PONE-D-24-08399Estimation equation of limb lean soft tissue mass in Asian athletes using bioelectrical impedance analysisPLOS ONE

Dear Dr. Hsieh,

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 May 27 2024 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,

Gianpiero Greco

Academic Editor

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. Thank you for stating the following in the Acknowledgments Section of your manuscript:

"This work was supported by grants from the Tzu Hui Institute of Technology Research Program (THIT-110004) and was supported in part by the National Science and Technology Council, Republic of China, under Grants MOST 111-2622-E-005-001."

We note that you have provided additional information within the Acknowledgements Section that is not currently declared in your Funding Statement. Please note that funding information should not appear in the Acknowledgments section or other areas of your manuscript. We will only publish funding information present in the Funding Statement section of the online submission form.

Please remove any funding-related text from the manuscript and let us know how you would like to update your Funding Statement. Currently, your Funding Statement reads as follows:

"This work was supported by grants from the Tzu Hui Institute of Technology Research Program (THIT-110004) and was supported in part by the National Science and Technology Council, Republic of China, under Grants MOST 111-2622-E-005-001."

Please include your amended statements within your cover letter; we will change the online submission form on your behalf.

3. Thank you for stating the following financial disclosure:

"This work was supported by grants from the Tzu Hui Institute of Technology Research Program (THIT-110004) and was supported in part by the National Science and Technology Council, Republic of China, under Grants MOST 111-2622-E-005-001."    

Please state what role the funders took in the study.  If the funders had no role, please state: "The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript."

If this statement is not correct you must amend it as needed.

Please include this amended Role of Funder statement in your cover letter; we will change the online submission form on your behalf.

4. Thank you for stating the following in the Competing Interests/Financial Disclosure * (delete as necessary) section:

"The authors have read the journal’s policy and have the following competing interests: Dr. Kuen-Chang Hsieh was employed by a commercial company, StarBIA Meditek Co. Ltd., during this study. This does not alter our adherence to PLOS ONE policies on sharing data and materials. There are no patents, products in development or marketed products associated with this research to declare. All other authors have no conflicts of interest to declare. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results."

We note that you received funding from a commercial source: "StarBIA Meditek Co. Ltd"

Please provide an amended Competing Interests Statement that explicitly states this commercial funder, along with any other relevant declarations relating to employment, consultancy, patents, products in development, marketed products, etc.

Within this Competing Interests Statement, please confirm that this does not alter your adherence to all PLOS ONE policies on sharing data and materials by including the following statement: "This does not alter our adherence to PLOS ONE policies on sharing data and materials.” (as detailed online in our guide for authors http://journals.plos.org/plosone/s/competing-interests).  If there are restrictions on sharing of data and/or materials, please state these. Please note that we cannot proceed with consideration of your article until this information has been declared.

Please include your amended Competing Interests Statement within your cover letter. We will change the online submission form on your behalf.

Additional Editor Comments :

Dear Authors,

please reply point by point to the reviewers' comments.

Many thanks!

[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: Yes

**********

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

Reviewer #1: No

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: No

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: Dear Authors

the manuscript describe the validation of a new equation to predict limb lean soft tissue mass from BIA assessment in asian athletes.

This is my comment:

- in general the introduction appear too dispersive and the focus on the aim of the study is only in the end of the section. Much more references are used, some appear dated and others not relevant to the sentence (i.e. ref. 5).

- pag 2 line 66: please check "of muscle and muscle volume (MV),"

- is necessary a reference at pag. 4, line 102 "There are certain differences in the physiological quality of different races. Therefore, it is necessary to establish and verify the measurement equations of LSTM and BIA for Asian athletes."

- There is the use of "racial" terminology. Probably "ethnicity" is more appropriate. In addition, there are no information about the different socio-cultural habits in different populations instead the ethnicity-anthropological approach used in this manuscript.

- Why the authors choose to perform the assessments at 1:00 p.m? Before or after the lunch?

- no reference were reported for reliability of the instrumentation used in the manuscript.

- table 2 and table 3 is not clear. Please ensure the presentation.

- The authors performed a comparison of Sardinha equation. However, the Sardinha study was performed with a different BIA device. Please stated this aspect in discussion section and justify this choice.

- fig. 2 and 3 not reported any statistical results. Please add some additional informations.

- Why the authore not perfomed the ROC analysis as in 10.1186/s12967-023-04795-z

- please add some comment about the results described in fig. 3 b. and 3 d. Please clarify.

Reviewer #2: Abstract and elsewhere in the manuscript. The authors must make it clear that generated prediction equations are only applicable to measurements obtained at the locations used by the InBody device. These are unusual and not the commonly used wrist-ankle locations or the sole and palm as used in conventional stand-on devices.

Line 70 Strictly, BIA is considered a two-compartment model; a conductive compartment (FFM)and a non-conductive compartment (fat). It is a predictive or estimating method. It does NOT measure BMC although BIA manufacturers frequently provide a doubly indirect estimate. Please correct to describe BIA accurately as a 2C system.

Line 71 "non-penetrating" I believe that you mean non-invasive.

Line 86 onward. Again please avoid suggesting that BIA MEASURES body composition, e.g. line 9. It PREDICTS or ESTIMATES BC.

Line 146 Please make it clear whether you are simply making whole body impedance measurements or that the device measures segments.

Line 148. Why was this analyser used when the authors had available an alternative analyser (line 137). Why was the opportunity not taken to compare predictions from the two commercial analysers. In addition to testing their own equation? This would have added to the study.

Line 171. Were the ROI those provided by the software or adjusted/optimised by the DXA operator?

Lines 210-216. Please highlight some key observations from these data, e.g., a male female difference, apparent proportional effect in the LOA plots. At present, essentially fig titles are simply presented.

Line 217. Please state what was the basis for variable selection. Those chosen are typical for this type of study but their inclusion should be justified.

Line 218. Sex not gender.

Line 240 What is this reproducibility measure? How was it calculated? Does it have units?

Line 251. This picks up my first point. That empirically-derived prediction equations are population/device specific. Also highlights my point about why you did not test your Tanita predictions.

Line 284.and elsewhere. You quote absolute LOA, e.g., approximately +/-2.8 kg for leg LSTM. Since leg LSTM is around 19 kg, these LOA equate to about +/-15%. In practice the question is whether this level of inaccuracy is clinically acceptable? Would an athlete or coaches be happy with an estimate of LSTM with +/-15% LOA error. This point must be addressed. Your equation may perform better than the Sardinha equation but it may still not be sufficiently accurate for practical use.

Line 312. It is often found that inclusion of BIA in algorithms only improves prediction marginally compared to simple anthropometric predictions. Was this actually tested? If not why not?

Line 327 Include in limitations that the equation is specific to this device and population.

Line 347

What do you mean here by "proprietary"? Are you suggesting manufacturer's predictions?

**********

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

**********

[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.

Estimation equation of limb lean soft tissue mass in Asian athletes using bioelectrical impedance analysis

PONE-D-24-08399R1

Dear Dr. Hsieh,

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 will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, 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,

Gianpiero Greco

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 satisfactorily addressed the issues raised in my original review.

**********

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

**********