PONE-D-21-20733Dietary risk factors for hip fracture: an umbrella review of meta-analyses of prospective cohort studiesPLOS ONE

Dear Dr.  Webster,

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Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

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Reviewer #1: Title: `Dietary risk factors for hip fracture: an umbrella review of Meta-analyses of prospective cohort studies`

• Title:

� In articulating a title of this particular Umbrella Review, the population of interest is not evident.

� Is it a review of Meta-analysis (which is only 2 out of 34-exposures)?

� Suggestion: Dietary risk factors for hip fracture in adults: An Umbrella Review of Prospective cohort studies.

• Objective:

� `To summarize the totality of evidence regarding dietary factors and hip fracture incidence in adults, and to evaluate the methodological quality of systematic reviews and meta-analyses

� Is it appropriate to use the Term `Incidence`?

� `Methodological quality of systematic reviews` -This is the analysis procedure to be performed during the process and not the objective to be set

� Suggestion: To summarize the `totality of evidence regarding dietary factors for hip fracture` in adults

• Methodology and synthesis:

``The quality of evidence for all associations except combined fruits and vegetables intake and hip fracture incidence was downgraded from low to very low due to a serious or very serious risk of bias amongst primary studies``

� The purpose of UR quality assessment is to assess methodological quality, risk of bias, and reporting quality of reviews, and does not involve retrieving the quality of primary studies??

� Any modifications to the JBI umbrella review method?

• Result;

� `The quality of evidence (GRADE) was low for an inverse association between hip fracture incidence and intake of fruits and vegetables combined (adjusted relative risk for higher vs lower intakes: 0.92 [95% confidence interval: 0.87 to 0.98]), and very low for the remaining thirty-three exposures. Adjusted summary effect estimates and the quality of evidence for each exposure regarding risk of hip fracture are summarized.

Question:

� Wasn`t it necessary to show cumulative risk factor (effect size)? By forest plot, Summary ROC (SROC) curves…or other ways of addressing heterogeneity of the Meta-analysis. Because, if the differences are not the result of chance, then we need to be cautious in interpreting the results of the meta-analysis.

� Nineteen meta-analyses had an I2 value above 50%, and heterogeneity was significant for the 14 exposures. If studies are heterogeneous, is it certain or appropriate to synthesize the respective studies into meta-analysis??

• Does this UR not require approval of IRBs?

Reviewer #2: In general:

It is just very long and suggest to be shortened.

Introduction:

- Assessing the methodological quality of systematic review included in an umbrella review is part of the methodology and cannot be an objective. Please revise your second objective.

Method:

- The umbrella review required two authors to conduct each step of the process based on the PRISMA checklist. The data extraction process as you mentioned was conducted by one author only, while it should be conducted either in parallel or as confirmatory.

Results:

- The second sentence in line 186 (Total sample size…) It is not clear what you want to say, please rephrase.

Discussion:

- In line 353 NOF: Please do not start with writing an abbreviation without refereeing to the complete word, then you can repeat it freely.

- Possible mechanisms: This section is very interesting. I suggest to reduce the long discussion, removing all the repetition from the result and add it to give it a better value.

- Strength and limitation section is very long and no added value. Consider revision.

- You keep repeating that you used the high-quality reviews, while all of your included studies are either low or very low quality, Consider revision.

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Reviewer #1: Yes: Beyene WA,

Reviewer #2: No

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Attachments

Attachment

Submitted filename: UR review Report .docx

Dietary risk factors for hip fracture in adults: An umbrella review of meta-analyses of prospective cohort studies

PONE-D-21-20733R1

Dear Dr. James Webster,

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.

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Kind regards,

Yuan-Pin Hsu

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

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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: (No Response)

Reviewer #2: (No Response)

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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.Beyene WA

Reviewer #2: No