The relationship between smoking cigarettes and metabolic syndrome: A cross-sectional study with non-single residents of Seoul under 40 years old

Sun Woo Kim; Ho Jun Kim; Kyungha Min; Hobeom Lee; Sung-Ha Lee; Sunyoung Kim; Jong Seung Kim; Bumjo Oh

doi:10.1371/journal.pone.0256257

Peer Review History

Original SubmissionMay 24, 2020
6 May 2021 Decision Letter - Liou Y. Sun, Editor PONE-D-20-15624 Relationship between Smoking and Metabolic Syndrome in Engaged and Newly Married Couples Adults in Their 20s and 30s PLOS ONE Dear Dr. Oh, 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 Jun 20 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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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 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 If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references.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 If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. 3. Thank you for stating the following financial disclosure: [No]. At this time, please address the following queries: Please clarify the sources of funding (financial or material support) for your study. List the grants or organizations that supported your study, including funding received from your institution. State what role the funders took in the study. If the funders had no role in your study, please state: “The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.” If any authors received a salary from any of your funders, please state which authors and which funders. If you did not receive any funding for this study, please state: “The authors received no specific funding for this work.” Please include your amended statements within your cover letter; we will change the online submission form on your behalf. [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: Partly ******** 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 is an important area of research to explore how smoking affects the cardiometabolic parameters in people in their 20s and 30s. This paper can be published with some minor corrections. The paper needs overall editing for grammar and punctuation. Reviewer #2: Obesity and smoking are important causes of morbidity and mortality worldwide. Smoking reduces insulin sensitivity, induces insulin resistance, and enhances cardiovascular risk factors, such as elevated plasma triglycerides, reduced high-density lipoprotein–cholesterol, and hyperglycemia. Smoking is associated with metabolic abnormalities and increases the risk of metabolic syndrome. In this study, the authors evaluated the relationship between smoking and metabolic syndrome in 808 young adults and found that the odds ratio versus nonsmokers for metabolic syndrome, hypertriglyceridemia, and low HDL cholesterolemia was significantly higher in smokers. This study provides a positive association between smoking and metabolic syndrome in young adults. Some questions need to be addressed. Whether and how drinking affects metabolic syndrome in young adults either in the smoking group or non-smoking group. Was any difference of metabolic syndrome analyzed in the light smokers and heavy smokers, compared to the non-smoking group? ****** 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: Yes:** Debasish Kar 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. Attachments Attachment Submitted filename: PLOS One - April 2021.docx https://doi.org/10.1371/journal.pone.0256257.r001
Revision 1
21 Jul 2021 Author Response Dear Editor, We like to thank you and the reviewers for the very helpful advices. Please find our revision and answers to the open points enclosed. Best regards, ABSTRACT 1) Title – I am not quite sure why the authors have chosen ‘marriage’ as a determinant of metabolic syndrome? Marriage may not happen, and people can live together for decades. It does not affect their risk of developing metabolic syndrome. Answer: We agree with the reviewer's opinion. This was a kind of business, and the purpose was to recommend the health care of newlyweds, and I think that the title of this manuscript, written for research purposes, needs to be revised. So, we have changed it to: The relationship between smoking cigarettes and metabolic syndrome: a cross-sectional study with non-single residents of Seoul under 40 years old 2) Metabolic syndrome was defined using Adult Treatment Panel III.- Please tell the reader what is meant by the adult treatment panel. Answer: Thank you for your comment. The content was explained by quoting from the methodology, not the abstract. 3) Results – Please add standard deviation of age and male female split. This is going to help the reader to understand dispersion of data. Male female split will be helpful as you have mentioned the uptake of screening tests are comparatively lower in young males. Answer: Thank you for your comment. Men and women were separated and SD was indicated. 4) Conclusion – Glycosylated Haemoglobin, smoking and metabolic syndrome are closely linked. Why the authors only commented on TG and HDL and not other components of the metabolic syndrome? Answer: In this study, we looked at the relationship between smoking and metabolic syndrome, and further looked at the relationship between the components that define metabolic syndrome. Through this, the Conclusion emphasized and mentioned this part with the result that TG and HDL had a significant relationship with smoking. INTRODUCTION 1) The annual number of marriages in South Korea showed increases over a long period – correct grammar. Answer: We have corrected the sentence as you pointed out. 2) “Metabolic syndrome is the composite occurrence of abdominal obesity, dyslipidemia, elevated blood pressure, and impaired fasting glucose” – what about BMI and waist circumference? Answer: Thank you for your comment. The relationship between obesity index and metabolic syndrome risk factors has been suggested in various ways, and the authors selected one of them according to the criteria of Adult Treatment Panel III. This is because BMI and waist circumference are both used as indicators of obesity, but if they are selected at the same time, covariance may play a role. 3) “Therefore, this study is intended to conduct cross-sectional studies based on the results of health screenings of engaged and newly married couples who visited the health examination center of a general hospital in Seoul from July 2017 to March 2019 in order to analyze differences in the health status, various clinical tests, and prevalence between smoking and non-smoking among existing living habits in relatively young age groups” – too long sentence not sure what the authors are trying to say. Please rewrite the sentence. Answer: We agree with the reviewer's opinion, and have corrected the sentence as pointed out. STUDY METHOD 1) Statistical analysis – “In addition, after compensating for age, sex, drinking, ……” adjusting would be a better word than compensating. Answer: We agree with the reviewer's opinion, and changed the word as you instructed. 2) Table 3 – Can the author clarify what is meant by crude OR and adjusted OR, please? Answer: As you have pointed out, we added a description in Table 3. DISCUSSION 1) Why the authors decided only to comment of lipid profiles rather than the whole spectrum of components of metabolic syndrome? Answer: As mentioned in the Conclusion, this study confirmed that the prevalence of metabolic syndrome was higher in the current smoker group than in the non-smoker group. In particular, it was confirmed that the adjusted OR significantly increased in TG and HDL-C (high-density lipoprotein) among metabolic components. In this regard, the discussion was focused on the relevant risk factors. The authors emphasize this intention by amending the first sentence of the first paragraph of the Discussion. 2) Relationship between smoking and the components of metabolic syndrome is well established - https://pubmed.ncbi.nlm.nih.gov/27881170/ Answer: Thank you for your comment. We cited and mentioned it in the last sentence of the second paragraph of the Discussion after reviewing the contents of the review article. 3) The authors could inform the reader how this relationship is different in young people in their 20s and 30s. Answer: Thank you for your comment. The aforementioned papers are included as references. In addition, compared with previous studies, a significant increase in TG and a significant decrease in HDL were characteristic in smokers who were younger subjects under the age of 40, and this was mentioned in the Discussion section. 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 an important area of research to explore how smoking affects the cardiometabolic parameters in people in their 20s and 30s. This paper can be published with some minor corrections. The paper needs overall editing for grammar and punctuation. Answer: Thank you for your comment. We have completed language editing once again for the revised manuscript. Reviewer #2: Obesity and smoking are important causes of morbidity and mortality worldwide. Smoking reduces insulin sensitivity, induces insulin resistance, and enhances cardiovascular risk factors, such as elevated plasma triglycerides, reduced high-density lipoprotein–cholesterol, and hyperglycemia. Smoking is associated with metabolic abnormalities and increases the risk of metabolic syndrome. In this study, the authors evaluated the relationship between smoking and metabolic syndrome in 808 young adults and found that the odds ratio versus nonsmokers for metabolic syndrome, hypertriglyceridemia, and low HDL cholesterolemia was significantly higher in smokers. This study provides a positive association between smoking and metabolic syndrome in young adults. Some questions need to be addressed. Whether and how drinking affects metabolic syndrome in young adults either in the smoking group or non-smoking group. Was any difference of metabolic syndrome analyzed in the light smokers and heavy smokers, compared to the non-smoking group? Answer: Thank you for your comments, and we would like to respond to them. First, the researchers divided the subjects into three groups, namely current smokers, non-smokers, and ex-smokers, according to the definition of ever-smoker, and analyzed them. 1) Since the number of subjects is not large, if the categories are further divided by the new definition, the statistical power may decrease. 2) The definition of light/heavy smoker is not clear. 3) The smoking rate of female subjects is very low. For these reasons, the authors judged that it would be difficult to identify a significant difference between groups when additional conditions were added for analysis. However, we thought that there is a possibility of a dose-response between the amount of smoking and metabolic syndrome, so this was additionally described in the Discussion section. Second, we are well aware that alcohol consumption is also a major contributor to metabolic syndrome. However, it was later realized that the authors did not accurately determine the type and amount of alcohol the subjects drank when collecting the questionnaire. For convenience, since “if you drink more than once a week” is defined as a drinker, it is acknowledged that the proportion of drinkers is high. Therefore, the authors agreed that a more meaningful result would have been possible if the relationship with metabolic components was further checked by dividing it into appropriate/risk drinking according to the amount of alcohol consumed. Reflecting these details, an existing reference was added and this content was additionally described as a limitation in the Discussion section. Attachments Attachment Submitted filename: [PLOS_One]_Answers_to_the_Reviewers_Comments_submission.docx https://doi.org/10.1371/journal.pone.0256257.r002
4 Aug 2021 Decision Letter - Liou Y. Sun, Editor The relationship between smoking cigarettes and metabolic syndrome: A cross-sectional study with non-single residents of Seoul under 40 years old PONE-D-20-15624R1 Dear Dr. Bumjo Oh, 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, Liou Y. Sun Academic Editor PLOS ONE Additional Editor Comments (optional): two reviewers agree that the authors have addressed all the concerns. 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: Few comments made for the authors to pay attention to. Otherwise it is a publishable quality research. Reviewer #2: The authors have provided a detailed and thorough response to the comments from the previous review and have addressed my major concerns with the updated manuscript. The manuscript now reads with greater focus and clarity. ****** 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: Yes:** Dr Debasish Kar Reviewer #2: No Attachments Attachment Submitted filename: PONE-D-20-15624_R1.pdf https://doi.org/10.1371/journal.pone.0256257.r003
Formally Accepted
10 Aug 2021 Acceptance Letter - Liou Y. Sun, Editor PONE-D-20-15624R1 The relationship between smoking cigarettes and metabolic syndrome: a cross-sectional study with non-single residents of Seoul under 40 years old Dear Dr. Oh: 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. Liou Y. Sun Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0256257.r004

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