Title: The Impact of Carbohydrate Quality Index on Menopausal Symptoms and Quality of Life
in Postmenopausal Women
Version: 1 Date: 29 Mar 2025
Reviewer's report:
Comments
Dear Authors,
First, I would like to commend you on the design and execution of this study. Your
research provides valuable insights into the relationship between carbohydrate quality and
menopausal symptoms, a topic that is both relevant and underexplored in the literature.
The study is well-structured, and your use of validated scales strengthens the reliability
of your findings. Additionally, the statistical analyses are appropriate, and the discussion
effectively contextualizes the results within existing research. Once these revisions are made, the
manuscript will be significantly improved in clarity, methodological rigor, and academic impact.
I appreciate your efforts in this research and look forward to reviewing the revised version.
English Language and Academic Writing
The manuscript contains grammatical inconsistencies, awkward phrasing, and informal
expressions that affect readability. Please revise the text for better sentence structure, consistency
in tense, and clarity (consider professional language editing). o Ensure concise and precise
academic wording while avoiding.
Title
• The phrase "Evaluation of the Association" is somewhat vague. A more precise title could
specify the type of association (e.g., "Impact of Carbohydrate Quality on Menopausal Symptoms
and Quality of Life").
• The term "Carbohydrate Quality" may need further clarification—does it refer to glycemic
index, fiber content, whole grain intake, or a specific scoring system? If the study uses a
Carbohydrate Quality Index (CQI), it should be explicitly mentioned.
Abstract
• Missing Information in Methods:
o The study mentions carbohydrate quality but does not define how it was measured. If a
Carbohydrate Quality Index (CQI) was used, it should be explicitly stated.
o No mention of adjustments for confounders (e.g., physical activity, BMI, socioeconomic
status). Were these factors controlled?
o The statistical tests used should be specified (e.g., ANOVA, regression analysis).
• Results Clarity:
o The phrase "statistically weak negative correlation" lacks precision. Instead, the strength of
correlation (r-value) should be reported.
o "The highest scores were found in the 30-55 age group"—does this mean worse quality of life
and more symptoms? Clarify if a higher score = worse outcomes.
o No effect sizes are mentioned—this is crucial for understanding practical significance.
Keywords
• "Quality of life" is too broad—consider a more specific term like "Menopause-Specific Quality
of Life" (if this questionnaire is central to the study).
• "Menopausal symptom" should be plural: "Menopausal symptoms".
• Consider adding "Carbohydrate Quality Index" if this term is a core measure in the study.
Introduction section
• The problem statement should be clearer:
o What specific knowledge gap does this study address?
o Has previous research examined carbohydrate quality in relation to menopausal symptoms?
o If so, how does this study add something new?
2. The Concept of "Carbohydrate Quality" Needs More Definition
• The term "carbohydrate quality" is used frequently, but its exact definition is not provided.
• Does it refer to the Carbohydrate Quality Index (CQI), glycemic index, fiber content, or a
combination?
• If CQI is used, its components should be briefly mentioned here.
3. Some Claims Need More Specificity or References
• "Most studies have emphasized the association between carbohydrate quantity and disease…"
o Which diseases? Diabetes? Cardiovascular disease?
o Add references to strengthen this claim.
• "High glycaemic index foods promote inflammation and oxidative stress…"
o What mechanism is involved?
o Consider briefly explaining how insulin resistance or pro-inflammatory pathways play a role.
4. The Final Research Aim Needs More Precision
• The last sentence states:
o "This study aims to evaluate the association of carbohydrate quality on the quality of life and
menopausal symptoms in postmenopausal women and contribute to the existing literature."
• This could be more specific:
o Does it focus on a causal relationship or just an association?
o What methodological approach is used?
Methods Section
1. Cross-Sectional Study Limitations Not Addressed
• Cross-sectional studies cannot establish causality, only associations.
• The lack of temporal relationships should be acknowledged as a potential limitation.
2. Participant Characteristics Need More Detail
• The study excludes individuals with psychological diseases, cancer, and gynecological
conditions, but other potential confounders (e.g., physical activity, medication use, dietary
supplements) are not mentioned.
• How was menopausal status confirmed—self-reported or physician-confirmed?
3. More Clarity Needed in Carbohydrate Quality Index (CQI) Calculation
• The four components of CQI are listed, but how are they weighted?
• Is there a reference cutoff for high vs. low carbohydrate quality?
Results Section
1. Interpretation of Correlation Strength Needs Clarification
• The CQI-MENQOL correlation (r = -0.081, p = 0.046) is statistically significant but very weak.
This should be explicitly stated to avoid overinterpretation.
• The CQI-MRS correlation was non-significant (p > 0.05), yet this is only briefly mentioned.
2. Lack of Effect Sizes in Regression Analysis
• Effect sizes (e.g., R², confidence intervals for B-values) are not reported.
• Without R², it is unclear how much variation in CQI score is explained by marital status and
menopausal treatment.
4. Regression Analysis Should Consider More Potential Confounders
• While marital status and menopausal treatment were significant predictors of CQI, other dietary
or lifestyle factors (e.g., physical activity, socioeconomic status, medication use, chronic disease
status) were not included in the regression model.
• This should be acknowledged as a limitation.
Discussion Section
1. Interpretation of Weak Correlations Needs Refinement
• The correlation between CQI and MENQOL (r = -0.081, p = 0.046) is significant but very weak.
• The CQI and MRS correlation was not statistically significant (p > 0.05), yet the discussion
states that higher carbohydrate quality was linked to fewer menopausal symptoms.
• This could mislead readers into believing a strong association exists when the data does not
support it.
2. Overgeneralization of Findings
• The regression analysis found no significant associations between CQI and BMI, education, or
menopausal age, yet the discussion hints at a strong relationship between carbohydrate quality
and well-being.
• The discussion should clearly state that CQI was mainly associated with marital status and
menopausal treatment rather than strongly affecting quality of life or symptoms.
3. Lack of Emphasis on Dietary Context
• The discussion states that whole grains and fiber improve carbohydrate quality, but does
not explore other dietary factors (e.g., protein, fat intake, micronutrients) that could influence
menopausal symptoms.
• Other studies on Mediterranean diets, plant-based diets, or omega-3 intake in menopause could
be briefly mentioned.
4. Future Research Suggestions Could Be More Specific
• The discussion states that more large-scale research is needed, but does not specify what aspects
should be studied further.
• Future studies should:
o Use longitudinal designs to track how dietary changes affect menopausal symptoms over time.
o Include intervention studies to test whether improving carbohydrate quality actively reduces
symptoms.
o Examine the role of other macronutrients and their interaction with carbohydrate quality.
Best regards