Reviewer's report
Title:Excess weight and abdominal obesity in postmenopausal Brazilian women:
a population-based study
Version: 2Date:19 May 2013
Reviewer: Imke Janssen
Reviewer's report:
Major Revision required
1. Is the question posed by the authors well defined? Yes
2. Are the methods appropriate and well described? The sampling method
seems quite well and elaborately described.
The statistical methods lack detail, such as the test statistic used for comparing
groups. Need to clearly state that pre-obese and obese were combined.
3. Are the data sound?
Why did the authors use WC>=80cm (the cut-point for Asian women) instead of
>=88cm? Is it true that >=88 cm reflects obesity but 80-88cm corresponds to
pre-obese?
4. Does the manuscript adhere to the relevant standards for reporting and data
deposition?
Tables should be self-explanatory and include a footnote on how the outcome
variable was defined.
5. Are the discussion and conclusions well balanced and adequately supported
by the data?
Throughout the manuscript the recurring phrase is “menopause-related weight
gain”. This cannot be inferred from a cross-sectional study as this one. Similarly,
you study prevalence, not incidence of obesity. This needs to be changed
throughout the paper.
6. Are limitations of the work clearly stated?
The major limitation is the cross-sectional design of the study, and this is not
mentioned in “Limitations”.
7. Do the authors clearly acknowledge any work upon which they are building,
both published and unpublished? There are a number of studies following
women from pre-menopause to post-menopause, for example the Study of
Women’s Health Across the Nation. Some very relevant citations, both
presenting results from the longitudinal study, are missing:
(1) Sutton-Tyrrell K, Zhao X, Santoro N, Lasley B, Sowers M, Johnston J,
Mackey R, Matthews K.
Reproductive Hormones and Obesity: 9 years of Observation from the Study of
Women's Health Across the Nation.
American Journal of Epidemiology. 2010;171(11):1203-1213.
This paper examines incident obesity in a longitudinal study.
(2) Janssen I, Powell LH, Crawford S, Lasley B, Sutton-Tyrrell K.
Menopause and the Metabolic Syndrome: The Study of Women's Health Across
the Nation (SWAN).
Archives of Internal Medicine. 2008;168(14):1568-1575.
Although not reflected in the title, this paper presents longitudinal change in waist
circumference across the menoapsual transition, centered at the final menstrual
period.
(3) There is also a recent review article: Davis et al: Understanding weight gain at
menopause. Climacteric 2012.
You may also want to consider the following 3 papers from the Chicago site of
SWAN which used a population-based design:
(4) Dugan SA, Everson-Rose SA, Karavolos K, Avery EF, Wesley DE, Powell
LH. Physical Activity and Reduced Intra-abdominal Fat in Midlife
African-American and White Women. Obesity. 2010;18(6):1260-1265.
(5) Janssen I, Powell LH, Kazlauskaite R, Dugan SA. Testosterone and Visceral
Fat in Midlife Women: The Study of Women’s Health Across the Nation (SWAN)
Fat Patterning Study. Obesity. 2010;18(3):604-610.
(6) Kazlauskaite R, Karavolos K, Janssen I, Carlson K, Shipp KJ, Dugan SA,
Powell LH. The Association between Self-Reported Energy Intake and
Intra-Abdominal Adipose Tissue in Perimenopausal Women Journal of Obesity
2012;(Epub 2012 Jun 27).
8. Do the title and abstract accurately convey what has been found? Yes.
9. Is the writing acceptable? Yes, except where indicated.
- Minor Essential Revisions
The term is “logistic regression”, not “logistical regression”.
I would use “marital status” instead of “civic state”.
All tables would be easier to read if the reference category was always on the
bottom (or always on top).
Edits: In the abstract, “based on logistic regression analysis, …”
Intro: “lack of exercise” (not reduction). It would be a good idea to use the
terminology pre-obese and obese as in the rest of the paper. To relate this to
other studies, you could include a statement saying pre-obese is overweight and
not obese. As it reads now, it is confusing.
Methods: p.4 “psychological changes” (not psychic)
p.5 To calculate the sample size,…
p. 6 “more than one eligible woman …
p. 6 bottom “and 65-69 years” (not e)
p.7 “marital status” (not state)
p. 7: Please add a brief description of economic classes. E never appears again.
P.8: What do you mean by “A risk factor was evident…?”
p. 9: The discussion could be trimmed by 50%.
p. 12: Do you mean “health care” instead of hospitalizations?
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare that I have no competing interests.