Relationship between socio-demographics, body composition, emotional state, and social support on metabolic syndrome risk among adults in rural Mongolia

Jin Hee Kim; Hyun Lye Kim; Bolorchimeg Battushig; Jae Yong Yoo

doi:10.1371/journal.pone.0254141

Peer Review History

Original SubmissionJanuary 14, 2021
15 Mar 2021 Decision Letter - Frank T. Spradley, Editor PONE-D-21-00705 Effects of socio-demographics, body composition, emotional state, and social support on the risk level of metabolic syndrome of adults in rural Mongolia PLOS ONE Dear Dr. YOO, 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. Please submit your revised manuscript by Apr 29 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. 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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 ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: 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 ****** 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 ****** 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: Kim et. al explored relationships between socio-demographics, clinical parameters, emotional state, and social support level on risk of prevalence of metabolic syndrome in Mongolia. Data was collected from voluntary clinic visits. The paper overall is well written; however there is concern with the stated goals and some of the conclusions. It is this reviewers suggestion to stick to the findings without making assumptions about how to reduce MetS in this area. In addition, the novelty was not clear as most of these correlations are well established. Major Comments: Line 92 (Stated goal of the paper): The study is all correlations in nature. Therefore, stating that the study investigated the effects of socio-demographics… on the risk of MetS prevalence can’t be the goal. This would imply there is an interventions. Several of the conclusions are along the same lines. Without an intervention, you cannot say that a metastudy on depression and MetS that depression increases the prevalence of MetS without intervention. (Page 18, paragraph 3) Conclusion paragraph: It is hard to say that outsiders should “…ensure that they exercise regularly to reduce body fat and increase skeletal muscle.” While these thing do improve pathophysiology related to obesity, this usually isn’t effective long term as people tend to go back to their old lifestyle at some point. Minor Comments In the first paragraph of the results, the significant correlations between metabolic risk score and other variables are stated, with a blanket statement for directionality (i.e. “variables tended to be significantly higher.” Authors should be definitive here. Does the voluntary nature of the study bias the data given that the study subjects had to get to the clinic? It seems less mobile people might be excluded since they might be less likely to travel. ****** 6. 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Revision 1
15 May 2021 Author Response Authors' Response to academic editor's request 1) According to the editor's request, it was revised throughout the manuscript in compliance with PLOS ONE journal style standards. 2) We agree with PLOS ONE journal's data disclosure policy. According to the editor's opinion, we have attached data materials to the Supporting Information files. 3) We have attached the questionnaires (Mongolian version and Korean version) to the Supporting Information file at the request of the editor. The process of organizing the Mongolian version of the questionnaire was re-described in detail in the 'Measurements' section (Page 5, Line 119-126). Authors' Response to reviewers' request 1) Thank you for your valuable opinion. We completely agree with you. Our research team focused on metabolic syndrome in Mongolian rural areas (soum in the aimag) among local residents with a special life culture that consists of small communities and combines nomadic life. In Mongolia’s health care system, medical facilities and medical staff are heavily concentrated in Ulaanbaatar, the capital of Mongolia. Therefore, this study was conducted as a preliminary research to plan practical strategies for improving the health level of rural residents in Mongolia. Most previous studies have been conducted in countries or regions with generally good access to medical facilities and medical staff, and studies in Mongolia have been mainly conducted in Ulaanbaatar. However, local residents who we actually met in Mongolia said they were new to body composition measuring equipment or said they had performed blood sugar checks or urine tests years ago despite having diabetes. Thus, by identifying the factors related to metabolic syndrome among local residents living in areas with insufficient medical infrastructure and low access to medical care, we considered the planning of a health management strategy with limited resources. This is the novelty of our study. In addition, since biomarker indicators and psychosocial indicators (especially social support, depression indicators, etc) are used together, we think they can contribute to the construction of a multi-faceted intervention program for the management of metabolic syndrome in the future. We will fully reflect the valuable opinions and suggestions of the reviewer when planning follow-up research. We fully agree with the reviewer’s comment. In the title, abstract, and purpose of the study, all expressions that can infer the “effects of an intervention” have been revised. 2) We fully agree with the reviewer’s comment. In the title, abstract, and purpose of the study, all expressions that can infer the “effects of an intervention” have been revised. In addition, the analysis results of previous review studies on the relationship between depression and metabolic syndrome have been described more clearly and amended. 3) Thank you for your valuable opinion. We recognize that it is very important for members of the community to participate directly in order to manage the health level of local residents in the long term. Dahlgren & Whitehead’s “Rainbow model” of multi-layered influences of health also explains that factors of individual health behavior are not independent but are influenced by multi-layered influences (local community, socio-economic, cultural, and environmental conditions, etc.). In this sense, an individual’s health care ability is influenced by the community, and most of the factors affecting health are considered to be more effective when approached at the community level. We fully agree that there are limitations to improving and sustaining a healthy lifestyle among local residents with one-time/short-term projects, such as outsiders and the ODA program. In other words, it is necessary for local residents to experience the process of identifying and solving health problems on their own through “participation.” Through this, the health care capacity of local residents will increase, and it might become an independent activity with sustainability. According to the reviewer’s opinion, the content of the conclusion has been revised. 4) We re-described it specifically to improve the ambiguous representation of the research results. Methods to minimize study bias that may occur due to voluntary participation are described in detail in the limitations of the study. Thank you for kind reviews. Attachments Attachment Submitted filename: Response to Decision Box.doc https://doi.org/10.1371/journal.pone.0254141.r002
15 Jun 2021 Decision Letter - Frank T. Spradley, Editor PONE-D-21-00705R1 Relationship between socio-demographics, body composition, emotional state, and social support on metabolic syndrome risk among adults in rural Mongolia PLOS ONE Dear Dr. YOO, 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. Please submit your revised manuscript by Jul 30 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. 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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. 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) ******** 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: 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: The authors have addressed my comments mostly and improved the manuscript; however the conclusions in the abstract need to be about the data, not what the authors feel needs to happen to improve metabolic syndrome. Once this is addressed, I have no further comments and will recommend for publication. ****** 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. https://doi.org/10.1371/journal.pone.0254141.r003
Revision 2
17 Jun 2021 Author Response Authors' response to academic editor's request: Thank you for your careful review. We found that the one retracted article (Reference list: 25. Kaur JA. Comprehensive review on metabolic syndrome. Cardiol Res Pract. 2014;1-21. doi: 10.1155/2014/943162.) was included in a reference list. According to the editor's request, the retracted article removed and replaced with a new, relevant reference (Reference list: 25. Huang PL. A comprehensive definition for metabolic syndrome. Dis Model Mech. 2009;2(5-6):231-7. doi:10.1242/dmm.001180.). The revised reference list was marked in red. Authors' response to reviewer's comment: Thank you for your valuable opinion. We fully agree with the reviewer’s comment. Based on the reviewer’s opinions, the conclusion in the abstract has been revised to focus on the main finding of this study. The revised sections were marked in red. Attachments Attachment Submitted filename: Response to Decision Box.doc https://doi.org/10.1371/journal.pone.0254141.r004
21 Jun 2021 Decision Letter - Frank T. Spradley, Editor Relationship between socio-demographics, body composition, emotional state, and social support on metabolic syndrome risk among adults in rural Mongolia PONE-D-21-00705R2 Dear Dr. YOO, 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, Frank T. Spradley Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0254141.r005
Formally Accepted
23 Jun 2021 Acceptance Letter - Frank T. Spradley, Editor PONE-D-21-00705R2 Relationship between socio-demographics, body composition, emotional state, and social support on metabolic syndrome risk among adults in rural Mongolia Dear Dr. Yoo: 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. Frank T. Spradley Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0254141.r006

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