Review for 10.1186/s12876-025-03625-4 (2025)

Title: Associations between Systemic Inflammatory Biomarkers and Metabolic Dysfunction
Associated Steatotic Liver Disease: A cross-sectional study of NHANES 2017-2020
Version: 2 Date: 26 Dec 2024
Reviewer:  Amira A A Othman
Reviewer's report:
First of all
I want to congratulate the authors on their work. In this study, Qiu et al. used data from the 2017–
2020 National Health and Nutrition Examination Survey (NHANES) for adult Americans, this
research aims to to explore the roles of systemic inflammatory biomarkers, which have been
implicated in various liver conditions, in the context of MASLD.
The authors handled the reviewer comments satisfactorily, nevertheless, there is an observation
for which sufficient justification must be obtained.
In general:
1. The English writing level is shallow, and it is necessary to seek help from an English language
specialist to correct spelling and grammatical errors in the entire text and break long paragraphs
into shorter ones for improved readability.
2. Abbreviations must be fully written at their first use.
In Title:
The title should clearly indicate that the study utilized data from the 2017–2020 National Health
and Nutrition Examination Survey (NHANES).
In Abstract section
3. The background subsection:
-  Should be the shortest part of the abstract. It should briefly outline the following information:
What is already known about the subject, related to the paper in question. What is not known
about the subject and hence what the study intended to examine (or what the paper seeks to
present). Please reconstruct it properly.
4.  The type of study: a population-based study, cross-sectional study.
5. In method subsection:
- Nothing was mentioned about the participant's age, sex, ethnicity, etc.
- It would help if you described the aim of your statistical analysis. For example, Multivariate
linear regression models were used to examine the linear connection between the lymphocyte-
to-high-density lipoprotein ratio and non-alcoholic fatty liver disease. Fitted smoothing curves
and threshold effect analysis were used to describe the nonlinear relationship, etc.
- The term "Backgrounds" in the abstract should be corrected to "Background."
In the Introduction section:
6. Try to provide a summarized description of The National Health and Nutrition Examination
Survey (NHANES) in the background section. You may use the following “NHANES
(www.cdc.gov/nchs/nhanes) is designed to assess the health and nutritional status of adults
and children in the United States. The survey is distinctive in that it incorporates both
physical examinations and interviews. Several cross-sectional, nationally representative health
examination surveys are part of the NHANES program. Questions about demographics,
health insurance status, dietary habits, acute and chronic medical issues, mental health, and
prescription drug use are all included in the health interview. Exam components can change
between survey cycles but typically include blood pressure, dental exams, vision, hearing,
dermatology, fitness, balance and strength testing, respiratory testing, taste and smell, and
body measurements (weight, height, skin folds, body composition scans). Hematology, organ
and endocrine function (e.g., thyroid, kidney), environmental exposure, dietary biomarkers,
metabolic and cardiovascular health, and infectious disease are some laboratory components.”.
7. Include more recent studies on MASLD prevalence and mechanisms to reinforce the urgency
of the research.
In the Methods section:
8. Please provide the participants' sociodemographic data.
9. How the sample size was calculated.
10. Inclusion and exclusion criteria must be provided.
11. Expand on the justification for using specific covariates in the regression models.
12. The description of variables like PIR and education level could be condensed for better
readability.
13. Are data collections retrospectively on a survey form? Nothing mentioned.
In the Results section:
14. In all tables, please explain the abbreviations under tables.
15. You can title the statistical test column as “Test of significance” and use U= for the Mann–
Whitney U test, T= for the T-test, and #2 = for the Chi-square test, etc., Although the Chi-square
test was used to compare observed and expected results, nothing was mentioned in the statistical
analysis section.
16. What were the patients' complaints?
17. Include a clearer explanation of Figure 2's results in the text to avoid reliance solely on
visuals.
18. Highlight key findings from the dose-response analysis to ensure clarity for readers less
familiar with RCS regression.
19. Simplify figure captions to make them more self-explanatory.
In the Discussion section:
20. The discussion section is one of the final parts of a research paper, in which an author
describes, analyzes, and interprets their findings. They explain the significance of those results
and tie everything back to the research question(s). In this manuscript, there is confusion
between what should be written in the introduction and discussion sections. Please reconstruct
the discussion section.
21. Some discussions on mechanisms (e.g., roles of ALB, CRP) are speculative and require
additional citations.
22. Consider exploring the clinical applications of these findings more explicitly, such as
potential biomarker-based screening tools.
23. Avoid redundancy when comparing findings with previous studies; consolidate similar
points.
24. Discuss the novelty of your study.
25. Emphasize future directions, including specific types of longitudinal studies or clinical trials
that could validate the findings.
26. Suggest potential strategies to overcome these limitations in future research.
In the conclusion section:
27. The conclusion should restate your main points and provide closure. Please reconstruct.