Review for 10.1186/1471-230X-13-110 (2013)

Reviewer's report
Title:Fatty liver index correlates with non-alcoholic fatty liver disease, but not
with newly diagnosed coronary artery atherosclerotic disease in Chinese patients
Version: 1Date:6 February 2013
Reviewer: Emanuel Manesis
Reviewer's report:
The article by Jiang J-Y et al entitled "Fatty liver index correlates with
non-alcoholic fatty liver disease, but not with newly diagnosed coronary artery
atherosclerotic disease in Chinese patients" is a prospective study evaluating the
specificity of the fatty liver index (FLI) for the detection of NAFLD, as diagnosed
by ultrasound (US) in Chinese patients and also, the value of FLI as a prognostic
variable for moderate or severe coronary artery disease (CAD) diagnosed by
coronary angiography. The findings of the study confirm that FLI is correlated,
although weakly (r=0.372), with NAFLD, but they are in divergence with the
European experience that FLI may predict CAD.
Positive characteristics of this study include the homogeneity of ethnicity of the
studied population (Chinese patients only); the prospective design; the large
number of studied patients (n=713) and the fact that it represents the experience
of one institution. Weak point may be considered the absence of a histological
confirmation of fatty liver, since liver "brightness" may be due, not only to fat, but
to fibrous tissue as well. The paper is written in a concise manner.
My comments follow:
General Comments:
1. Authors should give in a Table the main demographic, laboratory and clinical
characteristics of the CAD and the non-CAD group and their statistical
comparisons. It is suggested that the table may include the age, sex, smoking
habits, history of hypertension, presence of dislipidemia, history of previous
myocardial infarction or angina, baseline blood pressure, total serum cholesterol,
HDL, LDL, triglycerides, fasting blood glucose, ALT, alkaline phosphatase and
the #GT serum levels.
2. English language needs correction.
Major Comments:
1. (Page 5, line 7 from top): Why patients with congestive heart failure (CHF)
were excluded? Hypertension or diabetes may cause CHF and still be associated
with metabolic syndrome and fatty liver.
2. (Page 5, line 14 from top): "if at least 50% diameter": Do the authors mean that
only patients with #50% were included in the study (i.e. those with moderate or
severe CAD only)? Please clarify.
3. (Page 5, lines 17-20 from top): Patients with minimal CAD (<50% stenosis in
one or more main coronary vessels) should be included as CAD cases, as well.
4. (Statistical analysis): AST should not be considered as a covariate in the
multivariable analysis along with ALT.
5. (Statistical analysis): For the expression "calculated by e# and e#±1.96sem"
please give reference or better omit it.
Minor Comments:
1. (Statistical analysis): Pearson's correlation.
2. (Statistical analysis): "AKP"? Please explain.
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare that I have no competing interests