PONE-D-19-19397

Adherences to oral nutritional supplementation among hospital outpatients: An online cross-sectional survey in Japan.

PLOS ONE

Dear Dr. Naoki Hashizume,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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ACADEMIC EDITOR: The reviewers have raised a number of points which we believe major modifications are necessary to improve the manuscript, taking into account the reviewers' remarks.  Please consider and address each of the comments raised by the reviewers before resubmitting the manuscript. This letter should not be construed as implying acceptance, as a revised version will be subject to re-review.

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Kind regards,

Wisit Cheungpasitporn, MD, FACP

University of Mississippi Medical Center

Twitter: @wisit661 Email: wcheungpasitporn@gmail.com 

Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

Reviewer #5: No

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: No

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

Reviewer #5: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

Reviewer #5: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: No

Reviewer #4: Yes

Reviewer #5: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Clearly state the objective of the study in the introduction section.

Add importance of oral nutritional supplements in the introduction section.

Table 3 is too long. If possible, divide into two or more parts.

Table 4 is too long. If possible, divide into two or more parts.

More statistical parameters are applied for the authentication of data.

The references are arranged according to the guidelines of journal.

Reviewer #2: The study design section has some results which can be move to the results section.

Reviewer #3: The manuscript should be revised for linguistic errors.

The oral nutritional supplementation should be specified within the manuscript.

The survey duration is too short and patients number is small.

Reviewer #4: Several studies have found health benefits associated with consumption of oral nutritional supplements (ONS). Hence, their consumption is often recommended, especially in the case of disease-related malnutrition. Hashizume et al. note that the health benefits from ONS consumption vary between patient groups with one of the explanatory factors being the extent to which patients adhere to ONS. Previous studies have found that higher adherence is associated with increase in body weight. With the motivation to find the right strategy to guide patient behavior towards ONS consumption, Hashizume et al. conducted an online survey in Japan. They examined whether the adherence of patients varies according to the kind of ONS that they are consuming — “prescribed” or “purchased”. The “prescribed” ONS are available with prescription only and the “purchased” ONS can be bought over-the-counter. The authors collected data from individuals of different ages, both genders, different BMIs, from different regions of Japan, different occupations and different income levels. They noted that the samples for the two categories of ONS were significantly different in terms of the regional composition of individuals and their BMIs. Although >80,000 individuals started the online questionnaire, the survey effectively included 107 individuals for “prescribed” ONS and 148 for “purchased” ONS. They report their observations on several factors that might distinguish the adherence of those consuming “prescribed” vs “purchased” ONS, e.g., patient characteristics, medical reasons for taking ONS, cost of taking ONS, type of ONS, having received medical advice, number of times and duration over which to take ONS, etc. They also asked the respondents why the patients did not adhere to the medical advice, if they were satisfied with the ONS that they were receiving or if they knew of the alternatives. Based on the responses, the authors conclude that encouraging patients and explaining the reasoning and aims of nutritional support can improve patient adherence. The authors describe the motivation for the survey, its design, the characteristics of data, data analysis methodology, limitations of the survey and provide helpful recommendations to medical teams on how to encourage patient adherence. Overall, the manuscript delivers what it promises in the abstract and the introduction. I have the following questions/suggestions, which I hope the authors will consider:

1. From what I could understand, what the authors call the “prescribed” ONS is also purchased by the patients. Similarly, what they call the “purchased” ONS may also be prescribed/recommended by nutritional experts. I found the terminology confusing. Since the difference between the two categories is that one is available with prescription only while the other is available over-the-counter, I recommend calling the “prescribed” and “purchased” ONS as “prescription” and “over-the-counter” ONS, respectively.

2. On the first page of the abstract, second to the last line, it starts as, “In contrast, in the prescribed ONS group, only 46 patients …”. Did the authors mean purchased ONS group instead?

3. The large majority of individuals who started the questionnaire did not complete it. Is there any systematic reason why this was the case?

4. All the figure legends are repetitions of text also in the main text. I suggest that the figure legends be replaced with a brief title.

Reviewer #5: 1. How did you select participants to invitation to survey

2. Did you have any incentive to complete the survey

3. The main limitation of this study is the low response rate to survey. Therefore, the result cannot represent the nationwide data in Japan

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Reviewer #1: Yes: Dr. Ghulam Abbas

Reviewer #2: No

Reviewer #3: No

Reviewer #4: No

Reviewer #5: No

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[EXSCINDED]

Adherences to oral nutritional supplementation among hospital outpatients: An online cross-sectional survey in Japan.

PONE-D-19-19397R1

Dear Dr. Naoki Hashizume,

We are pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it complies with all outstanding technical requirements.

Within one week, you will receive an e-mail containing information on the amendments required prior to publication. When all required modifications have been addressed, you will receive a formal acceptance letter and your manuscript will proceed to our production department and be scheduled for publication.

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With kind regards,

Wisit Cheungpasitporn, MD, FACP

University of Mississippi Medical Center

Twitter: @wisit661 Email: wcheungpasitporn@gmail.com 

Academic Editor

PLOS ONE

Additional Editor Comments:

I want to commend the authors on their superb efforts to revise the manuscript according to all reviewers’ suggestions. The quality of the manuscript has improved substantially.

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #3: All comments have been addressed

Reviewer #4: All comments have been addressed

Reviewer #5: (No Response)

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #3: Yes

Reviewer #4: Yes

Reviewer #5: (No Response)

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #3: Yes

Reviewer #4: Yes

Reviewer #5: (No Response)

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #3: Yes

Reviewer #4: Yes

Reviewer #5: (No Response)

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #3: Yes

Reviewer #4: Yes

Reviewer #5: (No Response)

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The authors have answered all the queries raised by the reviewer. The article may be accepted in its present form.

Reviewer #3: As the authors addressed the reviewers comments, I suggest acceptance of the manuscript. No further comments are required.

Reviewer #4: (No Response)

Reviewer #5: All of my comments have been addressed as much as possible. I have no further comments to improve this manuscript.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: Yes: Ghulam Abbas

Reviewer #3: No

Reviewer #4: No

Reviewer #5: No