Relationship between youth cardiometabolic health and physical activity in medical records

Bethany Forseth; Janelle R. Noel-MacDonnell; Sarah Hampl; Jordan A. Carlson; Kelsee Halpin; Ann Davis; Tarin Phillips; Robin P. Shook

doi:10.1371/journal.pone.0303583

Peer Review History

Original SubmissionJanuary 2, 2024
1 Mar 2024 Decision Letter - Toby Edward Mansell, Editor Transfer Alert This paper was transferred from another journal. As a result, its full editorial history (including decision letters, peer reviews and author responses) may not be present. PONE-D-23-36566Relationship between youth cardiometabolic health and physical activity in medical recordsPLOS ONE Dear Dr. Forseth, 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. ============================== The reviewers have identified aspects of the abstract that require revision, and have identified limitations of this study that require acknowledgement and/or discussion. In addition, please clarify the structure of the mixed models used (lines 177-178), particularly what was considered as random vs. fixed effects. ============================== Please submit your revised manuscript by Apr 15 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'. 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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, Toby Edward Mansell, PhD, MBiostat 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. In the online submission form, you indicated that data cannot be shared publicly because of it is identifiable patient data from electronic medical records. Data may be requested from the Children's Mercy Hospital Institutional Data Access / Ethics Committee (contact bhanson4@kumc.edu for more details and guidance) for researchers who meet the criteria for access to confidential data. All PLOS journals now require all data underlying the findings described in their manuscript to be freely available to other researchers, either 1. In a public repository, 2. Within the manuscript itself, or 3. Uploaded as supplementary information. This policy applies to all data except where public deposition would breach compliance with the protocol approved by your research ethics board. If your data cannot be made publicly available for ethical or legal reasons (e.g., public availability would compromise patient privacy), please explain your reasons on resubmission and your exemption request will be escalated for approval. 3. Your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please move it to the Methods section and delete it from any other section. Please ensure that your ethics statement is included in your manuscript, as the ethics statement entered into the online submission form will not be published alongside your manuscript. 4. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. [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: Partly ******** 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 ****** 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: The study contributes valuable information to the field and highlights the potential benefits of incorporating lifestyle assessment questions into electronic medical records for identifying children at higher risk for adverse cardiometabolic health. The Author is aware about the study limitations but the following could be added: Dichotomizing physical activity and screen time into meeting or not meeting recommendations oversimplifies the complexity of physical activity and screen time behaviors, potentially overlooking nuanced variations in lifestyle. Although the study used a large data set with racial diversity, its generalizability is limited due to many factors, such as the exclusion of missed data and type I diabetics. Self-reported data can be subject to biases, including social desirability bias, where respondents may provide answers they believe are socially acceptable rather than accurate Reviewer #2: Dear Editor, I would like to express my appreciation for having the opportunity to review the manuscript titled: "Relationship between youth cardiometabolic health and physical activity in medical records." The manuscript is well-written, and the author has put in a commendable effort to prepare it. However, there are some comments that I believe need to be addressed: Abstract: -The background section lacks clarity and should be rewritten to present the problem instead of just reporting results. -Abbreviations must be mentioned in the abstract or before the start of the manuscript text in the metadata. -The conclusion does not effectively summarize the findings and should be rewritten. The authors did not evaluate the dietary intake and diet habits which is very important and make a very serious limitation for their study. In a cross-sectional study investigating the correlation between physical activity and cardiometabolic risk factors, evaluating and assessing dietary intake and habits is crucial for several reasons: Understanding Confounding Variables: Dietary intake and habits can act as confounding variables in the relationship between physical activity and cardiometabolic risk factors. Without controlling for diet, it's challenging to ascertain whether observed effects are truly due to physical activity or if they are influenced by dietary factors. Assessing Lifestyle Patterns: Diet and physical activity are intertwined aspects of lifestyle. Evaluating both allows researchers to understand the holistic lifestyle patterns of participants. This comprehensive approach helps in identifying potential interactions and associations between diet, physical activity, and cardiometabolic risk factors. Identifying Mediating Effects: Dietary factors may mediate the relationship between physical activity and cardiometabolic risk factors. For instance, certain dietary patterns might amplify or mitigate the effects of physical activity on cardiometabolic health. By assessing diet, researchers can explore these potential mediating mechanisms. Enhancing Generalizability: Including dietary assessment enhances the generalizability of findings. Diet varies across populations and regions due to cultural, economic, and environmental factors. Assessing dietary intake and habits allows researchers to account for these differences and generalize findings to broader populations. Informing Intervention Strategies: Understanding participants' dietary habits provides valuable insights for designing effective intervention strategies. For instance, if certain dietary patterns exacerbate cardiometabolic risk factors, interventions can target dietary modifications alongside promoting physical activity. Comprehensive Risk Assessment: Cardiometabolic risk is influenced by multiple factors, including both physical activity and diet. Assessing dietary intake alongside physical activity provides a more comprehensive understanding of individuals' overall risk profiles. This holistic approach enables better risk stratification and personalized interventions. Data Interpretation and Adjustment: When analyzing data, researchers can adjust for dietary variables to isolate the specific effects of physical activity on cardiometabolic risk factors. This adjustment helps in elucidating the independent contribution of physical activity while accounting for potential dietary confounders. Promoting Public Health Recommendations: Findings from studies examining the relationship between physical activity, diet, and cardiometabolic risk factors can inform public health recommendations. Understanding how dietary factors interact with physical activity informs guidelines for promoting healthier lifestyles and reducing cardiometabolic risk at the population level. ****** 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: Yes: Dr. Anees Alyafei 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. https://doi.org/10.1371/journal.pone.0303583.r001
Revision 1
12 Apr 2024 Author Response Dear Editor Mansell, Editorial Board, and reviewers, Thank you for your review of our manuscript, ‘Relationship between youth cardiometabolic health and physical activity in medical records.’ We appreciate the time and thoughtfulness that you put into the reviews. We have edited the paper based on your comments and have also directly responded to the comments below. We apologize in advance, track changes were not on when we revised the abstract, so changes to not appear in the ‘track changes’ version, but this was updated! 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 Thank you for the helpful links! We have updated headers, figure / table /supplemental file names, references, etc. 2. In the online submission form, you indicated that data cannot be shared publicly because of it is identifiable patient data from electronic medical records. Data may be requested from the Children's Mercy Hospital Institutional Data Access / Ethics Committee (contact bhanson4@kumc.edu for more details and guidance) for researchers who meet the criteria for access to confidential data. All PLOS journals now require all data underlying the findings described in their manuscript to be freely available to other researchers, either 1. In a public repository, 2. Within the manuscript itself, or 3. Uploaded as supplementary information. This policy applies to all data except where public deposition would breach compliance with the protocol approved by your research ethics board. If your data cannot be made publicly available for ethical or legal reasons (e.g., public availability would compromise patient privacy), please explain your reasons on resubmission and your exemption request will be escalated for approval. Thank you for supporting transparency with data and publicly available data. Our dataset was created from electronic medical records from one hospital (the hospital is identified by name in the paper on the ethics approval line) and contains many data aspects that may compromise patient privacy. We did reach out to our IRB to identify best options for sharing the data. The IRB responded that our study was not approved to share patient data. We are able to share deidentified data with other researchers who complete a data user sharing agreement with Children’s Mercy; this agreement will need to be completed with the Children’s Mercy Office of Research Business Partners. As corresponding author, if another researchers requests the data I am happy to help with working through this process the data user agreement with the Children’s Mercy Institution. 3. your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please move it to the Methods section and delete it from any other section. Please ensure that your ethics statement is included in your manuscript, as the ethics statement entered into the online submission form will not be published alongside your manuscript. We have included an ethic statement in the methods section (line 112) and nowhere else in the manuscript. Per this request, we have removed the ‘ethics approval’ statement from the end of the main manuscript document following the conclusion. 4. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. We have included a caption for our supporting information table that matches the text. We have updated our supporting information file (supplemental table 1) and modified our IRB documents to ‘other’ files. Editor Please clarify the structure of the mixed models used (lines 177-178), particularly what was considered as random vs. fixed effects. Thank you for catching this missing information. We have added this information into the manuscript (Lines 178-180 – in the track changes document). Reviewer 1 The study contributes valuable information to the field and highlights the potential benefits of incorporating lifestyle assessment questions into electronic medical records for identifying children at higher risk for adverse cardiometabolic health. The Author is aware about the study limitations but the following could be added: Dichotomizing physical activity and screen time into meeting or not meeting recommendations oversimplifies the complexity of physical activity and screen time behaviors, potentially overlooking nuanced variations in lifestyle. This is an excellent point. We have included a comment on this into the limitation (lines 302-305– in the track changes document). Although the study used a large data set with racial diversity, its generalizability is limited due to many factors, such as the exclusion of missed data and type I diabetics. This has been added to the limitations on generalizability the population (lines 307 – 310– in the track changes document). Self-reported data can be subject to biases, including social desirability bias, where respondents may provide answers they believe are socially acceptable rather than accurate This is correct, thank you for pointing out this specific bias. We have included this into the limitations (line 302– in the track changes document). Reviewer 2 I would like to express my appreciation for having the opportunity to review the manuscript titled: "Relationship between youth cardiometabolic health and physical activity in medical records." The manuscript is well-written, and the author has put in a commendable effort to prepare it. However, there are some comments that I believe need to be addressed: Abstract: -The background section lacks clarity and should be rewritten to present the problem instead of just reporting results. Thank you for this comment, we have added additional information into the background to provide reader with more formation on the lack of research on this topic (lines 48-50– in the track changes document). We apologize – track changes were not tracked in the abstract. -Abbreviations must be mentioned in the abstract or before the start of the manuscript text in the metadata. Thank you for catching this. We have now defined ‘Odds Ratio’ (OR) for the statistical results within the abstract (line 61– in the track changes document). We apologize – track changes were not tracked in the abstract. -The conclusion does not effectively summarize the findings and should be rewritten. We have re-worked the conclusion to better represent our findings (Line 65– in the track changes document). We apologize – track changes were not tracked in the abstract. The authors did not evaluate the dietary intake and diet habits which is very important and make a very serious limitation for their study. In a cross-sectional study investigating the correlation between physical activity and cardiometabolic risk factors, evaluating and assessing dietary intake and habits is crucial for several reasons: Understanding Confounding Variables: Dietary intake and habits can act as confounding variables in the relationship between physical activity and cardiometabolic risk factors. Without controlling for diet, it's challenging to ascertain whether observed effects are truly due to physical activity or if they are influenced by dietary factors. Assessing Lifestyle Patterns: Diet and physical activity are intertwined aspects of lifestyle. Evaluating both allows researchers to understand the holistic lifestyle patterns of participants. This comprehensive approach helps in identifying potential interactions and associations between diet, physical activity, and cardiometabolic risk factors. Identifying Mediating Effects: Dietary factors may mediate the relationship between physical activity and cardiometabolic risk factors. For instance, certain dietary patterns might amplify or mitigate the effects of physical activity on cardiometabolic health. By assessing diet, researchers can explore these potential mediating mechanisms. Enhancing Generalizability: Including dietary assessment enhances the generalizability of findings. Diet varies across populations and regions due to cultural, economic, and environmental factors. Assessing dietary intake and habits allows researchers to account for these differences and generalize findings to broader populations. Informing Intervention Strategies: Understanding participants' dietary habits provides valuable insights for designing effective intervention strategies. For instance, if certain dietary patterns exacerbate cardiometabolic risk factors, interventions can target dietary modifications alongside promoting physical activity. Comprehensive Risk Assessment: Cardiometabolic risk is influenced by multiple factors, including both physical activity and diet. Assessing dietary intake alongside physical activity provides a more comprehensive understanding of individuals' overall risk profiles. This holistic approach enables better risk stratification and personalized interventions. Data Interpretation and Adjustment: When analyzing data, researchers can adjust for dietary variables to isolate the specific effects of physical activity on cardiometabolic risk factors. This adjustment helps in elucidating the independent contribution of physical activity while accounting for potential dietary confounders. Promoting Public Health Recommendations: Findings from studies examining the relationship between physical activity, diet, and cardiometabolic risk factors can inform public health recommendations. Understanding how dietary factors interact with physical activity informs guidelines for promoting healthier lifestyles and reducing cardiometabolic risk at the population level. Thank you for you recommendation of the importance of dietary measures and their inclusion within health behavior research. We agree dietary measures are important components of health and how their addition could strengthen our paper and the field of research. This is definitely something we hope to consider for future papers, but due to limitations of the data and the scope of this paper, we are unable to incorporate diet behaviors/intake into this specific manuscript. We have recognized the importance of diet and other health behaviors related to cardiometabolic health into the discussion (lines 259-265) and highlight the scientific limitations (data interpretation and moderating effects) of this paper without the ability to report these variables (lines 305-307– in the track changes document). Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0303583.r002
29 Apr 2024 Decision Letter - Toby Edward Mansell, Editor Relationship between youth cardiometabolic health and physical activity in medical records PONE-D-23-36566R1 Dear Dr. Forseth, 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, Toby Edward Mansell, PhD, MBiostat Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0303583.r003
Formally Accepted
10 May 2024 Acceptance Letter - Toby Edward Mansell, Editor PONE-D-23-36566R1 PLOS ONE Dear Dr. Forseth, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, 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 customercare@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. Toby Edward Mansell Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0303583.r004

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