Reviewer’s report
Title: 
Factors associated with health-related quality of life in women using path
analyses: Mediation effect of the adiposity traits
Version: 
4 
Date: 
13 Sep 2021
Reviewer's report:
"STATISTICAL REVIEWER ASSESSMENT: 
Is the study design appropriate for the research question (considering whether the
analyzed population accurately reflects the design and whether you see any problems
with control/comparison groups, e.g., likely confounders)?
Yes - overall design, population, and control groups are appropriate
Are methodologies adequate and well implemented (considering whether assumptions
are addressed and whether analyses are robust)?
No - there are minor issues
Are the analyses adequately communicated (considering whether reporting details are
adequate and whether figures and tables are well labeled and described)?
No - there are minor issues
Does the interpretation accurately reflect the analyses without overstatement
(considering whether limitations/bias are acknowledged and whether accurate
descriptors, e.g., 'significant', are used)?
No - there are minor issues
Could an appropriately REVISED version of this work represent a statistically sound
contribution? 
Probably - with minor revisions
STATISTICAL REVIEWER COMMENTS:
I appreciate the authors' efforts in responding to my previous round of concerns. 
Still, I
cannot be convinced of the authors' reasoning as regards the issue I had raised
previously -- the authors mistakenly used scores in lieu of variables in the related tables
and figures of their paper.
In their rebuttal letter, the authors stated: "Dear reviewer, as you know, to measure and
provide values for something that's unobservable and can't observe it directly (e.g.
eating behaviors, sleep quality and quality of life), based on Likert theory, we can use
instruments that contain variables (items) which are not measured individually but
rather item values (scores) are summed. These obtained scores can be treated
statistically as interval-type variables, and in the analysis can be equated the use of
parametric and non-parametric tests (#Curado MA, Teles J, Marôco J. Analysis of
variables that are not directly observable: influence on decision-making during the
research process. Revista da Escola de Enfermagem da USP. 2014;48:146-52.). On the
other hand, as we mentioned in previous revision, in a path model, an independent
observed variable is a raw score obtained from a measurement instrument (for example
scores obtained from validated and reliable questionnaires) or assigned to an attribute
variable. So, based on scientific evidence, it's not surprising to include these scores in
the analysis."
Firstly, regarding the only supporting reference the authors had offered (#Curado MA,
Teles J, Marôco J. Analysis of variables that are not directly observable: influence on
decision-making during the research process. Revista da Escola de Enfermagem da
USP. 2014;48:146-52.), the text read:
Variables and measures
A variable [emphasis added] is a structure of characteristics, qualities, or quantities that
in some form provide information about a specific descriptive phenomenon ……
Interval variables or those classified with this status (e.g., intelligence quotient, Psi 20)
[emphasis added] assume quantitative values …… Qualitative variables can be nominal
(e.g. gender, marital status) [emphasis added] or ordinal (e.g. risk scale, satisfaction
level) [emphasis added].
As could be observed form the above-quoted text, unobservable variables are
"intelligence quotient", "Psi 20", "satisfaction level", and the like, and they are
measured by either quantitative or qualitative scales. 
The authors argued, "as you know,
to measure and provide values for something that's unobservable and can't observe it
directly (e.g. eating behaviors, sleep quality and quality of life), based on Likert theory,
we can use instruments that contain variables (items) which are not measured
individually but rather item values (scores) are summed.". 
I have no problem with the
arguments here. 
However, as I pointer out previously, intelligence is an unobservable
variable, and it is measured using IQ scores. 
But, the authors can NOT declare
""intelligence = scores"". 
Take Figure 2 of this paper. 
The authors used "PSQI"
(Pittsburgh sleep quality index) (a score), rather than "sleep quality" (a variable)
accurately.
The authors also declared: "So, based on scientific evidence, it's not surprising to
include these scores in the analysis." 
Once again, using those scores/data to carrying
out statistical analysis is not the issue. 
Rather, it is the concept of variable vs. score, as I
pointed out before -- "The property or quality that's being measured for an object is
called a variable. 
Values or scores are the numbers or labels we assign to represent
amounts of this quality or property." 
Finally, I am not sure what the authors meant in
terms of "based on scientific evidence based on scientific evidence, it's not surprising to
include these scores in the analysis". 
Simply several counterarguments as follows
(unobservable variables, instead of scores, are used in ALL path analysis models): 
https://www.cambridge.org/core/journals/applied-psycholinguistics/article/roles-of-
morphological-awareness-in-the-reading-comprehension-of-spanishspeaking-language-
minority-learners-exploring-partial-mediation-by-vocabulary-and-reading-
fluency/583DC77EB84A0E8379650D4C0930833E
http://bayes.acs.unt.edu:8083/BayesContent/class/Jon/SAS_SC/SAS_Module8_Path.htm
https://crab.rutgers.edu/~goertzel/pathanal.htm
http://people.musc.edu/~elg26/teaching/psstats2.2006/pathmodels3.pdf
https://basicmedicalkey.com/path-analysis-and-structural-equation-modeling/
https://graziano-raulin.com/supplements/path_analysis.htm
REQUESTED REVISIONS: 
As noted above."
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Is the study design appropriate to answer the research question (including the use of
appropriate controls), and are the conclusions supported by the evidence presented?
No
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
No
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free from
apparent manipulation?
Yes