Dear Dr. pei,

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.

Kind regards,

Amir Hossein Behnoush

Academic Editor

PLOS ONE

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[This study was supported by two major projects of Hunan Province, China: 2021SK2004; 2021SK1040;c].

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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?

Reviewer #1: Yes

Reviewer #2: Yes

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

Reviewer #1: I Don't Know

Reviewer #2: Yes

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

The PLOS Data policy

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Dear Authors, I had the privilege to review the manuscript PONE-D-24-54649 entitled "Association of predicted lean body mass and fat mass with prognosis in patients with heart failure preserved ejection fraction" for possibile publication in PLOS one.

In this trial you evaluated the role of lean BMI and FMI in a cohort of HF patients enrolled in the TOPCAT trial showing that a lower Lean BMI and a higher FMI were associated with an increased risk of primary endpoint events and all-cause mortality. The limits of a BMI only-centred evaluation in HF are already well known being the base of the "obesity paradox" concept, as you also explain in your manuscript.

Trying to estimate the body composition in HF patients is, therefore, important from a prognostic point of view.

My evaluation includes a positive feedback.

I suggest to expand the discussion section including more previous studies and trying to suggest more clinical implication. Moreover, could you analyze the impact of spironolactone in different lean BMI/FMI subgroups?

Reviewer #2: This manuscript is well-written, to-the-point, and statistically accurate. I have one point to recommend:

Several studies have shown that it is the waist circumference (and not BMI) that is a significant risk factor for many cardiovascular disorders and cardiovascular events. I believe at least some of these studies must be discussed in your manuscript since visceral fat, lean body mass, and fat mass are greatly emphasizing the waist circumference over BMI. Here are some articles that I recommend to add to your manuscript: PMID: 32020062 (discusses importance of waist circumference) ,PMID: 37227560 ( shows significant association between major cardiovascular events including heart failure and waist circumference, I highly recommend both)

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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:  Massimo Mapelli

Reviewer #2: Yes:  Alireza Ramandi

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[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.]

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Association of predicted lean body mass and fat mass with prognosis in patients with heart failure preserved ejection fraction

PONE-D-24-54649R1

Dear Dr. pei,

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,

Amir Hossein Behnoush

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions??>

Reviewer #1: Yes

Reviewer #2: Yes

**********

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

Reviewer #1: I Don't Know

Reviewer #2: Yes

**********

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

The PLOS Data policy

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

Reviewer #2: Yes

**********

Reviewer #1: I think the article improved after the authors addressed the minor revisions requested. The discussion has been expanded accordingly

Reviewer #2: thank you for your revision. All comments have been addressed and all questions have been addressed appropriately.

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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:  Massimo Mapelli

Reviewer #2: Yes:  Alireza Ramandi

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