Title: Association Between Triglyceride Levels and Rheumatoid Arthritis Prevalence in
Women: A Cross-Sectional Study of NHANES (1999–2018)
Version: 2 Date: 01 Feb 2025
Reviewer:  Eham Amer Ali
Reviewer's report:
Review a Manuscript
Dear Editor,
Thank you for considering me as a reviewer to review the manuscript titled, "Association
between Triglyceride Levels and Rheumatoid Arthritis Prevalence in Women: A Cross-
Sectional Study of NHANES (1999–2018)" in your esteemed journal. I take peer review
seriously and am very willing to serve the scientific community in this way. By looking at the
manuscript, we can put in front of the author the following observations, which we hope will
be useful.
1-  In fact, what the author/s presented in my opinion is a very important study, especially since
such tests are not of interest to many doctors, so I believe that it will open many ways and future
research in this regard.
2- I believe that this study is highly reliable for several reasons:
- It included a very large number of women, and this is a very important point for relying on
the results of this type of study.
- It included different age groups, races and nationalities, and this is very important for the
comprehensiveness of the results.
3-  Despite the positive points that have been mentioned, the research needs some points that
must be taken into consideration, including:
• The author/s mentioned that there is a linear relationship between rheumatoid arthritis and
triglycerides and there are possible non-linear relationships. What are these relationships? It
must be explained precisely.
• The author/s presented the discussion well, but it included repeated phrases in its scientific
content. However, he did not address the real mechanism behind the role of triglycerides in
causing this inflammation, which I believe is very important for women in order to come up
with recommendations that can be followed for early prevention. The author/s was satisfied
with commenting on the greater task for the future, which is that "future studies may explore
new horizons in research on the real mechanism behind this effect." I believe that this phrase
weakens the importance of the efforts made by the author/s in collecting the scientific material
for this manuscript. It needs to mention a simple hypothetical mechanism that supports what
he emphasized from the previous results. The researcher is kindly requested to pay attention to
this paragraph
In fact, raising such topics is very important, especially since most direct tests are sometimes
affected by many factors, including age, gender, weight, concomitant diseases and some
treatments. On the other hand, these tests may be inaccurate due to the efficiency of laboratory
equipment or errors associated with manual work and perhaps differences in the companies
that manufacture laboratory equipment. All these factors suggest seeking to find more accurate
alternatives that are less affected by what was mentioned above. Based on what was mentioned,
I suggest that the researcher pay attention to measuring triglycerides relative to high-density
lipoproteins. Therefore, I leave to the researcher a point that I believe is important for the future
and is worth discussing based on what the researcher presented, which is:
• Triglyceride to high density lipoprotein cholesterol ratio (TG/HDL-c) is crucial when
researching metabolic and vascular diseases, and its involvement in inflammation. Meanwhile,
inflammation could lead to a rapid spike in levels of ROS, which established a feedback-loop
between inflammation and oxidative stress. Increase in triglyceride (TG) and decrease in high
density lipoprotein cholesterol (HDL-c) may be caused by inflammatory cytokines, and it has
been suggested that triglyceride to high density lipoprotein cholesterol ratio (TG/HDL-c ratio),
a simple, non-invasive, and convenient measurement indicator, could integrate predictive risks
of two parameters into a single risk factor and showed better predictive value than TG and HDL-
c alone in an inflammation like (Rheumatoid Arthritis).