Reviewer ’s report  
 
Title: Double burden of malnutrition among ever -married women in Bangladesh: A pooled 
analysis  
 
Version: 0 Date: 29 May 2018  
 
Reviewer: Hanna Augustin  
 
Reviewer's report:  
 
The manuscript by Tania Sultana Tanwi et al, entitled Double burden of malnutrition among 
ever-married wo men in Bangladesh: A pooled analysis, encompasses in total 57605 ever -married 
women in Bangladesh. The authors investigate the change in prevalence of under - and over 
nutrition, and evaluate in factors related to these conditions. The manuscript is well wr itten, 
although some corrections are suggested below.  
 
Abstract  
Make clear in ethics that the sample include ever -married women of age 15 -49 years.  
Be consequent with what tempus to use. There is now a mixture of perfect and imperfect.  
Please consider to reduce the number of decimals for percentages. Be careful to suggest 
interventions, since that is out of the scoupe of this manuscript.  
 
Introduction  
Page 4:  
Line 11. To me epidemiological transition is new. Please clarify what you mean  and include 
reference. Maybe also obesity should be mentioned along with overweight.  
Line 18. The shortening DBM is scarcely used throughout the text. Consider not to include this 
shortening.  
Line 28. Start sentence with On the one hand, overweight and ob esity...  
Line 30. No need to list different types of cardiovascular diseases, enough with saying 
cardiovascular disease.  
Line 35 -42. Your definition of CDs makes me uncertain. Low birth weight is not a CD. Please, 
rephrase these lines so that you distingui sh between CDs and other states.  
Overall, it is preferred that the authors further clarify the added value of including several of the 
latest DHS.  
 
Methods, page 6  
Lines 8 -13. Please include reference on the health surveys eg the webpage that is now menti oned 
separately at the end. Or are there any previous publications from these surveys?  
Line 18. Omit the word successful here. This can be addressed in the discussion instead where 
the strengths of this study should be included.  
Line 20. Include informati on on the Women's questionnaire.  
Line 39. Include information what standardized procedure encompass.  
Lines 41 -44. Clarify what you did with missing data and with outliers.  
Also include, some information on how many were invited, and how many did participat e. Also 
how many were excluded, or clarify that such data is missing (if that is the case).  
 
Variables, page 7  
Include reference for who BMI categories.  
Include information on wealth index.  
 
Statistical analysis, page 7  
Include company delivering the STAT A program.  
The authors must clarify that the normal weight category is compared with the categories for 
overweight/obesity and underweight, respectively.  
Include information on reference category for each independent variable in this section.  
Include significance level (α).  
Multinominal logistic regression is used with BMI categories as dependent variables. Make clear 
how these categories are used, what was your reference and were overweight and obesity 
aggregated? Did you take confounders and  effect modifiers into account? I think his would help 
to understand how all these factors together is modelling the odds of having underweight or 
overweight/obesity.  
Multinomial logistic regression delivers odds ratio and not relative risk ratio. Please, correct this 
and make sure you report the right thing thoughout the manuscript.  
 
Results  
Use the tempus perfect consequently. Sometimes presence is used now.  
Avoid the big overlap between text and table 1 and 2. All values are not needed to show again in 
the text. Please also consider fewer decimals for all percentages.  
Page 8, Lines 44 -54. Here for example the percentages only for the highest and the lowest 
categories can be shown.  
 
Table 1.Consider not to include so many decimals.  
Table 2. Maybe call urba n/rural for Place of recidence instead of type of place...  
Table 2. Include the type statistical analysis that was used.  
 
Discussion  
Please include discussion on strengths and weaknesses of your study.  
You mentioned that the surveys were successful, how ha ve you come to that conclusion. Let the 
reader understand this by giving information to evaluate the external and internal validity.  
Page 15, Line 48. The authors mentioned "the work index". What is that? Should that be 
introduced in the methods?  
 
Conclusi on 
Make sure the conclusion is based on your results. You cannot make conclusion on what policies 
to implement. To say that tax on energy -dense foods should be implemented is to jump to 
conclusions. I suggest the authors take a more modest approach here ba sed on their results and 
make clear what are you own thoughts of the future.  
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 c ontrols 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 reco mmend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in t he past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisat ion that may in any way gain or lose  
financially from the publication of this manuscript, either now or 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 reimbursemen ts, 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 t his paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
No 
 
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