PONE-D-20-23153

Prevalence of dyslipidemia and associated risk factors among adults living in Mekelle city, Northern Ethiopia, a community-based cross-sectional study.

PLOS ONE

Dear Dr. Gebrehiwot,

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.

Two experts in the field handled your manuscript, and we are very thankful for their time and efforts. Although some interest was found in your study, there were major concerns that arose during review that overshadowed this enthusiasm. Notably, there were several comments about the experimental design, including the need for describing the inclusion criteria; the data presentation needs work; and the text needs to be rewritten to simplify the results and explanations. Someone should be hired to proof the manuscript for spelling and grammar. Please address ALL of the reviewers' comments in your revised manuscript.

Please submit your revised manuscript by Oct 09 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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• 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'.
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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,

Frank T. Spradley

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: No

Reviewer #2: Yes

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

Reviewer #1: No

Reviewer #2: 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

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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: No

Reviewer #2: 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: 1- Given the definition of the prevalence of the disease in a community, it cannot be said that this study examined the prevalence of dyslipidemia in Ethiopia.

2- What was the inclusion criteria?

3- From line 219 to line 241 the text is added because most of the explanations are in Table 1 and there is no need for explanation in the text.

More appropriate and concise sentences can be used instead. For example, most people were married and the marital status of men and women was significantly different (P = 0.001), women consumed significantly more vegetables during the week than men (P = 0.007).

4- In line 204, the name of the test is Hosmer, not Hesmer.

5- Many parts of an article have a very long text.

Reviewer #2: This manuscript provides critical information on dyslipidemic rates in the Northern Ethiopian population. Overall, the study was well designed and written, but a few points should be addressed.

1). Carefully check for spelling errors and proper grammatical usage throughout the manuscript and correct. Lines 124-128 read somewhat disjointed and are confusing to the reader (possible footnotes for further description?). Please clarify this information.

2). Under Methods: Move ' Ethical Issues' subsection information into the 'Study Design and Participants' subsection at the beginning of the Methods section.

3) Considering that roughly ~10% of participants could not read/write, how was consent given from these participants? Was proxy or next-of-kin consent given for these participants? Were they read the consent form specifically? Mention how the study gained consent in this subpopulation and list this important detail in the Methods.

4). While table 3 does a great job addressing the covariable relationship between several characteristics of the participants and dyslipidemia, an interesting comparison should be made to include "Alcohol use" which was significantly greater in the cohort. Because alcohol can dramatically alter lipid metabolism, this comparison should be made.

5). TABLE 1: The far left column is confusing to read. Recommend a headline for the far left column as "Characteristics" and show each characteristic in the subcolumn either outlined with separate borders or place break lines between characteristics. As written, the wording seems to run together and is difficult to distinguish transitions to the next characteristic listed.

6) TABLE 3: Add borders around the p-value row. As mentioned above, it is difficult to identify and read the table as presented. Consider alternative ways to organize the data, or at the very least, add more break lines and subcolumns to organize the presentation in a clearer manner.

7). Discussion: Line 453: Discuss how characteristics related to household income (e.g. House ownership, wealth, house servant, laundry machine) are related to the prevalence of dyslipidemia. Also, significant alcohol use in the cohort is a limitation that should be addressed.

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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.

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

[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.

PONE-D-20-23153R1

Prevalence of dyslipidemia and associated risk factors among adults living in Mekelle city, Northern Ethiopia.

PLOS ONE

Dear Dr. Gebrehiwot,

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.

There are still major revisions that require the attention of the authors. Notably, these revisions relate to English grammar and syntax. The reviewer has kindly offered suggestions in this regard, but the manuscript must be critically reviewed by the authors for readability. Moreover, and importantly, there are concerns about discrepancies in the findings. Please address ALL of the reviewer's comments in your revised manuscript.

Please submit your revised manuscript by Nov 28 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,

Frank T. Spradley

Academic Editor

PLOS ONE

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: (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

**********

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

Reviewer #1: 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

**********

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: (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: Generally

Although the statistical methods used in this article are good and the analysis is well done, but is poorly written in terms of the principles of article writing.

I have mentioned many corrections in the findings section and other parts of the findings also need corrections similar to the ones mentioned, and this type of bug has been repeated throughout the findings section. The authors need to modify and resubmit the entire section of the findings as noted

......................................................................

It is best to add a reference to line 102, To determine what is the formula for calculating the sample size.

The “Materials and methods” section is very long and should be summarized. For example, if possible,” Study design and setting” And “Study population”, it is better to combine them and write more briefly.

Also, if possible,” Selection and training sections of data collectors” And “Data collection and quality control”, it is better to combine them and write more briefly.

Also, if possible,” Blood sample collection and laboratory analysis” And “Definition of terms”, it is better to combine them and write more briefly.

Please shorten the text wherever possible in all parts of the manuscript. For example in line 172, the phrase “Sample characteristics were expressed as mean ± standard deviation (SD) for continuous variables, and frequencies and percentages for categorical variables” can be omitted because this is specified in the results section.

In “Result” section, As mentioned in the previous review, items that are clear from the tables should not be repeated in the text. Please provide brief explanations in the text only in cases where the difference is significant.

It is better to remove the phrase “the mean + SD age of the participants was 38.99 + 14.22 years” in line 197.

It is better to remove the phrase “More than half (54.8%) of participants were women.” in line 197.

In line 199 to 203, additional text has been written about marital status, occupation, smoking and alcohol, and a brief explanation can be written instead. For example, please briefly explain that men and women were significantly different in terms of marriage, occupation, smoking and alcohol (P<0.005). And only give a brief explanation if you see an interesting result for each of them.

Please correct lines 203 to 210 as described above.

In line 207, in the table of this frequency, 13.1 is written, but in the text, 13.4.

In line 221, the phrase "slightly higher among men (68.3%) compared to women (65.3%)" It is better to remove it because it is not more common in men.

Please delete these phrases because they are clear from the table:

Line 222 “Half (49.5%) of the study participants had elevated LDL-C while 30.8% had an elevated total cholesterol level”

Line 226 “More than one fourth (27.1%) of the participants were overweight.”

Line 230 “Almost one-thirds (30.5%) and 18.7% of the participants were hypertensive and pre-hypertensive respectively”

Line 233 “The mean + SD BMI and WC were 24.4+4.9 kg/m2 and 85.6+13.6 cm respectively, with no significant difference across gender”

Line 259 “The prevalence of dyslipidemia was 57.8%, 79.3%, and 95.2% among normal, overweight, and obese participants respectively”

Also is in lines 260 to 264.

In line 229, it is better to write that the difference between men and women was significant.

In line 257 It cannot be said that the behavior of TG and HDL with the age variable, is as mentioned.

In line 264, this phrase is the type of phrase at the beginning of the paragraph. It is better to combine them and bring them in one sentence: "The risk of dyslipidemia and its component lipid abnormalities were also consistently increased with FBG and blood pressure."

In Table 2, there is a discrepancy in the findings! For the “Waist to hip ratio” in qualitative state, it is observed that a higher percentage of women have high values of Waist to hip ratio. But in quantitative state, we see that the average of this variable is higher in men. It’s not logical.

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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

[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.

Prevalence of dyslipidemia and associated risk factors among adult residents of Mekelle City, Northern Ethiopia

PONE-D-20-23153R2

Dear Dr. Gebrehiwot,

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.

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Kind regards,

Frank T. Spradley

Academic Editor

PLOS ONE