Sex-specific association of visceral adiposity index with renal dysfunction in chinese type 2 diabetes: A cross-sectional study

Songfang Liu; Louyan Ma; Yu Niu; Ranran Ma; Ting Qi; Bingyin Shi

doi:10.1371/journal.pone.0343375

Peer Review History

Original SubmissionDecember 11, 2025
29 Dec 2025 Decision Letter - Aleksandra Klisic, Editor Dear Dr. Shi, 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 Feb 12 2026 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 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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We look forward to receiving your revised manuscript. Kind regards, Aleksandra Klisic 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. PLOS requires an ORCID iD for the corresponding author in Editorial Manager on papers submitted after December 6th, 2016. Please ensure that you have an ORCID iD and that it is validated in Editorial Manager. To do this, go to ‘Update my Information’ (in the upper left-hand corner of the main menu), and click on the Fetch/Validate link next to the ORCID field. 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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 If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [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 Reviewer #2: Yes ******** 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 Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes Reviewer #2: Yes ****** Reviewer #1: Thank you dear authors for conducting such important public health issue; saying this I would like to give my comments and I need some clarifications. 1. As much as possible it is better to avoid abbreviations on the Abstract section 2. The Abstract section lacks background which summarizes the magnitude and severity of renal dysfunction among T2DM patients and the real gaps filled by this specific study 3. How did you calculate the sample size in accordance with your source population manually or using software? 1300 Vs 1335 is unclear. 4. What is your outcome variable? it hasn't been well emphasized 5. What were the limitations of your study? 6. How did you resolve incompleteness of records, eligibility issues for the incompletes 7. What was the main reason why you didn't you conduct a community based study and collect primary data? Lastly, it is better to present your findings using tables and figures as well. Reviewer #2: Its a really interesting topic, it must have been well thought before execution began. The research also has a generous sample size which makes it very valid. Your results also give a positive correlation to your topic, which is quite good. A few things i would like to point out include 1. Your figures should have been in the body of the results and not the appendix to make the work easier to understand. While the tables are okay in the appendix, the figures should be in the body of your work. 2. Instead of the meaning of all the abbreviations for indices being under table 2 in the appendix. It should preferably be in a list form and very bold so it can be properly seen. preferably just after the disclosure statement. ****** 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: ADEFUSI TEMILOLUWA ******** [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.] To ensure your figures meet our technical requirements, please review our figure guidelines: https://journals.plos.org/plosone/s/figures You may also use PLOS’s free figure tool, NAAS, to help you prepare publication quality figures: https://journals.plos.org/plosone/s/figures#loc-tools-for-figure-preparation. NAAS will assess whether your figures meet our technical requirements by comparing each figure against our figure specifications. https://doi.org/10.1371/journal.pone.0343375.r001
Revision 1
7 Jan 2026 Author Response Response to Journal Requirements: 1.Formatting and Style: We have reviewed the PLOS ONE style requirements and adjusted the file naming and manuscript formatting accordingly. 2.ORCID iD: The corresponding author has updated their information in Editorial Manager and validated their ORCID iD as requested. 3.Ethics Statement: We confirm that the ethics statement is now exclusively located in the Methods section of the manuscript. 4.Data Availability: We have updated our Data Availability Statement. The minimal data set underlying the findings described in our manuscript has been uploaded as Supporting Information (S1 Dataset). 5. References: We have checked the reference list for completeness and correctness, ensuring no retracted papers are cited. Response to Reviewer #1 1.As much as possible it is better to avoid abbreviations on the Abstract section. Reply: Thank you for this suggestion. We have revised the Abstract to minimize abbreviations. Terms such as T2DM, eGFR, and VAI have been spelled out where appropriate to improve readability. Changes made: [See Abstract, Page 1-2] 2.The Abstract section lacks background which summarizes the magnitude and severity of renal dysfunction among T2DM patients and the real gaps filled by this specific study. Reply: We have added a background sentence to the Abstract to contextualize the study. It now briefly highlights the impact of renal dysfunction in diabetes and the gap regarding visceral adiposity indices in the Chinese population. Changes made: [See Abstract, Page 1] 3.How did you calculate the sample size in accordance with your source population manually or using software? 1300 Vs 1335 is unclear. Reply: We apologize for the confusion. The sample size of 1,300 was our calculated target to ensure sufficient power for sex-stratified analysis. The final number of eligible participants enrolled was 1,335, which met and slightly exceeded this target. We have clarified this distinction in the "Sample Size Calculation" section. Changes made: [See Methods, "Sample Size Calculation" section, Page 5] 4.What is your outcome variable? it hasn't been well emphasized. Reply: We have revised the text to explicitly state that the primary outcome variable is renal dysfunction, defined as an eGFR < 60 mL/min/1.73 m². Changes made: [See Methods, "Variables" section, Page 6-7] 5.What were the limitations of your study? Reply: We have reviewed the "limitations" paragraph in the Discussion section. We explicitly acknowledge the single-center design, the cross-sectional nature preventing causal inference, and potential residual confounding. We have also added a note regarding the retrospective nature of data collection. Changes made: [See Discussion, Page 21] 6.How did you resolve incompleteness of records, eligibility issues for the incompletes. Reply: Participants with missing data on core variables (key visceral fat markers or renal function) were excluded from the study as per our exclusion criteria. For covariates with minimal missing data (<5%), we utilized multiple imputation to minimize bias and maximize data utility. We have clarified this in the Statistical Analysis section. Changes made: [See Methods, "Statistical Analysis" section, Page 7-8] 7.What was the main reason why you didn't you conduct a community based study and collect primary data? Reply: This is a valuable question. We chose a hospital-based retrospective design for two main reasons: Clinical Precision: Hospital records provide more comprehensive and precise laboratory measurements (e.g., specific biochemical markers) compared to what is typically feasible in large-scale community screenings. Efficiency: Utilizing electronic medical records allowed us to efficiently analyze a large cohort of confirmed T2DM patients to generate hypotheses regarding sex-specific differences, which can subsequently be tested in future prospective community-based studies. 8. Lastly, it is better to present your findings using tables and figures as well. Reply: Thank you for this suggestion. We have ensured that our findings are comprehensively presented using Tables and Figures. Regarding the placement of figures, we initially moved them into the text body per your suggestion; however, in strict adherence to the journal’s submission guidelines received from the Editorial Office, we are required to upload figures as separate high-resolution files (TIFF/EPS) rather than embedding them in the manuscript. We have ensured that the Figure Legends are clearly placed within the Results section to indicate the logical flow of the findings. Changes made: [Figures have been uploaded as separate files per journal policy; Figure Legends are retained in the Results section] Response to Reviewer #2 1.Your figures should have been in the body of the results and not the appendix to make the work easier to understand. While the tables are okay in the appendix, the figures should be in the body of your work. Reply: We fully appreciate and agree with the reviewer’s view that placing figures within the text improves readability. However, we have received specific technical instructions from the Editorial Office requiring us to remove embedded images from the manuscript file and upload them as separate standard image files (TIFF/EPS). Therefore, to comply with the journal’s production requirements, we have uploaded the figures separately. The submission system will automatically compile these files into the final PDF for your review. We have placed the Figure Legends within the body of the Results section to assist with the reading flow. Changes made: [Embedded figures were removed and uploaded as separate files to comply with editorial instructions] 2.Instead of the meaning of all the abbreviations for indices being under table 2 in the appendix. It should preferably be in a list form and very bold so it can be properly seen. preferably just after the disclosure statement. Reply: We have created a bolded List of Abbreviations and placed it immediately after the Disclosure statement as requested, ensuring all indices are clearly defined for the reader. Changes made: [See Page 23] Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0343375.r002
21 Jan 2026 Decision Letter - Aleksandra Klisic, Editor Dear Dr. Shi, 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 07 2026 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 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 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, Aleksandra Klisic Academic Editor PLOS One Journal Requirements: If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. 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. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author Reviewer #2: (No Response) ******** 2. Is the manuscript technically sound, and do the data support the conclusions??> Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #2: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #2: Yes ****** Reviewer #2: The article has been properly revised, it is concise and precise to read. I appreciate that the tables have been incorporated in the results section for easy correlation too and plagiarism issues have been addressed. However, i still do not think it right that we have picture legends and footnotes in the midst of the article and the pictures aren't preceding it. it makes more sense that the picture legends and footnotes are where the pictures are, either in the body of work or in the appendix. Thank you. ****** 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 #2: Yes: ADEFUSI TEMILOLUWA ******** [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.] To ensure your figures meet our technical requirements, please review our figure guidelines: https://journals.plos.org/plosone/s/figures You may also use PLOS’s free figure tool, NAAS, to help you prepare publication quality figures: https://journals.plos.org/plosone/s/figures#loc-tools-for-figure-preparation. NAAS will assess whether your figures meet our technical requirements by comparing each figure against our figure specifications. https://doi.org/10.1371/journal.pone.0343375.r003
Revision 2
25 Jan 2026 Author Response Response to Reviewer #2 We sincerely thank the reviewer for this thoughtful comment and fully understand the concern regarding the placement of figure legends and footnotes. However, we would like to clarify that this format is in accordance with PLOS ONE's submission requirements. During our previous revision submission, when we included figures alongside their legends in the main text (following the reviewer's preference), the submission failed the journal's format check. We received the following specific instruction from the journal: "Please remove your figures from within your manuscript file, leaving only the individual TIFF/EPS image files. These will be automatically included in the reviewer's PDF." Following this guidance, we removed all embedded figures and uploaded them as separate image files. Therefore, the current format—with figure legends in the manuscript and figures as separate files—is in compliance with PLOS ONE's submission guidelines. Once the manuscript is accepted and published, the figures and their corresponding legends will be properly integrated in the final published version. We sincerely appreciate the reviewer's understanding on this matter. Attachments Attachment Submitted filename: Response_to_Reviewers_auresp_2.docx https://doi.org/10.1371/journal.pone.0343375.r004
5 Feb 2026 Decision Letter - Aleksandra Klisic, Editor Sex-specific Association of Visceral Adiposity Index with Renal Dysfunction in Chinese Type 2 Diabetes: A Cross-sectional Study PONE-D-25-64102R2 Dear Dr. Shi, 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. For questions related to billing, please contact billing support . 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, Aleksandra Klisic Academic Editor PLOS One Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions??> Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #2: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #2: Yes ****** Reviewer #2: All necessary comments raised have been addressed. It is a very insightful and interesting study. Well done ****** 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 #2: Yes: Adefusi Temiloluwa ******** https://doi.org/10.1371/journal.pone.0343375.r005
Formally Accepted
Acceptance Letter - Aleksandra Klisic, Editor PONE-D-25-64102R2 PLOS One Dear Dr. Shi, 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. You will receive an invoice from PLOS for your publication fee after your manuscript has reached the completed accept phase. If you receive an email requesting payment before acceptance or for any other service, this may be a phishing scheme. Learn how to identify phishing emails and protect your accounts at https://explore.plos.org/phishing. 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. Aleksandra Klisic Academic Editor PLOS One https://doi.org/10.1371/journal.pone.0343375.r006

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