Review for 10.1186/s12876-024-03556-6 (2024)

Title: Association between composite dietary antioxidant index and metabolic dysfunction-
associated fatty liver disease: a cross-sectional study from NHANES
Version: 0 Date: 07 Oct 2024
Reviewer:  Emad Yuzbashian
Reviewer's report:
The manuscript entitled "Association between composite dietary antioxidant index and
metabolic dysfunction-associated fatty liver disease: a cross-sectional study from NHANES"
offers valuable insights into the role of dietary antioxidants in the prevention of MAFLD.
While the study is timely and relevant, there are several areas that would benefit from further
clarification and refinement to enhance the manuscript’s overall quality and rigor.
Abstract (Line 30): The phrase "two groups" is mentioned without a clear reference to the
specific groups being compared. It is recommended to specify which two groups are being
discussed to avoid ambiguity.
The manuscript uses the term "multivariate logistic regression" in some sections. I suggest using
"multivariable logistic regression" as it more accurately describes the statistical method used
when analyzing multiple predictors simultaneously.
The age variable is categorized into only two groups (18–60 years and #60 years). This broad
categorization may oversimplify the data, especially given the wide range within the first
category. It might be helpful to consider stratifying the age groups further for a more meaningful
analysis.
Was a specific, validated questionnaire used to assess physical activity levels? If so, please
provide details of the questionnaire in the methods section to ensure transparency.
The results section begins with the exclusion of participants but does not provide clear
information on the inclusion and exclusion criteria. It is recommended to move this information
to the methods section and include the specific criteria and the number of participants excluded
and retained for final analysis.
The sentence “Furthermore, we observed the baseline characteristics of the CDAI scores” is
vague. Please provide more specific details about what was observed regarding the baseline
characteristics.
It would be helpful to include more detailed footnotes in Table 2, explaining the statistical
methods used to generate the data presented.
The presentation of participant percentages within each quartile appears inconsistent. For
example, the first quartile for physical activity seems off. Please review and ensure the
percentages are reported consistently across all categorical variables.
The section 3.2, the analysis of variables with MAFLD should be more clearly tied to the study’s
primary objective. Please provide a clearer explanation of how this section supports the main
research aim.
Instead of showing the number of participants with MAFLD and non-MAFLD in Table 3, it
might be more informative to present the total number/the number of MAFLD participants only.
Since the confidence intervals (CIs) provide clear information on statistical significance,
consider replacing the p-values with a p-for-trend analysis, which could be more informative.
Additionally, the p-value for 0.91 (0.82-1.01) may need verification.
The above suggestions regarding p-values also apply to Tables 4, S1, and S2.
Table 4 contains odd ratios (OR) of 1.0 with confidence intervals of 1.0, making interpretation
difficult. It appears that the variability among participants in the CDAI components is very low.
Including the mean and standard deviation of the CDAI components in Table 2 could better
illustrate the distribution across quartiles.