PONE-D-23-39724Exposing Telomere Length's Impact on Malnutrition Risk among Older Adults Residing in the Community: Insights from Cross-Sectional Data AnalysisPLOS ONE

Dear Dr. Brito-Costa,

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Academic Editor

PLOS ONE

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Additional Editor Comments:

Please follow the reviewers suggestions and improve the manuscript.

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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

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

Reviewer #1: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

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Reviewer #1: No

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Reviewer #1: 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 manuscript presents an important study on the association between telomere length and the risk of malnutrition among older adults. The research is methodologically sound, the data analysis is robust, and the findings are significant. The manuscript is well-structured and clearly written, making it a valuable contribution to the field of geriatric science.

Specific Comments:

1. Title and Abstract:

* The title is informative and accurately reflects the study's content.

* The abstract provides a concise and clear summary of the study. It effectively highlights the background, objectives, methods, results, and conclusions.

2. Introduction:

* The introduction is comprehensive and provides a good context for the study. It outlines the importance of investigating the relationship between telomere length and nutritional status in older adults.

* The literature review is thorough and identifies the gap that this study aims to fill.

3. Methods:

* The study design is appropriate for the research question. The cross-sectional design and the probabilistic sampling method are well-explained.

* The data collection process, including the use of validated tools like the Mini Nutritional Assessment and real-time qPCR for telomere length measurement, is clearly described.

* The statistical methods are appropriate and well-justified. However, providing more detail on the rationale for choosing specific statistical tests would enhance clarity. The software used for statistical analysis, specifically for the regression model, should be indicated. Currently, only the software for sample size calculation (G*Power) is mentioned.

* Suggestion for Additional Analysis:

* Consider including the following parameters to provide a more comprehensive evaluation of the model's fit (e.g. -2 Log Likelihood, Pseudo R^2 (Nagelkerke, Cox & Snell), Model Chi-Square, and a parameter to evaluate the model fit, maybe Hosmer-Lemeshow Test?)

* Additionally, only if the authors deemed interesting, adding ROC Curve and AUC to provide information on the discriminative power of the model could be valuable.

4. Results:

* The results are presented clearly and concisely. Tables and figures are used effectively to summarize the data.

* The findings indicate a significant association between shorter telomere length and increased risk of malnutrition. These results are discussed in the context of existing literature.

5. Discussion:

* The discussion section is well-organized and provides a comprehensive interpretation of the findings.

* The authors acknowledge the limitations of the cross-sectional design and potential selection bias. They also highlight the study's strengths, such as the large sample size and comprehensive analysis.

* The practical implications of the findings are discussed, and suggestions for future research are provided.

6. Conclusion:

* The conclusion succinctly summarizes the study's contributions and emphasizes the potential of telomere length as a biomarker for assessing nutritional risk in older adults.

* The call for further research to explore the underlying mechanisms and conduct longitudinal studies is well-founded.

7. Ethical Considerations:

* The manuscript includes an appropriate ethics statement, indicating approval from the relevant ethics committee and informed consent from participants.

8. Funding and Acknowledgments:

* The sources of funding are clearly disclosed, and the authors have declared no competing interests.

* The acknowledgments section appropriately credits those who contributed to the study.

9. Data Availability Statement:

* Suggestion: The manuscript currently does not include a data availability statement. PLOS ONE requires authors to make all data underlying the findings described in their manuscript fully available without restriction. Please include a data availability statement describing where the data supporting the findings can be accessed. This should be part of the manuscript or its supporting information, or deposited in a public repository. If there are any restrictions on publicly sharing data, such as participant privacy or use of data from a third party, please specify these restrictions.

_______________________________Recommendations for Revision:

1. Statistical Methods:

* Provide more detail on the rationale for choosing specific statistical tests in the methods section.

* Indicate the software used for the statistical analysis, specifically for the regression model.

2. Practical Applications:

* Include more specific examples of how the findings can be applied in clinical settings to prevent and treat malnutrition in older adults.

3. Additional Analysis:

* Incorporate the model evaluation parameters to provide a more comprehensive evaluation of the model's fit.

* Additionally, if deemed interesting, adding ROC Curve and AUC to provide information on the discriminative power of the model could be valuable.

4. Add Data Availability Statement:

* Include a data availability statement as per PLOS ONE's requirements. Describe where the data supporting the findings can be accessed, either as part of the manuscript, its supporting information, or deposited in a public repository. Specify any restrictions on data sharing, if applicable.

Conclusion: This manuscript provides valuable insights into the relationship between telomere length and malnutrition risk in older adults. It is methodologically sound, well-written, and makes a significant contribution to the field. I recommend it for publication with minor revisions to enhance clarity and ensure the results are communicated as effectively as possible.

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Reviewer #1: No

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Exposing Telomere Length's Impact on Malnutrition Risk among Older Adults Residing in the Community: Insights from Cross-Sectional Data Analysis

PONE-D-23-39724R1

Dear Dr. Brito-Costa,

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.

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Kind regards,

Gabriele Saretzki, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

the authors have carefully and comprehensively addressed the minor comments from the reviewer which greatly improved the manuscript,

Reviewers' comments: