PONE-D-24-37623Short sleep duration is a significant risk factor of obesity: A multicenter observational study of healthy adults in JapanPLOS ONE

Dear Dr. Yamamichi,

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.

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We look forward to receiving your revised manuscript.

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Hidetaka Hamasaki

Academic Editor

PLOS ONE

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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

Reviewer #2: Yes

Reviewer #3: Partly

Reviewer #4: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: 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

Reviewer #3: No

Reviewer #4: Yes

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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

Reviewer #2: Yes

Reviewer #3: No

Reviewer #4: 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: This multicenter study examined the link between sleep duration and lifestyle-related disorders in Japanese population. The results showed longer sleep is linked to better health markers, while shorter sleep increases obesity risk. The findings of the study are valuable for promoting healthy lifestyles among local and Asian populations. However, I have several points of criticism for the authors to consider.

1.The study used healthy adults who came for a checkup. How did authors define a healthy population? How was the unhealthy population excluded? The exclusion criteria were not mentioned in the method section or Figure 1.

2.The study lacks data on ethnic groups within the population. The authors mention that the findings are relevant to an Asian demographic. Yet, the population in this study is likely dominated by East Asians. Please provide basic information on the ratios of other ethnic groups like South Asian, Caucasian, and Black.

3.Follow-up study: How long did the authors monitor the population? This needs clarification. Was the follow-up period sufficient to identify HR, particularly for glucose intolerance? The event rate for glucose intolerance is lower compared to the other two.

4.Quantitative data in Table 2 are not defined as mean ± SD, which should be detailed in the methods section.

Reviewer #2: 1. The manuscript is technically sound, and the data do support the conclusions.

2. The statistical analysis has been performed appropriately and rigorously.

3. The authors have made all data underlying the findings in their manuscript fully available.

4. The manuscript is presented in an intelligible fashion and written in standard English.

Reviewer #3: The study titled ‘short sleep duration is a significant risk factor of obesity: A multicenter observational study of healthy adults in Japan’ aimed to document the associations between sleep duration and the development of some metabolic distubances (obesity, glucose intolerance, dyslipidemia). The authors identified a cohort who had been received medical checkups from 2010 to 2020, they analyzed data of these participants cross-sectionally and longitudinally. After presenting the results, the authors conclude that shorter sleep duration is a significant risk factor for obesity.

The study is potentially attractive with its huge study population and popular topic. On the other hand, the presentation should be improved to clear doubts related to confounding factors.

1.The methodology is not clear. I suggest the authors to provide more detail about the medical check-up, the facility care of the study participants had been evaluated, the laboratory measurements (in a central or in various centers), the inclusion and exclusion criteria in more detail

2.Does Table 2 identify baseline characteristics of the study participants?

3.How many of the study participants were shift-workers?

4.How many of the study participants had thyroid dysfunctions?

5.How many of the study participants had been diagnosed with chronic diseases (hypertension, diabetes, dyslipidemia)?

6.How many of the study participants had been on sleep modifier medications, including antidepresants, antihistaminics, etc?

7.Did the authors have data related to family history of diabetes, dyslipidemia, etc?

8.Did the authors have data on menopause status of women participants? This may have impact on sleep duration

9.How many of the participants had been on hypolipidemic, antihypertensive drugs when evaluated longitudinally.

10.I suggest the authors to include triglyceride to HDL-C ratio as a surrogate marker of insulin resistance and may be considered a reliable marker for such a study.

11.In Table 2, I suggest the authors to provide the percentages of age in parenthesis.

12.In Discussion, it should be emphasized that most of the study population had normal BMI, and the obese patients constituted the minority. Such a population may not reflect the importance of the association between sleep duration and the investigated parameters.

Reviewer #4: The study is interesting and carries an important message on sleep.

The manuscript is clearly written however some minor revision is required

Please define what is habitual drinking and also habitual exercise?

In the discussion, can authors elaborate on the physiological mechanism of sleeping as mentioned.

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Reviewer #1: No

Reviewer #2: Yes:  Kassa Demissie Abdi (PhD)

Reviewer #3: No

Reviewer #4: No

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Attachments

Attachment

Submitted filename: Mansuscript26_1_with_embedded_tables-2.docx

PONE-D-24-37623R1Short sleep duration is a significant risk factor of obesity: A multicenter observational study of healthy adults in JapanPLOS ONE

Dear Dr. Yamamichi,

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 Mar 08 2025 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,

Hidetaka Hamasaki

Academic Editor

PLOS ONE

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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

Reviewer #3: 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

Reviewer #3: Partly

**********

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: 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

Reviewer #3: No

**********

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

Reviewer #3: 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: I conglutinate authors. All the comments have been addressed. The manuscript is now in a good shape for publication.

Reviewer #2: 1. All comments have been addressed.

2. The manuscript is technically sound, and the data supported the conclusions.

3. The statistical analysis has been performed appropriately and rigorously.

4. The authors have made all data underlying the findings in their manuscript fully available.

5. The manuscript is presented in an intelligible fashion and written in standard English.

Reviewer #3: The authors have revised the raised concerns properly. It has much improved. However, I have some more comments:

1. HDL-C levels differ between sex. Therefore, the cutoff values should be different for men (40 mg/dL) and for women (50 mg/dl).

2. Line 149, no habitual exercise, probably a typo error and it should be ‘habitual exercise’. Please check

3. Since fasting plasma glucose, postprandial plasma glucose, and HOMA-IR were not available, I suggest the authors to provide triglyceride to HDL-C ratio (TG/HDL-C) as a surrogate marker of insulin resistance. Please consider such an analysis.

4. The total observation period was 11 years. But what was the median or mean follow-up duration. Please specify. Were all of the participants with a follow-up duration shorter than a certain period (for example 1-year) excluded? please clarify

5. In regard to sleep duration, was it validated in sequential visits, or just the baseline data were considered in the analysis? Was there much participants with changing sleep habits? Please clarify.

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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:  Kassa Demissie Abdi (PhD)

Reviewer #3: 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.

Attachments

Attachment

Submitted filename: Revised Manuscript27_1_black.docx

Short sleep duration is a significant risk factor of obesity: A multicenter observational study of healthy adults in Japan

PONE-D-24-37623R2

Dear Dr. Yamamichi,

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,

Hidetaka Hamasaki

Academic Editor

PLOS ONE

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