Association between atherogenic index of plasma and depression in premenopausal and postmenopausal women: A cross-sectional study

Siyi Deng; Weihong Huang; Jinwen Liao; Yanling Liu; Yang Song; Gang Fu; Mingguo Xu

doi:10.1371/journal.pone.0327103

Peer Review History

Original SubmissionMarch 27, 2025
22 May 2025 Decision Letter - Emmanuel Ofori, Editor Dear Dr. Ming-Guo Xu, 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 Jul 06 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. 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'. 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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 study was supported by the Guangdong Basic and Applied Basic Research Foundation (2022A1515012468) and Shenzhen Longgang District science and technology innovation project (LGKCYLWS2022035).” Please include your amended statements within your cover letter; we will change the online submission form on your behalf. 5. 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 delete it from any other section. 6. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Additional Editor Comments (if provided): Thank you for choosing PLOS ONE. The manuscript has been reviewed and a decision of revision is required. Please address all editorial and reviewer comments in your revision. General comments An easy to follow paper worth publishing. Authors should however improve on the discussion part finding plausible explanations to support the results obtained or otherwise. There are few situations in text that need to be supported by citation/references. Abstract First sentence is quite misleading and repetitive. There are some few studies that has explored AIP and depression in postmenopause (see PMID: 39648880 ....... there are few others). Avoid these emphatic claims. I suggest we keep the second sentence (aim) only. Introduction Estrogen deficiency in m ADDIN EN.CITE on in hepatocytes, .........There appears something missing here. Authors should 'fix' this sentence Discussion Could we have some suggested explanations or discussion on why at AIP> 0.60, we have reduced risk of depression among the postmenopausal cohort. Is it due to chance (I doubt)?, the characteristics of the study cohort? This is pivotal and needs to be discussed. Authors should revisit the limitation section. Comment on the unavailability of data on estrogen and other endocrine and biomarkers and how they would have impacted findings..... [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? Reviewer #1: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: I Don't Know ****** 3. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #1: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes ****** Reviewer #1: Thank you for inviting me to review the manuscript. Author Ming-Guo Xu has submitted a research manuscript on Association between AIP and depression in pre and post menopausal women. The chosen topic gains significance that it is known that globally perimenopausal women are at significant risk of developing Depression. Few comments to consider: The manuscript is well written and is easy to follow Introduction: I would suggest to add relevant reference for increased susceptibility of postmenopausal women to Depression and also Association of AIP and depression among women in general.if any. There are few typo errors next to reference 3, pl look into that. Methods: The location of study may be mentioned in the methods section. Also elaborate on how the samples are collected. There is lack of information regarding the potential confounders and how they are handled ( describe the models). Results: Overweight and Obesity are known risk of metabolic syndrome and also atherosclerosis. Would like to know the influence of weight/BMI on the results. Limitations: Though mentioned, would suggest to list and discuss all the limitations of the study including the confounders, information bias, self reporting bias etc. ****** 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? 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If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org https://doi.org/10.1371/journal.pone.0327103.r001
Revision 1
6 Jun 2025 Author Response Dear Editor and Reviewer, On behalf of all the contributing authors, I would like to express our sincere appreciation of your constructive comments concerning our article entitled Association between Atherogenic Index of Plasma and depression in premenopausal and postmenopausal women: A cross-sectional study (Manuscript ID: PONE-D-25-15440). We have carefully revised the manuscript to enhance its clarity and facilitate the understanding of the readers. Our point-to-point responses are presented in the following. We hope that the revision will satisfactorily address the comments and concerns of the editors and reviewers. Our manuscript had been revised to meet PLOS ONE's stylistic requirements. According to the requirements of the journal, we remove any funding-related text from the manuscript and include a funding statement in the cover letter. Changes to our manuscript were all highlighted within the document by using yellow padding. Editor# General comments Question: Authors should however improve on the discussion part finding plausible explanations to support the results obtained or otherwise. There are few situations in text that need to be supported by citation/references. Response: Thanks for the comment. We had added discussion sections and added reference citations. We interpreted the finding that the risk of depression in postmenopausal women was reduced when the AIP was > 0.60. Abstract Question: There are some few studies that has explored AIP and depression in postmenopause (see PMID: 39648880 ....... there are few others). Avoid these emphatic claims. I suggest we keep the second sentence (aim) only. Response: Thanks for the comments and we agree with you. We keep the second sentence only. Introduction Question: Estrogen deficiency in m ADDIN EN.CITE on in hepatocytes, .........There appears something missing here. Authors should 'fix' this sentence. Response: Thanks. We had amended the sentence ‘Estrogen deficiency in menopausal women decreases estrogen receptor α expression in hepatocytes, resulting in altered expression of key enzymes and genes involved in lipid synthesis and catabolism, and increased serum levels of total cholesterol, triglycerides (TG), and low-density lipoprotein (LDL), and decreased levels of high-density lipoprotein (HDL)’. Discussion Question 1: Could we have some suggested explanations or discussion on why at AIP> 0.60, we have reduced risk of depression among the postmenopausal cohort. Is it due to chance (I doubt)?, the characteristics of the study cohort? This is pivotal and needs to be discussed. Response 1: Thanks for the valuable comments. We reviewed the literature on postmenopausal women's susceptibility to depression and the association of AIP and depression, and added relevant content and references where possible. According to the estrogen withdrawal theory, the likely reason for this is that estrogen levels in postmenopausal women decline significantly and fluctuate almost imperceptibly, and their effect on depression is stronger than the effect of atherosclerosis on depression. Another possible reason lies in the limitations of the study sample. In the population of postmenopausal women, the sample size of AIP > 0.6 was only 67, and the large difference in sample size has a non-negligible impact on the results. Due to the specificity of the postmenopausal period, the relationship between AIP and depression in the postmenopausal female population seems to be more complex compared to premenopausal women. In future studies, we should incorporate both estrogens as well as indicators of atherosclerosis to further explore the mechanisms of depression in postmenopausal women. Question 2: Authors should revisit the limitation section. Comment on the unavailability of data on estrogen and other endocrine and biomarkers and how they would have impacted findings..... Response 2: Thanks. Because complete years of estrogen data are not available in the NHANES database, we were unable to verify the relationship between estrogen levels and AIP at different menopausal states and whether estrogen levels affect the relationship between AIP and depression. Reviewer # Introduction Question: I would suggest to add relevant reference for increased susceptibility of postmenopausal women to Depression and also Association of AIP and depression among women in general.if any. Response: Thanks. We reviewed the literature on postmenopausal women's susceptibility to depression and added relevant content and references as possible. Methods Question: The location of study may be mentioned in the methods section. Also elaborate on how the samples are collected. There is lack of information regarding the potential confounders and how they are handled ( describe the models). Response: Thanks. We had added the location of study as well as detailed instructions on how to collect samples. We handled how to deal with potential confounders. Results Question: Overweight and Obesity are known risk of metabolic syndrome and also atherosclerosis. Would like to know the influence of weight/BMI on the results. Response: Thanks for the valuable comments. We divided into two groups according to BMI (BMI < 24 kg/m2 and BMI ≥24 kg/m2) and conducted subgroup analyses. We did not find an interaction in premenopausal and postmenopausal women. Limitations Question: Though mentioned, would suggest to list and discuss all the limitations of the study including the confounders, information bias, self reporting bias etc. Response: Thanks for the comments. We list the limitations of the study as much as possible. Thank you once again for your valuable feedback. I look forward to receiving further comments from you. If you have any further questions or need further discussion, please feel free to contact me at any time. Yours sincerely, All authors Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0327103.r002
10 June 2025 Decision Letter - Emmanuel Ofori, Editor <p>Association between Atherogenic Index of Plasma and depression in premenopausal and postmenopausal women: A cross-sectional study PONE-D-25-15440R1 Dear Dr. %Mingguo_Xu%, 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, Emmanuel Kwaku Ofori, PhD Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0327103.r003
Formally Accepted
Acceptance Letter - Emmanuel Ofori, Editor PONE-D-25-15440R1 PLOS ONE Dear Dr. Xu, 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 You will receive further instructions from the production team, including instructions on how to review your proof when it is ready. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few days 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 Emmanuel Kwaku Ofori Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0327103.r004

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