PONE-D-20-10138

Sugar consumption in schoolchildren from southern Spain and influence on the prevalence of obesity

PLOS ONE

Dear Dr. Olea,

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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Please submit your revised manuscript by Sep 19 2020 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

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If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

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We look forward to receiving your revised manuscript.

Kind regards,

Jose M. Moran

Academic Editor

PLOS ONE

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2. Please include additional information regarding the survey or questionnaire used in the study and ensure that you have provided sufficient details that others could replicate the analyses. For instance, if you developed a questionnaire as part of this study and it is not under a copyright more restrictive than CC-BY, please include a copy, in both the original language and English, as Supporting Information. Moreover, please include more details on how the questionnaire was pre-tested, and whether it was validated.

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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: Yes

Reviewer #2: Partly

Reviewer #3: Partly

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: No

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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

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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: 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: Comments to the Authors:

1. Line 123: Methods section: Out of the initial sample of 700 individuals 42 subjects were excluded. That leaves the total sample size of 658. However, author reported that study conducted on 657 schoolchildren. Also, in the tables 3 and 4, the cumulative sample size is 631 and 630, respectively. Were there any drop-out from the subjects during the study period? If there were any drop-outs, I would recommend to mention this either in method or discussion section.

Reviewer #2: The study design can be followed. Critical point: What is new? The results simply confirm some previous studies. Please, make a statement on that point.

Introduction. Several wordings should be corrected. Lines 72f: From the physiological point of view, the cause of weight gain in otherwise healthy people is always (!!) in all ages an imbalance between energy intake and energy consumption; line 77: What is meant with "poor diet"? Please, define; lines 100f: It should be correctly mentioned that the consumption of energy(!)-containing beverages increase the risk to develop an energy imbalance - this is not only related to carbohydrates present in beverages.

Methods. Recruitment: All necessary criteria with respect to sample point selection, number of participants planned, exclusion criteria etc. must be given - is the study representative for Spain? Regression analysis: Why only carbohydrates taken into account? Why not fat intake? According to table 1, fat intake showed a broader variation than the sum of carbohydrate intake!

Discussion. Strengths/weaknesses of the study design must be discussed, eg, the compliance of data collection and the recruitment (see above). Most of the first 2 paragraphs are a repetition of results - can be shortened. What about studies in other European countries like Germany? Eg, KOPS? Line 211f: What is meant with "unhealthy" food? Criteria? And a "poorly balanced diet"? Please, explain.

Conclusion. Since only carbohydrate intake was taken into account, the conclusion is not valid.

Reviewer #3: The authors present an interesting dataset about sugar consumption and the prevalence of obesity in schoolchildren from southern Spain. However, the result is poorly structured and suffers from inappropriate data presentation and analysis as detailed below.

1. The cut-offs for normal weight, overweight, and obesity were not given.

2. The results were barely interpreted:

a. Per Table 1, I would suggest presenting the data by weight status, i.e. underweight, normal weight, overweight, and obesity. Is any participant underweight?

b. How did the authors conclude “industrial milkshakes were the predominant source of total carbohydrates representing 50.9%” (Line 166-168) from Table 2?

c. What are the definitions of total sugars, free sugars, and added sugars? Are they overlapped? What were their effects on body weight, respectively?

d. Did the authors perform analysis of covariance when investigating the association of sugar consumption and obesity?

3. Some sentences are confusing:

Line 64-66: “The likelihood of normal weight was significantly greater with lower energy expenditure in sedentary activities (OR=3.03), higher energy expenditure in sports activities (OR=1.72), and total activity/day measured as METs (OR=8.31).”

Similarly, line 177-178: “Normal weight was found to be associated with physical activity, as measured by METs or total energy expenditure/day, and with energy intake.”

Please rephrase the above sentences to better interpret the data.

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6. 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.

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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: No

Reviewer #2: No

Reviewer #3: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Attachments

Attachment

Submitted filename: Review Comments.docx

PONE-D-20-10138R1

Sugar consumption in schoolchildren from southern Spain and influence on the prevalence of obesity

PLOS ONE

Dear Dr. Olea-Serrano,

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.

Thank you for the job done in reviewing your manuscript. Please address any minor issues highlighted by the reviewers before recommending acceptance of the manuscript. 

Please submit your revised manuscript by Dec 03 2020 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

We look forward to receiving your revised manuscript.

Kind regards,

Jose M. Moran

Academic Editor

PLOS ONE

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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 #2: (No Response)

Reviewer #3: (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 #2: Yes

Reviewer #3: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

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 #2: Yes

Reviewer #3: Yes

**********

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 #2: Yes

Reviewer #3: Yes

**********

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: This submitted manuscript evaluated the impact of sugar consumption on prevalence of obesity in school children of Granada and Malaga, Spain. The subject of the paper is interesting that provides new data and the scope covered by the manuscript is worth to be published in PLOS One. The abstract and keywords are fine. The manuscript is well revised and the authors have made appropriate changes as suggested, and thus, I recommend to publish the manuscript in its current form.

Reviewer #2: Obviously, the authors generally answered the questions in their response commentaries adequatly; however, the text was not always changed accordingly. Some examples:

1. Recruitment: The text formulated as response to the reviewers` question should be integrated completely in the Methods section!

2. Line 102: The authors should simply write "energy-containing beverages" and add in brackets (optional) "carbohydrates, fat and protein".

3. Line 77: If a "hyperenergetic diet" is meant, then the authors should use this term! A "poor diet" is not only a question of energy content.

4. Line 215f: The term "unhealthy food" is simply not correct in this context. The study only evaluate "energy intake" with respect to body weight and does not focus on e.g. micronutrients. This sentence must be reworded.

Reviewer #3: The authors did a good job addressing all my questions and concerns except one.

Regarding Table 2 (Line 171-172), the authors interpreted the data incorrectly. R squared (60.9% rather than 50.9%, 74.7-82%) in Stepwise regression analysis doesn't equal to % of the contribution. I would suggest authors add a column in Table 2 as % of contribution and correct the data accordingly in Line 171-172.

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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: No

Reviewer #2: No

Reviewer #3: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Sugar consumption in schoolchildren from southern Spain and influence on the prevalence of obesity

PONE-D-20-10138R2

Dear Dr. Olea-Serrano,

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

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Jose M. Moran

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: