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PONE-D-22-12990The influence of body composition and fat distribution on circadian blood pressure rhythm and nocturnal mean arterial pressure dipping in patients with obesityPLOS ONE

Dear Dr. Tałałaj,

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.

 Reviewers found your article of interest but each suggested comments for improvement. In particular, make sure your rationale is clear and easy to follow in the introduction. There were also some concerns with the methodology, so please ensure that is addressed in the revision.

Please submit your revised manuscript by Sep 22 2022 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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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.

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We look forward to receiving your revised manuscript.

Kind regards,

Jeremy P Loenneke

Academic Editor

PLOS ONE

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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

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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

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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: No

Reviewer #2: Yes

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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: General Comments:

This paper explores an interesting question, however, some significant rewriting of the article for clarity and correction of grammatical error is required. Also, there are some issues with the paper described below.

It would’ve been interesting to explore further how hypertension status within BMI group relates to the nocturnal blood pressure dipping status (even though non-dipping is an independent predictor of CV risk and mortality, as stated by the authors.)

Introduction

The rationale built here is difficult to follow. Particularly, the section on central blood pressure does not fit in. This paper does not measure central blood pressure.

Methods

generally sound

Results

-only report results to the decimal to which they were measured (rules of significant figures)

-line 136 and 137 – “blood pressure lowering drugs, 1-6” To what is this referring?

-Tables 2 and 6 – the “(No)” is confusing; please find a way to present this differently

-Table 3 - as men and women should statistically significant differences in systolic and diastolic pressure that day, night, and in the mean value, it would strengthen the paper to provide further analysis examining variables with men alone and with women alone. It is interesting to note that the females alone would not even reach the hypertension classification while the males would. If this kind of analysis were added, in my opinion, some of the other analyses performed could be eliminated so as not to bloat the paper. Keep the analyses simple and related to the main purpose of the paper.

Discussion

-Line 311 – This is interesting: “whereas normotensive individuals had larger FM, BF%, and PerF.” the authors mention this finding in passing (line 250, “a possible protective role for peripheral adipose tissue” but it is not really discussed.

-line 293 - if central blood pressure measurement is arguably better, and “nocturnal SPB decline of the aorta and central arteries was significantly less pronounced compared with brachial SBP” (refs 42,43), how important are the peripheral nocturnal blood pressure measurements? What was the relationship between central dipping and peripheral dipping in other studies?

Reviewer #2: Thank you for the opportunity to review this manuscript. The authors sought to investigate the relationship between markers of body composition and the distribution of fat on nocturnal blood pressure dipping. The results suggest that those with the highest body weight and, BMI, and lean body mass, had reduced nocturnal blood pressure dipper. The manuscript is very interesting; however, improvement is required in some areas before it is ready for publication.

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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

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Attachments

Attachment

Submitted filename: BP_Bodycomp_Nocturnal.docx

PONE-D-22-12990R1The influence of body composition and fat distribution on circadian blood pressure rhythm and nocturnal mean arterial pressure dipping in patients with obesityPLOS ONE

Dear Dr. Tałałaj,

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.

Both reviewers found that the manuscript was improved, however, each had additional minor comments that need to be addressed.

Please submit your revised manuscript by Dec 03 2022 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: https://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,

Jeremy P Loenneke

Academic Editor

PLOS ONE

Journal Requirements:

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.

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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)

Reviewer #2: (No Response)

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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: Overall, this paper is significantly improved. It addresses an important question is generally clearly presented. The grammar and punctuation issues have clearly been addressed although some minor grammar and punctuation issues remain.

Abstract

• Still some minor grammatical correct / punctuation issues

Intro

• Significantly improved! - although still some minor grammatical correct / punctuation issues

Results

• decimals are still shown for values for which it was unlikely the original measurement was to a decimal (age and BP, for example)

• “Blood pressure-lowering drugs, 1 137 through 6, have been taken by 289 participants” � where can the reader find the 1-6 info?

Discussion

• Still some minor grammatical correct / punctuation issues – review your comma usage particularly (while comma usage can be subjective, there are a few cases throughout the paper where the usage is clearly incorrect. For example, “Previous studies 288 have documented, that mean arterial pressure better reflected central, aortic SBP, and better 289 predicted cardiovascular risk, as compared with brachial SBP [38,39].” Between “documented” and “that” there clearly should not be a comma. This type of error occurs in other places.

Reviewer #2: Thank you for the opportunity to re-review this manuscript. The authors addressed most of my comments. I have still have three points that need to be addressed.

Page 5 lines 90-94

“Waist and hip circumferences (WC, HC) were measured to the nearest 1 cm, and the waist-to-hip ratio (WHR) was calculated. WC was determined in a horizontal plane, midway between the iliac crest and the costal margin, at the end of a normal expiration; HC was measured at the level of the greater trochanter, using a non-stretch tape measure.”

Sorry if my last comment on this was not clear. I agree that there is no consensus on how to measure waist circumference. I am just suggesting that the authors provide a reference for who recommends this method of measurement.

Page 6 lines 105-112

“Systolic and diastolic BP (DBP) were measured every 30 minutes during the day (between 6.00 and 22.00) and every 60 minutes during the night (from 22.00 to 6.00). The average daytime and nighttime BP were computed as the means of all readings during each period, and the average circadian SBP and DBP were calculated as the means of all legible measurements within a 24-hour period. Hypertension was diagnosed according to the 2018 European Society of Cardiology guidelines [7]. Non-dipping of BP was defined as a decline in MAP values <10% from the average daytime to the average nighttime values.

“I have to agree that ‘this unfairly weights the influence of daytime blood pressure’. The mean 24-hour values of SBP and DBP presented in the paper were 127.8 and 75.4 mmHg, respectively. Assuming that all 40 measurements (32 + 8) are legible, mean SBP and DBP should be 128.5 and 75.9 mmHg, respectively (daytime/nighttime measurements in the proportion of 4 to 1). If we calculate mean 24-hour SBP and DBP values including diurnal and nocturnal measurements in a 2-to-1 ratio (16 + 8 hours), the average SBP and DBP should be 127.2 and 74.8 mmHg, respectively. This means that approximately 1/3 of the daytime readings were not legible, and that the real daytime-to-nighttime measurement ratio was approximately 3 to 1.

Unfortunately, the exact numbers of legible measurements were not collected in our database, and are contained in individual patients’ source data only.

In the paper we decided to write that ‘the average circadian systolic and diastolic BP were calculated as the means of all legible measurements within a 24-hour period.”

I appreciate the authors honesty. But they need to explicitly state this in the manuscript. It is important the reader knows how the data was affected by the unequal number of measurements.

Page 12 lines 194-198

The assessment of nocturnal BP decline revealed that the magnitude of SBP dipping (9.9 ± 8.2

mmHg) was significantly greater than that of the DBP dipping (8.5 ± 7.0 mmHg, p<0.001), while the percentage of the DBP decline (10.8 ± 8.7%) was greater than that of SBP decline (7.6 ± 6.8%, p<0.001). The average MAP dipping was 9.4 ± 7.5%. Reduced nocturnal MAP decline was diagnosed in 219 patients (50.2%).

The authors should consider reported the difference and SD of that difference between the SBP and DBP dipping. That is the information we are interested in.

**********

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

**********

[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.

PONE-D-22-12990R2The influence of body composition and fat distribution on circadian blood pressure rhythm and nocturnal mean arterial pressure dipping in patients with obesityPLOS ONE

Dear Dr. Tałałaj,

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.

 A reviewer has requested additional minor revisions in order to add clarity related to the ratio of measurements used.

Please submit your revised manuscript by Jan 28 2023 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: https://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,

Jeremy P Loenneke

Academic Editor

PLOS ONE

Journal Requirements:

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.

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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: (No Response)

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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: No

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: No

**********

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: All comments have been addressed. I have no further comments. I appreciate the work the authors did on this manuscript.

Reviewer #2: Thank you again for the opportunity to review this manuscript. The authors have made substantial improvements to the paper. However, I still have one concern that should be addressed.

Page 8 lines 144-147.

“The 24-hour BP monitoring included 40 measurements: 32 daytime and 8 nighttime readings. The comparison of average daytime, average nighttime and mean diurnal SBP and DBP values shows that actual daytime-to-nighttime ratio of legible BP measurements was 3 to 1. That means that approximately 1/3 of the daytime readings were not legible.”

I appreciate the authors adding this section in. However, I believe more discussion is warranted about why this is a problem. Perhaps discussing this in the limitations could be useful. But ultimately, I think the authors needs to discuss why the ratio is important. Simply when looking at mean blood pressure the data is skewed to be more like the day time measurements compared to the night time measurements due to the increased number of measurements taken during the day.

**********

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

**********

[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: Obesity_nocturnal_r2.pdf

The influence of body composition and fat distribution on circadian blood pressure rhythm and nocturnal mean arterial pressure dipping in patients with obesity

PONE-D-22-12990R3

Dear Dr. Tałałaj,

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,

Jeremy P Loenneke

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 #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 #2: Yes

**********

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

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 #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 #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 #2: The authors have made substantial improvements to the paper. I appreciate the authors hard work in preparing this manuscript

**********

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 #2: No

**********