Cardiometabolic risk factors in South American children: A systematic review and meta-analysis

Carolyn M. H. Singleton; Sumeer Brar; Nicole Robertson; Lauren DiTommaso; George J. Fuchs III; Aric Schadler; Aurelia Radulescu; Suzanna L. Attia

doi:10.1371/journal.pone.0293865

Peer Review History

Original SubmissionJuly 28, 2022
24 Apr 2023 Decision Letter - Emily Chenette, Editor PONE-D-22-19334Cardiometabolic Risk Factors in South American Children: A Systematic Review and Meta-AnalysisPLOS ONE Dear Dr. Haugh, Thank you for submitting your manuscript to PLOS ONE. I sincerely apologise for the unusually delayed review timeframe. Your manuscript has been assessed by one reviewer, whose comments are appended below. 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 note that we have only been able to secure a single reviewer to assess your manuscript. We are issuing a decision on your manuscript at this point to prevent further delays in the evaluation of your manuscript. 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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, Emily Chenette Editor in Chief 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 that your search is up to date and any relevant studies published since 2021 are included in your systematic review. 3. 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 If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references.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. [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 ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: 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 ****** 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 ****** 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: I am very grateful for the opportunity to review this manuscript. The manuscript aims to study the cardiometabolic risk factors in South American children through a systematic review and meta-analysis. A great effort was done in the preparation of this manuscript and the data presented might give a valuable insight about the high rates of obesity, overweight and dyslipidemia in these children. In addition, it highlights the knowledge gap and gives recommendation for the possible future research in this field. I have only few comments: Methods In the search strategy section, database search date was not mentioned. Line 164: “priams”, should be Prisma Line 173: “baseline data was recorded”, should be “were” Results Regarding the definitions used for cardiometabolic risk factors, some definitions are exactly the same but using different units. For example triglycerides 150 mg/dl is the same as 1.96 mmol/L and blood glucose of 100 mg/dl is almost the same as 5.55 mmol/l. I would rather merge these similar definitions into one rather than considering them as two different definitions. In the study that used the cut off value of “Fasting glucose ≥126 mg/dL”, was that used to define impaired glucose tolerance/prediabetes or for diabetes mellitus? Line 295: “data is”, should be “are” Discrepancies between the text and tables Line 227: IQR: 6.35-17.2. In the table: 6.3-17.3 Line 228 IQR (16.6-39.0). In the table: 16.5-39.3 Line 229: median IQR 21.9% (IQR 10.0-33.2). In the table: 21.9 (9.4-33.9) - Lines 236-237 urban setting: 12.6%, 6.3-17.3. In the table: 12.6 (6.5-18.0) Line 250 P-value is 0.07. In the table: 0.007 Lines 257-258: "the most commonly used definition of waist circumference was WC ≥90% for age, height and gender" Lines 260-261: " elevated waist circumference defined by WC ≥90% for age and gender Table 3:" WC ≥90% for age, height and gender" Table 4: "WC ≥90% for age and gender" Line 286: (IQR 5.1-20.6). In table 4: (4.6-20.6) Line 303: "IQR in mixed: 4.49%. In table 4: 44.9 Line314: "mixed: 37.0%, 14.4-69.5". In table 4: 14.1-69.5) - urban: 28.8%, 19.5-36. In table 4: 28.8 (19.5-36.4) Tables In the columns heading it is written N(%), it is better to remove the “%” as no percentages where mentioned in these columns In both text and table, data that are not represented as median (IQR), has to be explained to the readers ******** 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 ******** [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.0293865.r001
Revision 1
11 Jun 2023 Author Response Methods 1. In the search strategy section, database search date was not mentioned. Response: Thank you for bringing up this limitation in our methods. Unfortunately, though we did record dates of searches for some database searches, we did not record all of them. For this reason, we did not include the dates of the searches. 2. Line 164: “priams”, should be Prisma Response: This change was made. 3. Line 173: “baseline data was recorded”, should be “were” Response: This was addressed. Results 1. Regarding the definitions used for cardiometabolic risk factors, some definitions are exactly the same but using different units. For example triglycerides 150 mg/dl is the same as 1.96 mmol/L and blood glucose of 100 mg/dl is almost the same as 5.55 mmol/l. I would rather merge these similar definitions into one rather than considering them as two different definitions. Response: Thank you for suggesting this way to streamline the presentation of our findings. We have merged the similar definitions and updated Table 3. 2. In the study that used the cut off value of “Fasting glucose ≥126 mg/dL”, was that used to define impaired glucose tolerance/prediabetes or for diabetes mellitus? Response: We reviewed that article closer, and it did indeed use that definition to defint diabetes mellitus but did not provide a definition for impaired fasting glucose. Since this study did not provide relevant data on that particular risk factor based on our inclusion criteria, we removed the data from that study for that risk factor. -Line 295: “data is”, should be “are” Response: Thank you, this has been addressed. Discrepancies between the text and tables 3. Line 227: IQR: 6.35-17.2. In the table: 6.3-17.3 Response: Thank you, the text has been changed to agree with the correct data in the table. 4. Line 228 IQR (16.6-39.0). In the table: 16.5-39.3 Response: Thank you, the text has been changed to agree with the correct data in the table. 5. Line 229: median IQR 21.9% (IQR 10.0-33.2). In the table: 21.9 (9.4-33.9) Response: Thank you, the text has been changed to agree with the correct data in the table. 6. Lines 236-237 urban setting: 12.6%, 6.3-17.3. In the table: 12.6 (6.5-18.0) Response: Thank you, the text has been changed to agree with the correct data in the table. 7. Line 250 P-value is 0.07. In the table: 0.007 Response: Thank you, the text has been changed to agree with the correct data in the table. 8. Lines 257-258: "the most commonly used definition of waist circumference was WC ≥90% for age, height and gender" Lines 260-261: " elevated waist circumference defined by WC ≥90% for age and gender Table 3:" WC ≥90% for age, height and gender" Table 4: "WC ≥90% for age and gender" Response: Updated definition in lines 260-261 to include full definition. 9. Line 286: (IQR 5.1-20.6). In table 4: (4.6-20.6) Response: Thank you, the text has been changed to agree with the correct data in the table. 10. Line 303: "IQR in mixed: 4.49%. In table 4: 44.9 Response: Thank you, the text has been changed to agree with the correct data in the table. 11. Line314: "mixed: 37.0%, 14.4-69.5". In table 4: 14.1-69.5) - urban: 28.8%, 19.5-36. In table 4: 28.8 (19.5-36.4) Response: Thank you, the text has been changed to agree with the correct data in the table. Tables 1. In the columns heading it is written N(%), it is better to remove the “%” as no percentages where mentioned in these columns Response: Thank you for this comment, we have removed the “%” 2. In both text and table, data that are not represented as median (IQR), has to be explained to the readers Response: In tables, inserted * with explanation in caption of “Unable to provide full IQR as study N=2” and * with caption of “**Unable to provide IQR as study N=1.” In the text, inserted “Study N=1” or “Study N=2” as appropriate. https://doi.org/10.1371/journal.pone.0293865.r002
16 Aug 2023 Decision Letter - Patricia Khashayar, Editor PONE-D-22-19334R1Cardiometabolic Risk Factors in South American Children: A Systematic Review and Meta-AnalysisPLOS ONE Dear Dr. Attia, 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. ============================== There are some minor comments that need to be addressed before the manuscript could be published ============================== Please submit your revised manuscript by Sep 30 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, Patricia Khashayar 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. [Note: HTML markup is below. Please do not edit.] 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: (No Response) ******** 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: (No Response) ****** 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: I reviewed the manuscript entitled “Cardiometabolic Risk Factors in South American Children: A Systematic Review and Meta-Analysis”. This is an interesting article assessing the effect of WWI on stroke risk. The manuscript is in the scope of the journal, but certain shortcomings should be addressed before the article could be published: • Several language and grammar editing is required. • The introduction section is too long. Some information mentioned here belongs to the discussion section • Why did you exclude Caribbean islands from geographical region of South America? Moreover, as mentioned in the article the data from several South American countries data are missing, how does this affect the generalizability of the results to South America? • In the abstract you have mentioned 1,540 screened studies, however, in the results (Line 206) “2,181 studies screened” is written. Which one is the correct number? • Figure 2 is missing in the manuscript. • As you already mentioned in the limitation, heterogeneity of definitions of CMRF is the main concern. How have you addressed that. Please elaborate. • Is the inter-study heterogeneity studied? ****** 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: Yes: Pouria Khashayar ******** [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: Review Cardiometabolic Risk Factors in South American Children.docx https://doi.org/10.1371/journal.pone.0293865.r003
Revision 2
28 Sep 2023 Author Response Thank you for your constructive comments and the time you took to review our work. Please find our responses below. Please note that the line references are given as lines in the tracked changes version/ lines in clean version. 1. We have reviewed the document for language and grammar edits. 2. We made several edits to the Introduction section, as detailed in the revised manuscript. Notably, we moved two paragraphs about the utility of metabolic syndrome in children to the Discussion section. 3. We excluded the Caribbean Islands due to their increased cultural and culinary heterogeneity as compared to the countries conventionally considered South America. We have addressed this in lines 136-137/112-113. In results and discussion (lines 212-214/187-188 and 372-373/340-341 respectively), we list the South American countries and territories that did not have data. We discussed this as a limitation to generalizability in our Discussion section (lines 373-374 / 341-342). 4. The number originally listed in the abstract was the total number of articles screened before we added the additional, targeted Google searches. This number has been updated to match the number in the body of the article. 5. Figures 1 and 2 are in a separate document per editor’s instructions. Please let the editor know if you are unable to view this document. 6. We address heterogeneity in our analysis by completing separate statistical analysis by the most used definition of each CMRF to assess the effect of the differing definitions on our outcomes (addressed in Methods 201-203/175-177 and Discussion in lines 366-371/335-336. We did not find a statistical test that would be appropriate to test the heterogeneity of our studies. Attachments Attachment Submitted filename: CMRF.Haugh.Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0293865.r004
23 Oct 2023 Decision Letter - Patricia Khashayar, Editor Cardiometabolic Risk Factors in South American Children: A Systematic Review and Meta-Analysis PONE-D-22-19334R2 Dear Dr. Attia, 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, Patricia Khashayar 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: (No Response) ****** 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: Yes: Pouria Khashayar ******** https://doi.org/10.1371/journal.pone.0293865.r005
Formally Accepted
13 Nov 2023 Acceptance Letter - Patricia Khashayar, Editor PONE-D-22-19334R2 Cardiometabolic Risk Factors in South American Children: A Systematic Review and Meta-Analysis Dear Dr. Attia: 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. Patricia Khashayar Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0293865.r006

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