PONE-D-22-34815Malnutrition as a major related factor of frailty among older adults residing in long-term care facilities in KoreaPLOS ONE

Dear Dr. Hong,

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PLOS ONE

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Reviewers' comments:

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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

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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: No

Reviewer #2: Yes

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Reviewer #1: Yes

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: The study aims to investigate the prevalence and coexisting rate of frailty and malnutrition among older adults living in long-term care facilities (LTCFs) in Korea, and to identify factors related to frailty, including malnutrition. The study concludes that the prevalence of frailty and malnutrition, as well as the coexisting rate of both factors, is high among older adults living in LTCFs, and malnutrition is a major related factor of frailty that increases the incidence of frailty.Overall, the study focuses on interesting topic, while there are rooms for strengthen the results and discussion of the study. Also, the manuscript should cite relevant previous observation and intervention studies from Korean population.

1. Provide more detail on the study design and sample, including information on sample size calculation and the selection of LTCFs.

2. Provide more detail on the data collection process, including information on the training of staff who administered the measurements.

3. Describe the statistical analysis in more detail, including information on the variables included in the multivariate analysis and the criteria for determining statistical significance.

4. Provide more context for the results, including a comparison with previous studies on fraily, oral health, nutrition in South Korea such as --

Clin Interv Aging. . 2022 Dec 21;17:1863-1872. PMID: 36575660 PMCID: PMC9790170

BMC Geriatr . 2021 Sep 4;21(1):482. PMID: 34481482 PMCID: PMC8418721

and also discuss the potential implications of the high prevalence of frailty and malnutrition in this population, including the potential impact on morbidity, mortality, and social costs.

5. Address any issues with the generalizability of the study, such as the limited number of long-term care facilities and geographic location.

6. Include a discussion on potential interventions for improving the nutritional status of older adults in long-term care facilities and preventing or managing frailty. You may consider to read a Korean study:

Age Ageing . 2021 Nov 10;50(6):2157-2166. PMID: 34351363 PMCID: PMC8581390

7. Discuss the potential overlap between the FRAIL-NH and MNA-SF in assessing frailty and malnutrition and how this may affect the results. The use of the FRAIL-NH and MNA-SF to measure frailty and malnutrition, respectively, is appropriate, but it would be helpful to provide more information on the validity and reliability of these instruments in the Korean older adult population.

Ann Geriatr Med Res . 2018 Mar;22(1):20-25. PMID: 32743239 PMCID: PMC7387636

8. The results section could benefit from more in-depth analysis, including subgroup analysis by sex and age.

9. The language throughout the manuscript could be improved for clarity and conciseness.

10. Consider including more information on the potential impact of the COVID-19 pandemic on the study.

Reviewer #2: Thank you for the invitation.

Altough the co-existing frailty and malnutrition is well known, the study is one of the rare articles showing this relationship. However, I think references should be updated. In the recent lterature showed that there is a close relationship between frailty and nutritional status. And, both MNA-SF and MNA-long form are validated to determine frailty in older patients (https://pubmed.ncbi.nlm.nih.gov/31118593/, https://pubmed.ncbi.nlm.nih.gov/30262439/) If the authors discuss this issue, it would contribute power for the discussion section.

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Reviewer #1: No

Reviewer #2: Yes: Pinar Soysal

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Malnutrition as a major related factor of frailty among older adults residing in long-term care facilities in Korea

PONE-D-22-34815R1

Dear Dr. Hong,

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.

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Kind regards,

Mohammad Meshbahur Rahman, MS.

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: No

Reviewer #2: Yes

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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: Thanks for the revision and I found authors addressed all the issues that reviewers' have suggested.

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: No

Reviewer #2: Yes: Pinar Soysal

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