Association between sarcopenia level and metabolic syndrome

Su Hwan Kim; Ji Bong Jeong; Jinwoo Kang; Dong-Won Ahn; Ji Won Kim; Byeong Gwan Kim; Kook Lae Lee; Sohee Oh; Soon Ho Yoon; Sang Joon Park; Doo Hee Lee

doi:10.1371/journal.pone.0248856

Peer Review History

Original SubmissionDecember 12, 2020
21 Jan 2021 Decision Letter - Masaki Mogi, Editor PONE-D-20-39066 Association between sarcopenia level and metabolic syndrome PLOS ONE Dear Dr. Jeong, 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. Major revisions are needed in the present form. See the Reviewers' comments carefully and respond them appropriately. Please submit your revised manuscript by Mar 05 2021 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, Masaki Mogi Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. 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Competing interests can arise in relationship to an organization or another person. Please follow this link to our website for more details on competing interests: http://journals.plos.org/plosone/s/competing-interests [Note: HTML markup is below. Please do not edit.] 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 ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 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 ****** 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 ****** 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: This article elucidated the relationship between the prevalence of metabolic syndrome (MetS) and the degree of muscle loss. I read very interestingly. I have some questions and propose some revisions to authors. (1) I feel that Reference 1 and 2 are little bit old. (2) You mentioned the relationship between sarcopenia and gallbladder polyps in Introduction part. Is this sentence necessary? I think the clinical importance of gallbladder polyps are not equal to other diseases, such as cancer, diabetes, which you mentioned. (3) You cited Reference 28 as the definition of MetS. I think your definition is as same as the NCEP ATP-III, so you should add more suitable reference. (4) In statistical analysis, I have three questions. First, why did you adopt C-reactive protein level as variable? Second, why did not you adopt smoking -/+ or alcohol intake -/+ as variables? I think the lean is also related to sarcopenia and Mets. Why did not you adopt body mass index as variables? In addition, I would like to know the percentage of obesity and lean participants in Table 1, if possible. (5) The characteristics of patients with sarcopenia are heterogenous. Q1 group contained older, heavier, and less ASM and ASM (%) participants. Because you analyzed using many variables, such as age, sex, and obesity, I can accept your opinion. I would like to know results of subgroup analysis according to lean in Table 3. Reviewer #2: 1. This study is a cross-sectional and single-centered retrospective research. Thus it was difficult to assess the causal relationship between sarcopenia and MetS. However, the researchers have the opportunity to study the causal relationship by the repeated health checkup(n=4621). I would like to be showed the corresponding results. 2. Some typos should be corrected, such as P13 TG≥ 150 g/dL ****** 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: Yes:** Zhi-hao Wang [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. https://doi.org/10.1371/journal.pone.0248856.r001
Revision 1
17 Feb 2021 Author Response Response Letter Editors, PLOS ONE Thank you for allowing the revision of our manuscript: ID PONE-D-20-39066 entitled “Association between sarcopenia level and metabolic syndrome” We revised our manuscript in accordance with the reviewers’ suggestions. Our responses to the comments are as follows. Reviewer #1: This article elucidated the relationship between the prevalence of metabolic syndrome (MetS) and the degree of muscle loss. I read very interestingly. I have some questions and propose some revisions to authors. Comment 1> (1) I feel that Reference 1 and 2 are little bit old. Reply: Thank you for your valuable comments. We added newer references. Comment 2> (2) You mentioned the relationship between sarcopenia and gallbladder polyps in Introduction part. Is this sentence necessary? I think the clinical importance of gallbladder polyps are not equal to other diseases, such as cancer, diabetes, which you mentioned. Reply: Thank you for your valuable comments. Based on your comments, we eliminated gallbladder polyps from the sentence which you commented on. We revised our manuscript as follows. MetS increases the risk of diabetes mellitus (DM), CVD, chronic liver disease and hepatocellular carcinoma, other cancers, and mortality. Comment 3> (3) You cited Reference 28 as the definition of MetS. I think your definition is as same as the NCEP ATP-III, so you should add more suitable reference. Reply: Thank you for your valuable comments. We added a suitable reference as you commented. Comment 4> (4) In statistical analysis, I have three questions. First, why did you adopt C-reactive protein level as variable? Second, why did not you adopt smoking -/+ or alcohol intake -/+ as variables? I think the lean is also related to sarcopenia and Mets. Why did not you adopt body mass index as variables? In addition, I would like to know the percentage of obesity and lean participants in Table 1, if possible. Reply: Thank you for your valuable comments. We revised our manuscript as follows with suitable references. - We adopted CRP as a variable as previous studies have shown the association between CRP and metabolic syndrome. According to your comments, we added another model adjusted with smoking and alcohol intake. We revised Table 2, 4, 5. We intended to analyze our data from the aspect of MetS component. Thus, we adopted obesity as a binary variable instead of using BMI as a numerical variable. We added the percentage of obesity, overweight, normal BMI and lean (underweight) participants in Table 1. Comment 5> (5) The characteristics of patients with sarcopenia are heterogenous. Q1 group contained older, heavier, and less ASM and ASM (%) participants. Because you analyzed using many variables, such as age, sex, and obesity, I can accept your opinion. I would like to know results of subgroup analysis according to lean in Table 3. Reply: Thank you for your valuable comments. We performed subgroup analysis according to lean (underweight) in Table 3. We modified Table 3 according to your comments. Reviewer #2: Comment 1> 1. This study is a cross-sectional and single-centered retrospective research. Thus it was difficult to assess the causal relationship between sarcopenia and MetS. However, the researchers have the opportunity to study the causal relationship by the repeated health checkup(n=4621). I would like to be showed the corresponding results. Reply: Thank you for your valuable comments. As you mentioned, it seems that causal relationship may be assessed by analyzing the data of subjects who underwent repeated health checkup. However, in the current study, we intended a cross-sectional study. We indeed have a plan to perform another study in the next step with the data of subjects who underwent repeated health checkup. As of now, it’s a pity that we can’t show you the data you want, but we’ll be able to show you when the next paper is completed. We sincerely ask for your kind understanding. Comment 2> 2. Some typos should be corrected, such as P13 TG≥ 150 g/dL Reply: Thank you for your valuable comments. We revised our manuscript as follows. TG ≥ 150 mg/dL or the use of medication Thank you again for your insightful advice. Yours sincerely, Ji Bong Jeong, MD, PhD Associate Professor Department of Internal Medicine Seoul Metropolitan Government Seoul National University Boramae Medical Center 20 Boramae-ro 5-gil, Dongjak-gu Seoul 07061, Republic of Korea Phone: +82-2-870-2222 Fax: +82-2-870-3863 E-mail: jibjeong@gmail.com Attachments Attachment Submitted filename: Response to reviewers.docx https://doi.org/10.1371/journal.pone.0248856.r002
23 Feb 2021 Decision Letter - Masaki Mogi, Editor PONE-D-20-39066R1 Association between sarcopenia level and metabolic syndrome PLOS ONE Dear Dr. Jeong, 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. ============================== The Reviewer recommends some modification of conclusion before acceptance. ============================== Please submit your revised manuscript by Apr 09 2021 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, Masaki Mogi Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] 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 ******** 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 ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: 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 ****** 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 ****** 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: Thank you very much for answering my questions. I understood your reply well. I think this research article is very valuable. Thanks to authors and academic editor, I was able to have an important experience. As you plan to perform another study, I hope your next research will also be successful. Comment 1＞ Thank you for your adding references. Comment 2＞ After this, the topic of polyps was not mentioned, so I think the text became clear and concise. Thank you. Comment 3＞ Thank you very much for adding a reference. Comment 4＞ Thank you very much for telling me why you adopt CRP as a variable. I have known the close relation between high-sensitivity CRP and chronic inflammation (as Ref 41 mentioned). This time I understand the relation between CRP (not hs CRP) and metabolic syndrome (Ref40). In addition, I appreciate your revising tables and adding the information of lean. I understand your intention. Comment 5＞ Thank you for conducting sub group analysis. I think the result of lean is also consistent with the sentence “the association between sarcopenia and MetS seemed more prominent in participants with low visceral fat or in non-obese participants”. Reviewer #2: Still it was difficult to assess the causal relationship between sarcopenia and MetS. Therefore, the conclusion should be revised. If the author think that sarcopenia by BIA is independently associated with the risk of MetS and has a doseresponse relationship, the repeated health checkup would still be needed.I suggest modification of conclusion. ****** 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 [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. https://doi.org/10.1371/journal.pone.0248856.r003
Revision 2
24 Feb 2021 Author Response Response Letter Editors, PLOS ONE Thank you for allowing the revision of our manuscript: ID PONE-D-20-39066 entitled “Association between sarcopenia level and metabolic syndrome” We revised our manuscript in accordance with the reviewers’ suggestions. Our responses to the comments are as follows. Reviewer #1: Thank you very much for answering my questions. I understood your reply well. I think this research article is very valuable. Thanks to authors and academic editor, I was able to have an important experience. As you plan to perform another study, I hope your next research will also be successful. Comment 1> (1) Thank you for your adding references. Comment 2> (2) After this, the topic of polyps was not mentioned, so I think the text became clear and concise. Thank you. Comment 3> (3) Thank you very much for adding a reference. Comment 4> (4) Thank you very much for telling me why you adopt CRP as a variable. I have known the close relation between high-sensitivity CRP and chronic inflammation (as Ref 41 mentioned). This time I understand the relation between CRP (not hs CRP) and metabolic syndrome (Ref40). In addition, I appreciate your revising tables and adding the information of lean. I understand your intention. Comment 5> (5) Thank you for conducting sub group analysis. I think the result of lean is also consistent with the sentence “the association between sarcopenia and MetS seemed more prominent in participants with low visceral fat or in non-obese participants”. Reply: Thank you for your valuable comments. Reviewer #2: Comment 1> 1. Still it was difficult to assess the causal relationship between sarcopenia and MetS. Therefore, the conclusion should be revised. If the author think that sarcopenia by BIA is independently associated with the risk of MetS and has a dose-response relationship, the repeated health checkup would still be needed. I suggest modification of conclusion. Reply: Thank you for your valuable comments. Based on your comments, we revised our manuscript as follows. In conclusion, our study demonstrated that sarcopenia by BIA is independently associated with the risk of MetS and with a dose-response relationship. Future studies that assess causal relationship between sarcopenia and MetS are needed using the data of subjects who underwent repeated health checkup. By measuring sarcopenia using BIA, the risk of MetS can be assessed easily, safely, and cost-efficiently. BIA can be used as an easy, useful, and important guide to identify participants with the risk of MetS. Thank you again for your insightful advice. Yours sincerely, Ji Bong Jeong, MD, PhD Associate Professor Department of Internal Medicine Seoul Metropolitan Government Seoul National University Boramae Medical Center 20 Boramae-ro 5-gil, Dongjak-gu Seoul 07061, Republic of Korea Phone: +82-2-870-2222 Fax: +82-2-870-3863 E-mail: jibjeong@gmail.com Attachments Attachment Submitted filename: Response to reviewers_2.docx https://doi.org/10.1371/journal.pone.0248856.r004
8 Mar 2021 Decision Letter - Masaki Mogi, Editor Association between sarcopenia level and metabolic syndrome PONE-D-20-39066R2 Dear Dr. Jeong, 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. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. 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, Masaki Mogi Academic Editor PLOS ONE Additional Editor Comments (optional): Accept with modification according to the Reviewer's comment. See it and respond to the Reviewer's suggestion. 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 #2: All comments have been addressed ******** 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 #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #2: 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 #2: 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 #2: 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 #2: The conclusion should be modified. "our study demonstrated that sarcopenia by BIA is independently associated with the risk of MetS and might have a dose-response relationship" ****** 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 #2: No https://doi.org/10.1371/journal.pone.0248856.r005
Formally Accepted
11 Mar 2021 Acceptance Letter - Masaki Mogi, Editor PONE-D-20-39066R2 Association between sarcopenia level and metabolic syndrome Dear Dr. Jeong: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. 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. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Masaki Mogi Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0248856.r006

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