Title: The association between Healthy Beverage Index and psychological disorders among
overweight and obese women: A cross-sectional study
Version: 1 Date: 01 May 2022
Reviewer's report:
Thanks for the opportunity to review this manuscript. This manuscript focused on the
relationship between healthy beverage index and psychological disorders among overweight
and obese women in Iran, which presents an interesting view and valuable guidance on obesity
prevention and intervention. However, there are several issues concerned in the manuscript.
ABSTRACT:
Line 28: typo mistakes of ‘th4’.
INTRODUCTION:
Overall, the authors have to improve the INTRODUCTION part. In this part, the authors should
clarify why they conducted this study, why they targeted this population, and the significance
of this study.
Line 41: typo mistakes of ‘2030,’
Lines 43-47: 1. It would be better to introduce the status quo of psychological distress followed
by depression and anxiety. 2. The authors should also introduce the prevalence of psychological
problems in Iran, especially among Iran women.
Para 2: The authors should briefly state the association between sex and obesity, that is to say,
to clarify why to conduct this study on overweight and obese women.
Lines 62-71: Literature regarding HBI is scarce. The authors only listed two. Does this index be
validated by other teams or validated in Iran?
Line 71-72: As the authors said that the HBI is a kind of ‘incorporated index,’ how can this
index help to choose healthy beverages? The authors should explain it more clearly.
Line 77-80: What are the HBI diet and HBI dietary patterns? The authors should clarify this
in detail.
METHODS AND MATERIALS:
Women in emerging adulthood (18-to-25-year-old) or perimenopause (older than 45) would be
more vulnerable to psychological disorders. How to eliminate such a ‘physiological effect’?
Data collection:
Line 92-95: Only the participants' weight was measured in this study? How about height?
Lines 97: Generally, we choose the right arm for blood pressure measurement or measure both
arms and choose the higher one as a result. Why do the authors measure the left arm? Is it because
all Iranian women have higher blood pressure in their left arm than their right?
Lines 98: Which version of IPAQ did the authors use? Long-form or short-form? Please clarify
in the manuscript.
As HBI is the primary variable in this manuscript, the authors should clarify this part clearly,
at least answer the questions as follows:
1. How to collect the information regarding HBI? Using the FFQ or other tools?
2. If the authors collect HBI-related information by FFQ, was this FFQ semi-quantitative or
qualitative? How many food categories and food items are in this FFQ? How to calculate the
dietary intake via this FFQ?
3. What’s the purpose of dietary assessment? Now that the authors mentioned ‘HBI dietary
pattern’, how to analyze the dietary patterns? What kind of methods did the authors use?
Besides, Lines 116-125 confused me. The authors should explain the calculation methods of
HBI in detail. Moreover, my question is, there are eight categories of beverages; why the final
HBI score ranges from 0 to 100? Does every item in the HBI system score different scores? How
to convert the final scores? Why with a higher number indicate better compliance with beverage
standards? What kind of standards is it?
Lines 126-132: The authors should introduce DASS-21 in detail and clarify how to calculate
scores of different facets.
Lines 134-135: Are there any literature related to ‘marginally significant?’
Lines 142-148: Which is the dependent variable in the binary logistic regression? This confused
me.
RESULTS:
Lines 153-156: The authors did not mention ‘economic status’ in the above, and the definition
on ‘moderate economic status’ was also unclear.
Lines 152 & 156: Please keep the same way of data description: SD or standard deviation.
Lines 166-173: The authors did not mention ‘neck circumference, fat-free mass, bone mineral
content, skeletal muscle mass, soft lean mass, fat-free mass index, intracellular water, and
extracellular water’ in the methods part.
Lines 181-187: Actually, this section confused me. Did the authors want to explore the role of
dietary nutrients in the association between beverage intake and psychological disorders? If so,
the authors should discuss the results of this section in the DISCUSSION. Please explain what
exactly the authors wanted to explore in this part.
3.4 & 3.5: I suggest the authors use linear regression models to analyze the association
between HBI and DASS-21. I also suggest exploring the relationship between different beverage
categories and psychological disorders.
DISCUSSION:
The authors should improve this part. Neither the repeated version of the results nor the list
of existing research is the DISCUSSION; it explains the results and extension of the study. I
suggest the authors rewrite this section, combining the results of this study with other similar
research closely and logically. Not just state findings existed.
CONCLUSIONS:
This section should be enlarged and improved, reporting the main results and the future
perspective of this study.