 Feb 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-While the introduction mentions the relationship between sarcopenia and several diseases, it
could be improved by expanding on the limited studies specifically related to gallstones. For
example, highlighting the gaps in existing literature or previous research (if any) that directly
addresses sarcopenia and gallstone risk would better establish the significance of the current
study.
-A clearer statement on how this study addresses an important knowledge gap in the literature
would enhance the introduction. Emphasizing that sarcopenia and gallstone association remain
largely unexplored makes the study’s objectives more compelling.
-While the sarcopenia index is clearly explained, it could be beneficial to briefly mention
why specific cutoffs for men and women (0.512 for women, 0.789 for men) were chosen.
Additionally, a discussion of how these cutoffs compare to other definitions or indices used in
similar studies would strengthen the rationale for using this measure.
-While the inclusion of various covariates (age, gender, race, education level, etc.) is thorough,
it may be beneficial to justify the inclusion of each variable based on prior studies or known
associations with sarcopenia or gallstones. Further elaborating on how these covariates are
selected would add transparency to the statistical analysis.
-While exclusion criteria for missing data are stated, a brief note on how missing data was
handled or imputed (if applicable) would be helpful. This would enhance the clarity regarding
how the study ensured robustness in its findings.
-The statistical methods outlined—t-tests, chi-square tests, and multivariable logistic regression
—are appropriate, but it might be useful to briefly mention how multivariable models were
adjusted for potential confounders. For instance, a mention of which variables were included
in the adjusted models could be useful for the reader to understand how the study controlled
for these factors.
-While the study notes that the positive association between sarcopenia and gallstones was
significant in females but not in males, further exploration of why this occurs could be beneficial.
Are there specific factors, such as hormonal influences or differences in body composition,
that may contribute to this finding? A more thorough discussion of gender differences would
strengthen this part of the analysis.
-The study mentions that the association between sarcopenia and gallstones was reduced in non-
Hispanic black individuals but was not statistically significant. Further elaboration on why this
might be the case would be helpful. Additionally, it would be useful to briefly discuss why the
lower prevalence of gallstones in non-Hispanic blacks may affect the results.
-While the discussion connects sarcopenia to gallstones, providing more specific suggestions
for clinical practice, such as how healthcare providers can incorporate this information into
screening strategies, would be valuable. For example, could sarcopenia assessments be routinely
included in gallstone screening for at-risk populations?