Urinary minerals excretion among primary schoolchildren in Dubai—United Arab Emirates

Rola Al Ghali; Carla El-Mallah; Omar Obeid; Ola El-Saleh; Linda Smail; Dalia Haroun

doi:10.1371/journal.pone.0255195

Peer Review History

Original SubmissionApril 13, 2021
10 Jun 2021 Decision Letter - Samson Gebremedhin, Editor PONE-D-21-12286 Urinary minerals excretion among primary schoolchildren in the United Arab Emirates: Alarming iodine levels. PLOS ONE Dear Dr. Haroun, 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. Specifically, please address the reviewers' comments related to the statistical analysis of data. Further, the study conducted in Dubai should not be generalized to the entire UAE and the title has to be modified accordingly. Please submit your revised manuscript by Jul 25 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. 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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. In the ethics statement within the Methods section, please clearly indicate that written informed consent was obtained from the parents/guardian of the minors included in the study. Furthermore, in your Methods section, please provide a justification for the sample size used in your study, including any relevant power calculations (if applicable). 3. PLOS requires an ORCID iD for the corresponding author in Editorial Manager on papers submitted after December 6th, 2016. Please ensure that you have an ORCID iD and that it is validated in Editorial Manager. To do this, go to ‘Update my Information’ (in the upper left-hand corner of the main menu), and click on the Fetch/Validate link next to the ORCID field. This will take you to the ORCID site and allow you to create a new iD or authenticate a pre-existing iD in Editorial Manager. Please see the following video for instructions on linking an ORCID iD to your Editorial Manager account: https://www.youtube.com/watch?v=_xcclfuvtxQ [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: No ****** 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 is a simple study of the levels of Ca, Mg, I, and Fl in the urine of children in the UAE. The paper is well-organized and well-written. The methodology is sound, with a large sample size and good precision on measurements. For the analysis of age effects on mineral excretion, I recommend a correlation analysis instead of dividing into arbitrary age groups, since age is a continuous variable. The discussion of iodine, including the history of iodine fortification, is very good, and makes important conclusions that iodine fortification may need to be somewhat reduced for optimal health. However, it is important to note that urinary iodine is useful as a good simple measure for populations, not for individuals, due to daily fluctuations. The discussion of fluoride levels and dental caries is also important. The study would have been more powerful if thyroid status were evaluated, and if the level of dental caries were assessed, to determine linkages of to iodine and fluoride, respectively. In summary, this is a simple study that was conducted well, and resulted in important findings on levels of iodine and fluoride in children in UAE. Reviewer #2: In this study, the urinary concentration of some minerals, including Ca, Mg, P, iodine and fluoride, among children in the United Arab Emirates have been first reported. These results are of great significance for the mineral nutrient assessment in this country. However, there are some issues need to be addressed before it would be published. 1.In 223-231, the iodine status of the Emirati school-aged children was evaluated in this study. However, according to the recommendation of the international organization, median UIC is a population indicator, which only defines the iodine status of a population. It can’t be used to evaluation the individual iodine status. 2.Do the minerals in urine in school-aged children follow the normal distribution? If they did not, the results should be presented as median and interquartile range. As far as I know, at least the UIC does not follow the normal distribution. Besides, the corresponding statistical methods should also be changed. 3.In “Study population and sampling”, the participants were only recruit from Dubai, however, in the title, it showed as “in the United Arab Emirates”. Can children in Dubai represent the whole United Arab Emirates? It is suggested to be corrected as Dubai in the United Arab Emirates. 4.Why is it an “Alarming iodine levels” in the title? In the new recommendation of international organizations, median of UIC in the range of 100~300 are classified as an adequate level. In this study, what is the value of median UIC? ****** 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. https://doi.org/10.1371/journal.pone.0255195.r001
Revision 1
1 Jul 2021 Author Response Additional Editor Comments: 1.Table 1: rather than plain BMI, please compare the BMI for age z-score between boys and girls. Response: BMI z-score was reported in table 1. 2. Table 4: for significant ANOVA tests, please also report the results of a post-hoc test. Response: post-hoc test results were added in the results section (line 193-199) and (line 214-218). 3. In the ethics statement within the Methods section, please clearly indicate that written informed consent was obtained from the parents/guardian of the minors included in the study. Response: This was added in the methodology section (line 98). 4. Furthermore, in your Methods section, please provide a justification for the sample size used in your study, including any relevant power calculations (if applicable). Response: We targeted 5% of the total population of primary school students (11,147) accounting for approximately 50% response rate and using proportional representation according to school size (lines 86-87). Reviewer #1: 1. For the analysis of age effects on mineral excretion, I recommend a correlation analysis instead of dividing into arbitrary age groups, since age is a continuous variable. Response: In the results section, opening statements were added for tables 4 and 5 that state the results of the correlation between age, as continuous variable, and the different excretions (lines 188-192; lines 212-213). This was followed by the post-hoc results as requested by the editor. The age groups were used to: 1. Compare our findings with other studies who used similar categories; 2. To be able to detect the trends of minerals excretion as children grow and approach pubertal ages. 2. The discussion of iodine, including the history of iodine fortification, is very good, and makes important conclusions that iodine fortification may need to be somewhat reduced for optimal health. However, it is important to note that urinary iodine is useful as a good simple measure for populations, not for individuals, due to daily fluctuations. Response: changes in the both the result (line 239-241) and discussion (lines 322-326) sections were done to reflect the population reference rather than the emphasis on the individual classification. 3. The discussion of fluoride levels and dental caries is also important. Response: a section about the relationship between fluoride and dental caries was added in the discussion section (lines 364-367). 4. The study would have been more powerful if thyroid status were evaluated, and if the level of dental caries were assessed, to determine linkages of to iodine and fluoride, respectively. Response: A statement was added as a recommendation in the conclusion section (line 379-383)/ Reviewer #2: 1.In 223-231, the iodine status of the Emirati school-aged children was evaluated in this study. However, according to the recommendation of the international organization, median UIC is a population indicator, which only defines the iodine status of a population. It can’t be used to evaluation the individual iodine status. Response: changes in the both the result (line 239-241) and discussion (lines 322-326) sections were done to reflect the population reference rather than the emphasis on the individual classification. 2.Do the minerals in urine in school-aged children follow the normal distribution? If they did not, the results should be presented as median and interquartile range. As far as I know, at least the UIC does not follow the normal distribution. Besides, the corresponding statistical methods should also be changed. Response: Before checking the normality of all minerals, we were expecting non-normal distribution for Iodine. Surprisingly, this was not the case, Iodine was found to be normally distributed. The skewness and kurtosis were both around 0 (0.6 and 0.2 respectively). In addition, since N is large enough, we assumed normality using the central limit theorem. We included both the median (interquartile range) and mean levels of Iodine in the discussion section to allow for comparisons with other studies (lines 322-323). 3.In “Study population and sampling”, the participants were only recruit from Dubai, however, in the title, it showed as “in the United Arab Emirates”. Can children in Dubai represent the whole United Arab Emirates? It is suggested to be corrected as Dubai in the United Arab Emirates. Response: This was changed across the manuscript to Dubai – UAE: in the abstract, methodology and conclusion. 4.Why is it an “Alarming iodine levels” in the title? In the new recommendation of international organizations, median of UIC in the range of 100~300 are classified as an adequate level. In this study, what is the value of median UIC? Response: The mean value of the population was used to conclude the status of the general study group rather than individual categorization. The Emirati population had a mean of 224 µg/dl and median of 208 µg/dl, classified as at slight risk. Hence, title of the manuscript has been modified and “alarming iodine levels” removed and this was also removed from the conclusion. Attachments Attachment Submitted filename: Response to Reviewers 2.docx https://doi.org/10.1371/journal.pone.0255195.r002
12 Jul 2021 Decision Letter - Samson Gebremedhin, Editor Urinary minerals excretion among primary schoolchildren in Dubai - United Arab Emirates PONE-D-21-12286R1 Dear Dr. Haroun, 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, Samson Gebremedhin, PhD Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0255195.r003
Formally Accepted
28 Jul 2021 Acceptance Letter - Samson Gebremedhin, Editor PONE-D-21-12286R1 Urinary minerals excretion among primary schoolchildren in Dubai - United Arab Emirates Dear Dr. Haroun: 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. Samson Gebremedhin Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0255195.r004

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