PONE-D-20-36065

Proposed cut-off points for anthropometric and bioelectrical measures based on overweight and obesity criteria in Spanish institutionalised elderly people.

PLOS ONE

Dear Dr. Ordonez,

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Kind regards,

Simone Perna, Ph.D

Academic Editor

PLOS ONE

Additional Editor Comments:

Dear Author

the following article is well written and worth it for the publication. Only minor comments should be addressed in according to the reviewers suggestions.

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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: Yes

Reviewer #3: Partly

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

Reviewer #1: I Don't Know

Reviewer #2: Yes

Reviewer #3: I Don't Know

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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: The paper is written in a good English, sections are quite complete in terms of information and discussion and data appear interesting, even if the argument is not particularly novel.

There are some aspects that should be addressed to improve the general quality of the article:

- ROC and AUC abbrevation should be explained also in abstract section

- Girth should be named "circumference" as latest research is generally using this term instead of girth, especially if WC (waist circumference) abbreviation is used.

- Introduction section is too long and should be reduced as the aspects discussed are quite well known and should not described in detail.

- Methods: Issues regarding the measure of waist circumference and height should be largely discussed, also in discussion section: waist circumference is a heavily operator dependent parameter and hard to measure especially in obese subjects due to skinfolds and fat rolls; height in elderly is hard to measure (hunched back) and is commonly approximated.

- BMI: Another sentence should be added discussing BMI classification also in methods section, these references may be useful:

Kvamme, J.M.; Holmen, J.; Wilsgaard, T.; Florholmen, J.; Midthjell, K.; Jacobsen, B.K. Body mass index and mortality in elderly men and women: The Tromsø and HUNT studies. J. Epidemiol. Community Health 2012, 66, 611–617.

Sergi, G.; Perissinotto, E.; Pisent, C.; Buja, A.; Maggi, S.; Coin, A.; Grigoletto, F.; Enzi, G. An adequate threshold for body mass index to detect underweight condition in elderly persons: The Italian Longitudinal Study on Aging (ILSA). Journals Gerontol. - Ser. A Biol. Sci. Med. Sci. 2005, 60, 866–871.

Janssen, I.; Mark, A.E. Elevated body mass index and mortality risk in the elderly. Obes. Rev. 2007, 8, 41–59.

- Line 99, too much data, should be put in results section

- Bioimpedance: Is the instrument validated for measuring trunk fat and visceral fat ratio in particular? add a reference.

- descriptive characteristics show that the mean age in men is 71.5 +- 7.3 y, please check if subjects are all older than 65 years old.

Reviewer #2: The study presented is well conducted with potential clinical impact. The analysis and conclusions are convincing and publication is recommended after a few minor issues are addressed.

In the abstract you need to mention what ROC and AUC stand for. Overall, all acronyms in the manuscript should be defined including BMI (L. 91), WHO (L. 141), CT and DEXA (L. 223).

The sentence starting from L. 63 to L. 81 in the introduction is too long. Please consider rephrasing.

The sentence in L. 81 is incomplete. Please add the word "persons" or "individuals" at the end.

Delete the word "of" in the sentence (L. 89)

The word "size" in L. 117 is incorrectly used in the definition of BMI and should be replaced with "height."

Delete "of" in L. 122.

Significance levels should be mentioned at the foot of all tables.

In the discussion, L.282, the following sentence should be changed: “several limitations to the study should be also recognized” to several limitations to the study should also be recognized.

Reviewer #3: This study is well-conducted and of great interest.

My additional comments:

- The age of subjects reported in the abstract is 74.3 and 71.5, while along the text and in the table it is 84.3 and 81.5. Which are the correct ones?

- The bioelectrical impedance used for the measures of trunk and visceral fat is validated and it is comparable to Dxa measure for visceral vat (core scan software)? You should include the validation study in the methods section.

- The exclusion of patients with waist girth greater than 130 cm could be referred as a limitation.

- I suggest to cite one of these 2 interested studies:

Perna et al. Comparison between Bioimpedance Analysis and Dual-Energy X-ray Absorptiometry in assessment of body composition in a cohort of elderly patients aged 65-90 years. Adv Gerontol

. 2019;32(6):1023-1033.

Spadaccini et al. DXA-Derived Visceral Adipose Tissue (VAT) in Elderly: Percentiles of Reference for Gender and Association with Metabolic Outcomes. Life (Basel). 2020 Aug 24;10(9):163.

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

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Proposed cut-off points for anthropometric and bioelectrical measures based on overweight and obesity criteria in Spanish institutionalised elderly people.

PONE-D-20-36065R1

Dear Prof. Ordonez,

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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If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Prof Simone Perna, Ph.D

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Dear Author

greetings,

After your careful revision, this article is valuable to be accepted on Plos One.

Thanks a lot for your cooperation

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: All comments have been addressed

Reviewer #3: All comments have been addressed

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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

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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

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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 #2: Yes

Reviewer #3: Yes

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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: (No Response)

Reviewer #2: The authors have replied to all my comments raised during the revision of the manuscript. I have no further comments.

Reviewer #3: The authors have met all the requirements.

The article is suitable for publication without any additional corrections.

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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.

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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