Title: Association between dietary total antioxidant capacity and hypertension in Iranian
Kurdish women
Version: 1 Date: 19 Mar 2022
Reviewer's report:
This manuscript aimed to examine the “Association between dietary total antioxidant capacity
and hypertension in pre-and postmenopausal female; evidence from a cohort study in west of
Iran” The reviewer believes the topic is highly meaningful. However, major revisions in Title,
Abstract, Introduction, Methodology, Statistical analysis, Results, Discussion, and Conclusion
should be performed.
1. As a general comment, there are several writing and grammatical errors in the text, and having
an editor read through the paper would be useful to take care of this.
2. This study is a cross-sectional study. Please remove the terms “evidence from a cohort study
in the west of Iran” from the Title of the Manuscript because it causes ambiguity in recognizing
the type of study design.
3. The baseline results of the current study are not essential to provide in the Abstract. Please
remove the following sentence and more focus on details of the main findings: “The mean
daily intake of refined grains, legumes, white meat, omega-3, and omega-6 and vitamin D were
significantly higher among female non-hypertensive compared to hypertensive (P<0.05)”.
4. If the authors want to use the abbreviation of the phrases in the Abstract and full text, they
must define the abbreviation the first time the term is mentioned (not in the second or third case,
etc.), such as “SES” in Abstract or “BP” in the final part of the Introduction.
5. The "Introduction" section is not written correctly and has many redundant and irrelevant
items. In this section, the authors first should point out the importance of hypertension (HTN)
(especially in Iran), incidence or prevalence, and its impact on the risk of CVDs, quality of life,
and premature death. Then they should mention the risk factors or protective factors affecting
HTN, such as dietary pattern (with emphasis on antioxidant nutrients and compounds). In the
following, you should explain why this major health problem in a pre-and postmenopausal
female should be considered separately. Then, you should focus on the results of studies
examining the relationship between antioxidant capacity and HTN in adults (especially in pre/
postmenopausal women, if available) and mention the knowledge gap (provide the controversy
or consistency of studies results). Finally, you should state the purpose of the current study.
Please revise (or change) all these sections in the Introduction and specify the modified text.
6. Your study has been performed in the prevention of chronic diseases. Please avoid talking
about the results of intervention studies such as: “Intervention studies on antioxidants, focusing
on vitamins C and E, as well as pro-vitamins like beta-carotene have shown that can prevent
cardiovascular disease (CVDs) (5, 6).”
7. If studies on the association between TAC and the risk of HTN is very limited, you can refer
to the results of studies that assessed the association of this dietary index with the risk of chronic
metabolic diseases, such as metabolic syndrome, obesity, and CVDs, but, you do not need to
report the results of studies on cancers.
8. In the Introduction, please also mention the results of this study: PMID: 34229919
9. Sentences “High blood pressure (BP) is one of the most common and preventable risk factors
for CVDs (17). On the other hand, dietary pattern is one of the effective factors in blood pressure
status. Previous research has demonstrated association between food groups and hypertension
(18, 19).” This part of the text does not have good coherence! It should have been mentioned
in the previous parts of the Introduction.
10. The inclusion and exclusion criteria have not been fully stated in the "Study Population"
section! What are your entry criteria? Also, in your study, over and under-reporting for energy
and nutrients intakes, chronic diseases such as CVDs, liver and kidney failure, etc., and lack of
complete data about the study's outcome are not the exclusion criteria?
11. Please explain how physical activity information was obtained from individuals? Has the
questionnaire used been validated for your population?
12. Why were glycemic and lipid indices (FBS, TC, TG, HDL-C, and LDL-C) measured in this
study? Are they confounders in your research? If it is necessary to keep these variables in this
study, please describe the measurements of these variables in detail.
13. Has the food frequency questionnaire been validated for your population? Please provide
more explanation for dietary measurement.
14. The “Statistical analyses” section should be stated separately from the “Definitions section.”
Use the "Statistical Analyses" heading.
15. In the “Statistical analyses,” please specify how the normality of the variables is checked?
16. In the “Statistical analyses”, you need to state what variables are controlled in the multivariate
regression model?
17. Why did you not use the multivariable regression test for the analysis of this study? This
is a more appropriate test!
18. What variables were adjusted as confounders in your final analysis? You must state clearly
the list of confounders in the “Statistical analyses” and “Results” sections.
19. Please use “TC” instead of “T-C” as an abbreviation of total cholesterol.
20. The study's findings do not correspond to the Title and aim of the study (Table 4). Reporting
many findings and examining the relationship between different variables and an outcome (HTN
in this study) is not a sign of a study with strong results!! Please provide only the results that
indicate the relationship between TAC and the risk of HTN in pre/ postmenopausal females!
Or, if you want to assess other factors, please focus on them in the Title, Introduction, and Aim
of the study.
21. Explaining results on the relationship between TAC and the risk of HTN in the "Results
section" is not performed correctly. There are no significant results regarding the relationship
between this dietary index and the risk of HTN in none of the groups!
22. The odds ratios reported for the fourth quartile of the TAC compared to the first quartile show
that in both groups of women (pre/perimenopausal female and postmenopausal), the results are
not significant!.
23. The last paragraph of the Results section should be revised and corrected, and therefore the
Discussion section of the Manuscript should subsequently be revised based on the new results
report (no significant results are seen in this study).