Review for 10.1186/s12876-020-01501-x (2020)

Reviewer’s report
Title: 
Loss of skeletal muscle mass affects the incidence of minimal hepatic
encephalopathy: A case control study
Version: 
1 
Date: 
02 Sep 2020
Reviewer's report:
Manuscript ID: BMGE-D-20-00866R1
Title: Loss of skeletal muscle mass affects the incidence of minimal hepatic
encephalopathy:
A case control study
Author: Masakuni Tateyama st al.
Comments
The authors suggest that muscle mass loss serves as a predictive factor for
minimal hepatic encephalopathy (MHE) among patients with liver cirrhosis and
without advanced hepatocellular carcinoma (HCC). 
1. The authors should explain how the cut-off value of SMI was determined as
50 cm2/m2. 
2. Overall, gender difference in SMI and skeletal muscle mass (area) should be
analyzed and/or discussed.
3. The authors discussed about ammonia and concentration of BCAA as
mechanisms of MHE showing previous studies and recommend BCAA therapy
for MHE treatment, whereas the difference in these were negative between MHE
+/- in the current study. Discussion about their own results are missing.
4. In terms of clinical implementation, cut-off value of SMI should be obtained
using ROC analysis, which might be difficult in small sample size but at least,
the authors should discuss about that. 
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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?
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