Title: Eating disorders and their relationship with menopausal phases among a sample of
middle-aged Lebanese women
Version: 1 Date: 29 Oct 2021
Reviewer's report:
The article is interesting; however, it needs some clarifications.  I have provided some comments
that the authors should consider improving the validity and reliability of the results, even
suggesting further analysis. Moreover, I present some guidelines to improve the writing of the
manuscript.
1. In the abstract, quantitative measures of summary and association should be presented in the
results section, now only the findings are described qualitatively.
2. The study is not a descriptive design; it is an analytical cross-sectional study.
3. In the introduction, there is no academic structure of the paragraphs. Three elements are
essential here: What is known, what is unknown about the research question, and why the study
was needed to carry out. The paragraphs must have an academic structure with an opening
sentence, support sentences, and closing statement; using the corresponding bibliographic
references. The introduction has too many paragraphs, I suggest a maximum of four.
4. There should be an upper age limit; older adults should not be included in the analyzes. I
suggest considering women up to under 60 or under 65, thus excluding older women.
5. The authors mention that the patients who refused to answer the questionnaires were excluded.
The rejection rate should be presented, also if there were differences in some variables between
those who responded and those who did not respond, as it could introduce selection bias.
6. The exposure variable, the outcome variable, and the control variables should be correctly
defined in the methods section. It is important that the authors highlight a primary outcome and
secondary outcomes, in addition, that these outcomes could be correlated.
7. The authors must specify how they defined the menopausal stage and what criteria was used
(STRAW or the FIGO).
8. Another critical variable is climacteric symptoms, which has not been measured. It would be
correct to consider this in the discussion.
9. A highly relevant variable is the current use of menopausal hormone therapy, which may
affect the outcome or even the use of other alternative therapies for climacteric symptoms.
10. The BMI variable should be compared as numerical and categorical: normal, overweight,
and obesity for a better clinical interpretation.
11. In Figure 1, the authors present a bar graph for the means; it is suggested to present the
means with 95% confidence intervals.
12. I think the tables should be presented only for the primary exposure controlled for other
covariates, and presenting the associations of the outcomes with other covariates could "distract"
the primary association tested.
13. Economic income could be categorized based on the country's minimum wages; this could
be better suited to the context than an arbitrary definition.
14. Authors must specify that the questionnaires used are validated Arabic versions and add the
corresponding references.
15. The results section should have subheadings ordering descriptive aspects, bivariate analysis
and regression models. It is important to note that the regression models must include a crude
(bivariate) and adjusted (multivariate) approach. Likewise, it would be appropriate to present
analyses with categorical outcomes (with validated cut-off points), improving clinical and
epidemiological interpretation; for example, Prevalence ratios or odds ratios.
16. Also, the authors do not present the criteria (statistical or epidemiological) to include the
control variables in the multiple regression model. Nor is it mentioned if interaction terms were
applied or if the authors used post estimation methods to see the model's validity.
17. I think the discussion is disorganized. It should present the main findings, the mechanisms
that explain the results, compare them with previous studies, see the implications of the findings,
present future studies, limitations and strengths, and a recommendation and conclusion. I suggest
using subheadings for each subsection.
18. The limitations should be presented on how these would affect the study's validity (biases)
and reliability (random error). In addition, the strategies that the authors used to reduce the
negative effects of the limitations.
19. A significant limitation is the failure to measure comorbidities (hypertension, diabetes
mellitus, among others) since these could be relevant confounders.
20. I suggest adding a STROBE guide checklist as an annexe.