Association of obesity, visceral adiposity, and sarcopenia with an increased risk of metabolic syndrome: A retrospective study

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

doi:10.1371/journal.pone.0256083

Peer Review History

Original SubmissionMay 7, 2021
23 Jun 2021 Decision Letter - Mauro Lombardo, Editor PONE-D-21-15211 Association of obesity, visceral adiposity, and sarcopenia with an increased risk of metabolic syndrome: a retrospective study 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. Please submit your revised manuscript by Aug 07 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. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Mauro Lombardo 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. Please ensure you have described your statistical analysis in sufficient detail, including any post-hoc analyses performed Additional Editor Comments (if provided): Dear authors Please improve the English in the paper. Answer point-by-point to the reviews' observations [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: The manuscript provides evidence of the association between body composition parameters (obesity, visceral adiposity, and sarcopenia) and metabolic syndrome in a large sample of subjects. The manuscript is technically sound and the data do support the conclusions however there are a few revisions or clarifications I would suggest the authors address. Statistical Analysis/Study Population (Methods General): •The authors indicated that data from 4,621 repeated checkups were excluded from the analyses it would have been interesting to assess how the body composition parameters may have predicted changes in MS status over time using the repeated visits from the 4,621 with repeat data as this data was available. Results: •The results are clear however, the authors should include the percentages for the total number of subjects (n=2238) with MS as well as the percentages for the total number of subjects who were in the obesity group, visceral adiposity group and sarcopenia group. I would further suggest either updating this in Table 1 and Table 2. •Table 3 and the language describing table 3 is unclear, it states the prevalence of MS was significantly higher in those with obesity, visceral adiposity AND sarcopenia compared to those without however, the table appears to show these as mutually exclusive groups. That is to say, obesity vs none, visceral vs non, sarcopenia vs none NOT those with obesity, visceral adiposity AND sarcopenia I would assume the group of individuals whom may be categorized by all 3 conditions would be much smaller. Thus, I would suggest the authors use ‘or’ rather than ‘and’ to indicate these analyses were done separately for each of the 3 conditions. •It is unclear which models were used to assess the results reported in Table 3 and 4—were these done using chi-squared or the students t-tests? As these are counts for the number of parameters the authors should be more clear on how these results were modeled in the statistical analyses section. •Table 5 is clearly defined and easy to read as well as reported and described appropriately both in the analyses section as well as the results. Overall, the manuscript is clear and describes the association between obesity, visceral adiposity, and sarcopenia in a large sample of individuals. Reviewer #2: Comment for Authors The authors have undertaken study to explore the association of multiple body composition parameters such as obesity, visceral adiposity and sarcopenia with metabolic syndrome. The sample size is large and study span of 5 year have resulted in robust data. Over all study represent a major portion of Asian population. Despite these merits the study is not novel and is just an extension of earlier study by Kim S H et al., “Association between sarcopenia level and metabolic syndrome” (PMID: 33739984). GENERAL English should be improved throughout the text. Sentence needs to be rephrased and lines should be numbered throughout the manuscript. In discussion include a paragraph explaining the parameters that are included in the current study and merit of the current study over earlier study conducted by same author (PMID: 33739984). Methods and Materials Methods and material section is well written Results The table 1 and table 2 are duplication of table 1 of previous published article (PMID: 33739984) by the same author represented in different way. The figure 5B of the current study is duplication of figure 5 of previous published article (PMID: 33739984). Figure legends should be self-explanatory. Novelty The study is not novel ****** 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.0256083.r001
Revision 1
22 Jul 2021 Author Response Response Letter Editors, PLOS ONE Thank you for allowing the revision of our manuscript: ID PONE-D-21-15211 entitled “Association of obesity, visceral adiposity, and sarcopenia with an increased risk of metabolic syndrome: a retrospective study” We revised our manuscript in accordance with the reviewers’ suggestions. Our responses to the comments are as follows. Reviewer #1: The manuscript provides evidence of the association between body composition parameters (obesity, visceral adiposity, and sarcopenia) and metabolic syndrome in a large sample of subjects. The manuscript is technically sound and the data do support the conclusions however there are a few revisions or clarifications I would suggest the authors address. Comment 1> 1. The authors indicated that data from 4,621 repeated checkups were excluded from the analyses it would have been interesting to assess how the body composition parameters may have predicted changes in MS status over time using the repeated visits from the 4,621 with repeat data as this data was available. Reply: Thank you for your valuable comments. It seems that causal relationship may be assessed by analyzing the data of subjects who underwent repeated health checkup. However, in this 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 repeat data, but we’ll be able to show you when the next paper is completed. We sincerely ask for your kind understanding. Comment 2> 2. The results are clear however, the authors should include the percentages for the total number of subjects (n=2238) with MS as well as the percentages for the total number of subjects who were in the obesity group, visceral adiposity group and sarcopenia group. I would further suggest either updating this in Table 1 and Table 2 Reply: Thank you for your valuable comments. Based on your comments, we added the percentages of subjects with MS in Table 1. We also added the percentages of subjects in the obesity group, visceral adiposity group and sarcopenia group in Table 2. Comment 3> 3. Table 3 and the language describing table 3 is unclear, it states the prevalence of MS was significantly higher in those with obesity, visceral adiposity AND sarcopenia compared to those without however, the table appears to show these as mutually exclusive groups. That is to say, obesity vs none, visceral vs non, sarcopenia vs none NOT those with obesity, visceral adiposity AND sarcopenia I would assume the group of individuals whom may be categorized by all 3 conditions would be much smaller. Thus, I would suggest the authors use ‘or’ rather than ‘and’ to indicate these analyses were done separately for each of the 3 conditions. Reply: Thank you for your valuable comments. Based on your comments, we revised our manuscript. We used ‘or’ instead of ‘and’ to indicate these analyses were done separately for each of the 3 conditions. Comment 4> 4. It is unclear which models were used to assess the results reported in Table 3 and 4—were these done using chi-squared or the students t-tests? As these are counts for the number of parameters the authors should be more clear on how these results were modeled in the statistical analyses section. Reply: Thank you for your valuable comments. We added more specific contents in the statistical analyses section. In the results section, we revised some contents regarding Table 3 and Table 4. Comment 5> 5. Table 5 is clearly defined and easy to read as well as reported and described appropriately both in the analyses section as well as the results. Reply: Thank you for your valuable comments. Reviewer #2: The authors have undertaken study to explore the association of multiple body composition parameters such as obesity, visceral adiposity and sarcopenia with metabolic syndrome. The sample size is large and study span of 5 year have resulted in robust data. Over all study represent a major portion of Asian population. Despite these merits the study is not novel and is just an extension of earlier study by Kim S H et al., “Association between sarcopenia level and metabolic syndrome” (PMID: 33739984). Comment 1> 1. English should be improved throughout the text. Sentence needs to be rephrased and lines should be numbered throughout the manuscript. Reply: Thank you for your valuable comments. We rephrased some sentences and underwent additional English proofreading. And lines were numbered throughout the manuscript. Comment 2> 2. In discussion include a paragraph explaining the parameters that are included in the current study and merit of the current study over earlier study conducted by same author (PMID: 33739984). Reply: Thank you for your valuable comments. As you suggested, we added sentences explaining the parameters that are included in the current study and merit of the current study over earlier study. We revised our manuscript as follows. Discussion – 3rd paragraph The previous study of the same study population as this study (Figure 1) showed that sarcopenia diagnosed by BIA is independently associated with MS risk in a dose-response manner.46 Our previous study focused on the relationship between sarcopenia and MS.46 In contrast, the current study comprehensively analyzed the effects of obesity, visceral adiposity, and sarcopenia on the risk of MS. Our current study demonstrated that the risks for MS additively increased…… Comment 3> 3. The table 1 and table 2 are duplication of table 1 of previous published article (PMID: 33739984) by the same author represented in different way. Reply: Thank you for your valuable comments. Our current study and the previous published article share the same study population (N=13620), but the research topic and analysis methods were completely different between the two studies. However, since Table 1 and Table 2 in our current study have some overlap with the contents of the Table 1 of the previous paper, we added such contents in the main text and cited the previous paper in Table 1 and Table 2. Comment 4> 4. The figure 5B of the current study is duplication of figure 5 of previous published article (PMID: 33739984). Reply: Thank you for your valuable comments. Although the research topic and analysis methods were completely different between the two studies, patients who performed both CT and Inbody on the same day were the same. Therefore, the graph that correlated CT and Inbody in this current study was the same as the graph in the previous study. We added such contents in the main text and cited the previous paper in the Figure 5B. Comment 5> 5. Figure legends should be self-explanatory. Reply: Thank you for your valuable comments. Based on your comments, we revised the Figure legend of Figure 2. Comment 6> 6. The study is not novel. Reply: Although this study is not novel, the sample size of our study is large and 5-year span resulted in robust data as you commented. And our data strongly support our conclusion. Thus, our study is thought to have sufficient merit. Thank you. 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.0256083.r002
2 Aug 2021 Decision Letter - Mauro Lombardo, Editor Association of obesity, visceral adiposity, and sarcopenia with an increased risk of metabolic syndrome: a retrospective study PONE-D-21-15211R1 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, Mauro Lombardo Academic Editor PLOS ONE Additional Editor Comments (optional): 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: I Don't Know ****** 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: (No Response) Reviewer #2: All the Major comments have been addressed. Minor comments 1) The manuscript could be structured more reader friendly and improve the language by giving the manuscript for professionals for editing. ****** 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 https://doi.org/10.1371/journal.pone.0256083.r003
Formally Accepted
5 Aug 2021 Acceptance Letter - Mauro Lombardo, Editor PONE-D-21-15211R1 Association of obesity, visceral adiposity, and sarcopenia with an increased risk of metabolic syndrome: a retrospective study 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. Mauro Lombardo %CORR_ED_EDITOR_ROLE% PLOS ONE https://doi.org/10.1371/journal.pone.0256083.r004

Open letter on the publication of peer review reports

PLOS recognizes the benefits of transparency in the peer review process. Therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. Reviewers remain anonymous, unless they choose to reveal their names.

We encourage other journals to join us in this initiative. We hope that our action inspires the community, including researchers, research funders, and research institutions, to recognize the benefits of published peer review reports for all parts of the research system.

Learn more at ASAPbio .