Reviewer ’s report  
 
Title: Overweight and lower age at menarche: evidence from t he Italian HBSC cross -sectional 
survey  
 
Version: 1 Date: 13 Jul 2018  
 
Reviewer: Reviewer 2  
 
Reviewer's report:  
 
"PEER REVIEWER COMMENTS: To view t he full report from the academic peer reviewer, 
please see the attached file.  
 
 
REVIEWER COMMENTS FROM REPORT: The first impression on this study is good because 
I consider it relevant for several areas such as nutritional epidemiology, anthropology  or 
endocrinology. Not only does it contribute to the monitoring of trends of the age of menarche, as 
it adds current information about a relationship that has been debated for a long time: the 
potential relationship between overweight/obesity and early menarche.  
 
 
The methodology is clearly described and, in particular, the statistical treatment of the data was 
conducted in an interesting way. The study has important limitations but the authors recognize 
them in the text.  
 
 
The strength of the study concerns the si ze of the sample, and an analysis based on national data, 
representative of the adolescent female population of Italy. One weakness of the study concerns 
the expression ""is a risk factor"" (conclusion). In my opinion, the design of this study does not 
allow this conclusion to be drawn. (however authors can rewrite it)  
 
 
 
 
REQUESTED REVISIONS:  
 
The authors should be more cautious in how they write the conclusion. In my opinion, the cross -
sectional design of the study does not allow to state, in a peremptory way, that overweight is a 
risk factor for early puberty. The results clearly show an association but do not indicate the 
direction of this association. In other words, it remains unclear whether overweight is the cause 
or consequence of early menarche."  
 
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which cont rols are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recomm end an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please in dicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, f ees, funding, or salary from an 
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publication of this manuscript, either now o r in the future?  
 
3. Do you hold or are you currently applying for any patents  relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
If you can answer no to all of the above, write 'I  declare that I have  no compe ting interests' 
below. If your reply is yes to any, please give details below.  
 
This reviewer has been recruited by a partner organization, Research Square. Reviewers with 
declared or apparent competing interests are not utilized for these reviews. This reviewer has 
agreed to publication of their comments  online under a Creative Commons Attribution License 
attributed to Research Square and was paid a small honorarium for completing the review within 
a specified timeframe. Honoraria for reviews such as this are paid regardless of the reviewer 
recommendation . 
 
I agree to the open peer review policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I u pload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do n ot wish to be included in my named report can be in cluded as confidential comments 
to the editor s, which will not be published.  
 
I agree to the open peer review policy of the journal