-->PONE-D-25-22005-->-->The consumption of dietary supplements among active individuals in Saudi Arabia-->-->PLOS ONE

Dear Dr. Alsayegh,

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We look forward to receiving your revised manuscript.

Kind regards,

Jordan Llego, PhD ELM, D. Hon. Ex., PhDN, RN

Academic Editor

PLOS ONE

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9. 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.

Additional Editor Comments:

Thank you for submitting “The consumption of dietary supplements among active individuals in Saudi Arabia” to PLOS ONE. We appreciate the time, effort, and thought you have invested in this important work. Both reviewers recognize that your topic is timely and highly relevant for public health in Saudi Arabia. At the same time, they have identified several key areas—ranging from methods to analysis and presentation—where the manuscript could be strengthened. With thoughtful revisions, your study has the potential to make a meaningful contribution to the field.

First, please update your literature review and discussion to include recent, region-specific studies. Reviewer 1 has pointed to three particularly relevant papers—Aljebeli et al. (Cureus, 2023), Alotaibi et al. (Saudi Pharmaceutical Journal, 2024), and Alshehri et al. (Nutrients, 2025)—that will help sharpen your rationale and place your findings in the context of current Saudi data, including among female fitness-center populations. Integrating these references will also strengthen your interpretation of knowledge and attitude results. Where your findings differ from recent reports, briefly explore possible reasons, such as differences in sampling, setting, or definitions.

Second, please clarify your sampling approach and discuss its limitations more transparently. While you describe a two-stage cluster design with region-specific targets, actual recruitment was carried out online with the help of volunteers and gym administrators. This may have led to selection bias, favoring gym-affiliated and digitally connected participants, and under-representing others like community sports club members or informal exercisers. To strengthen your methods section, please: (a) explain how you compiled gym lists, which platforms you used, and how many gyms were contacted versus those that participated; (b) report the denominator, response rate, and regional yield; and (c) discuss representativeness in light of the large number of fitness facilities in Saudi Arabia, as Reviewer 1 suggested. If you did not use sampling weights, please update your description to reflect a nonprobability sample and temper your conclusions accordingly. These sampling considerations, along with recall and social desirability bias from self-reporting, should be clearly acknowledged in your Limitations section.

Third, please clarify your definitions and measurements. “Dietary supplements” can mean different things in various studies and policies, and products such as energy drinks, herbal remedies, protein powders, and prescribed supplements are often grouped together. Please provide a clear, authoritative definition (such as from the SFDA or DSHEA), specify exactly what you told participants qualified as a supplement, and break down supplement use by category (vitamins/minerals, protein powders, creatine or other ergogenics, herbal products, energy drinks, physician-prescribed products, and those recommended by dietitians). As Reviewer 2 observed, distinguishing between prescribed/nutritionist-suggested supplements and sports-nutrition products will help readers understand the behaviors you’re reporting.

Fourth, consider streamlining and refocusing your tables for clarity. As Reviewer 2 noted, Tables 1 and 2 repeat information that is later stratified in Tables 3 and 4. You can enhance readability by combining baseline characteristics into a single, compact table and moving extra descriptive details to the Supplement. Main-text tables should directly support your study’s objectives—such as showing prevalence overall and by subgroups, or presenting adjusted associations. For Table 5, which currently mixes “knowledge and practice” items, please either (a) explain why these items are included and how they relate to your aims or (b) move less relevant items to the Supplement and revise the text to align outcomes with objectives. Across all tables, standardize denominators, ensure percentages add up, report exact p-values, and avoid overlapping bivariate tests that could inflate error rates. Focusing your tables this way will make your findings easier to interpret and more impactful.

Fifth, please revise your modeling strategy and reporting. Currently, there are inconsistencies in the structural equation modeling (SEM) results—for example, reporting a “non-significant Chi-square” together with a “P-value: 0.000.” Please re-calculate and report fit indices (including χ² with degrees of freedom and p-value, CFI/TLI, RMSEA with 90% CI, and SRMR), using an estimator suited for ordinal data, such as WLSMV. Before conducting path analysis, establish your measurement models for the latent constructs (“knowledge and practices” and “health”) by including factor loadings, reliability (ω/α), and rationale for item inclusion. Please also explain why age and nationality were removed for “low loadings,” since these are demographic variables, not latent factor indicators. If you continue using SEM, clarify what specific research question it addresses, and avoid causal language since your data are cross-sectional. Addressing these modeling issues will help readers trust and understand your analytic approach.

Sixth, please make sure your aims, results, and conclusions are all aligned. Reviewer 2 pointed out that your conclusion suggests supplements had effects on endurance, energy, or health—outcomes not directly assessed in your study. If you wish to report participants’ perceptions of such effects, add this explicitly to your Objectives, specify which survey items measured perceived effects, and present those results consistently throughout your manuscript. Otherwise, revise your Abstract, Discussion, and Conclusion to keep the focus on prevalence, patterns, and correlates of supplement use, rather than on any effects.

Seventh, please strengthen your documentation of the survey instrument and data transparency. While you mention that the questionnaire was “self-developed” and “adapted from validated questionnaires,” it’s important to detail how you adapted and translated the instrument, including any pilot testing or psychometric evaluation. Please provide the original sources, describe the adaptation and translation/back-translation steps, and summarize cognitive testing and reliability metrics for each scale. Consider including item wording in a Supplement. Also, per PLOS ONE requirements, make the de-identified dataset and code available in a stable repository with DOIs at the time of revision, and update your Data Availability Statement accordingly. Finally, please confirm that your funding statement makes clear the funder’s role (or lack thereof) in study design, analysis, and publication decisions, and that your ethics and consent reporting matches both the Methods and submission system.

Eighth, your manuscript would benefit from careful language and presentation polishing. There are some recurring grammatical errors (e.g., “predectors,” “demonistrated”), spacing and capitalization inconsistencies, rounding issues, and a few contradictions between text and figures. We recommend a professional English-language edit and a final technical review to ensure consistency in your data and presentation. These steps will help your work read smoothly and appear as strong as possible.

In your rebuttal, in addition to responding to both reviewers’ comments point by point, please also include: (1) a clear plan for which tables will stay in the main text versus the Supplement (and your reasoning); (2) a precise operational definition of “dietary supplement” as used in your survey, along with updated, category-specific results; (3) corrected and fully reported SEM/CFA results (or your rationale for removing these analyses, if you choose to focus on descriptive or associational findings); (4) an expanded Limitations section, including discussion of selection and coverage bias from your online, gym-based recruitment and whether sampling weights were used; and (5) updated references from 2023–2025, including but not limited to the three key works suggested by Reviewer 1.

We look forward to receiving your thoroughly revised manuscript, along with a detailed response to reviewers and tracked-changes files. This decision is based on the version you submitted and the peer reviews provided. Thank you again for your hard work and commitment to improving your study.

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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: Partly

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

Reviewer #1: Yes

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 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: Yes

Reviewer #2: No

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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

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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 manuscript investigates the prevalence and patterns of dietary supplement consumption among physically active individuals in Saudi Arabia. This is an interesting topic given the increasing popularity of supplements and limited data in this region.

I have few recommendations

more updated references should be cited

1) Aljebeli, Shahad et al. “The Prevalence and Awareness of Dietary Supplement Use Among Saudi Women Visiting Fitness Centers in Riyadh, Saudi Arabia.” Cureus vol. 15,6 e41031. 27 Jun. 2023, doi:10.7759/cureus.41031

2) Alotaibi, Abdulkarim F et al. “Pattern of dietary supplement use and its psychosocial predictors among females visiting fitness centers in Saudi Arabia: Findings from a cross-sectional study.” Saudi pharmaceutical journal : SPJ : the official publication of the Saudi Pharmaceutical Society vol. 32,3 (2024): 101966. doi:10.1016/j.jsps.2024.101966

Alshehri, A.A.; Alqahtani, S.; Aldajani, R.; Alsharabi, B.; Alzahrani, W.; Alguthami, G.; Khawagi, W.Y.; Arida, H. Knowledge, Attitudes, and Practices of Dietary Supplement Use in Western Saudi Arabia: A Cross-Sectional Study. Nutrients 2025, 17, 1233. https://doi.org/10.3390/nu17071233

I think more limitation should be addressed such as

selection bias as the questionnaire was distributed online though gym administration taking into account that there is around 3,966 fitness gym is KSA. Participants may be recruited from gyms, fitness centers, or sports clubs, which may not represent all active Saudis.

Participants may include herbal products, energy drinks, protein powders, or even medications under "supplements," which makes comparisons difficult and inn the study there was clarification about supplements used by the participants

Reviewer #2: Tables 1 & 2 are additional, while these characteristics are already presented in Tables 3 & 4 with more details in relation to the use or non-use of nutritional supplements. There is information about the specific use or consumption of nutritional supplements, including vitamins, herbs etc. and further it can be categorized with other health characteristics, etc.

The details of prescribed supplements in addition to dietary nutritional supplements and the nutritionist's suggested supplements are not categorized.

Data presented in table 5 related to the knowledge and practice in relation to consumption of nutritional supplements is irrelevant and not in line with the rationale of the study.

Conclusion of study is also not in accordance with the findings/results, as the effect of nutritional supplements is not the objective of study. the perception of participants about their effect on their health should be added in the objectives and detailed in the results and discussion part.

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Reviewer #1: Yes:  Khloud Ghafouri

Reviewer #2: Yes:  Intisar Ahmad Siddiqui

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-->PONE-D-25-22005R1-->-->The consumption of dietary supplements among active individuals in Saudi Arabia-->-->PLOS ONE

Dear Dr. Alsayegh,

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 Jan 02 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.

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,

Jordan Llego, PhD ELM, D. Hon. Ex., PhDN, RN

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.

Additional Editor Comments:

Thank you for submitting the revised version of your manuscript, “The consumption of dietary supplements among active individuals in Saudi Arabia.” We appreciate all the effort you’ve put into responding to the initial feedback from reviewers and the editorial office. Your revisions show real commitment, especially with the updated literature review, moving some tables to the supplementary section, removing copyrighted materials, and expanding the limitations. Despite these improvements, a careful review shows that the manuscript still isn’t quite ready for publication. A number of important methodological, analytical, and reporting issues still need attention before the paper can progress.

One major concern is the structural equation modeling. Although you recalculated the model using the recommended WLSMV estimator, the fit indices are still below the journal’s standards, and the reporting needs to be more transparent. Key details—such as confirmatory factor analysis results, factor loadings, measurement model validation, and reliability for latent constructs—are missing. The reasoning behind grouping different items into latent variables also needs more explanation. Additionally, age and nationality are still presented as if they’re psychometric constructs rather than categorical predictors. These points affect the statistical validity of the model and should be clarified or reconsidered.

The sampling strategy also needs clearer explanation. While you’ve clarified some parts of the process, the manuscript still doesn’t mention how many gyms were contacted, the response rate, or exactly how volunteers and administrators were involved in recruiting participants. It’s also not clear how representative the sample is, since the study uses non-probability purposive sampling among gym-goers, but the conclusions suggest national-level generalizability. Please consider either adjusting the claims or providing more detail to make the methodology transparent.

The data availability statement still doesn’t meet PLOS ONE requirements. The journal asks that the minimal dataset be publicly available unless there’s a strong ethical or legal reason not to. Saying that data is available upon request isn’t enough. Please update this section either by depositing the dataset in a public repository or by giving a clear justification, supported by your institution’s policy, and naming a data access committee if needed.

The way dietary supplements are defined and categorized still needs work. You’ve included the DSHEA definition, but the results don’t separate out the different types of supplements participants used. Because “dietary supplements” covers such a wide range, not breaking them down makes it hard to interpret the findings. Reviewers specifically asked for a clear distinction between products like vitamins, herbs, protein powders, energy drinks, and prescribed supplements. This breakdown should be included in both the methods and results sections.

The questionnaire documentation also needs more detail. While you mention a pilot study and approval from the National Nutrition Committee, the manuscript still doesn’t explain how the questionnaire was adapted and translated, how cognitive testing was done, or provide psychometric details like internal consistency or construct validity. These are important for transparency and reproducibility, especially since the instrument is self-developed and key to your study. Please also include the full questionnaire or its item list as supplementary material.

There are also some conceptual and interpretive inconsistencies to address. The abstract, discussion, and conclusion still imply that dietary supplements affect health and performance, even though the study didn’t measure these outcomes. If perceived effects are part of your objectives, please make this clear in your analysis and presentation. If not, revise the conclusions so they match the descriptive and correlational nature of your data, and avoid using causal language throughout the manuscript.

Finally, even though you submitted a proofreading certificate, there are still some grammar issues, formatting inconsistencies, repeated statements, and unclear phrases that affect readability. Tables, figures, and statistical outputs would also benefit from careful editing to improve their accuracy and clarity.

Because of these remaining concerns, the manuscript will need another significant revision before it can be considered for publication. We encourage you to address all the methodological, statistical, and reporting issues, make sure your conclusions match your data, provide more transparency about the survey instrument, and review the language and presentation throughout. With thoughtful and thorough revision, this study could offer valuable insights into dietary supplement use among active individuals in Saudi Arabia. We look forward to seeing your revised version.

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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 #2: 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 #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 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 #2: Yes

**********

-->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 #2: Yes

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-->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 #2: The revision has addressed the comments, and modifications have been made in the revised manuscript. It can be accepted for further processing.

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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 #2: Yes:  Intisar Ahmad Siddiqui

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-->PONE-D-25-22005R2-->-->The consumption of dietary supplements among active individuals in Saudi Arabia-->-->PLOS One

Dear Dr. Alsayegh,

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 27 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.

Please include the following items when submitting your revised manuscript:-->

• 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 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,

Jordan Llego, PhD ELM, D. Hon. Ex., PhDN, RN

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.

Additional Editor Comments (if provided):

Thank you for sharing the revised version of your manuscript, “The consumption of dietary supplements among active individuals in Saudi Arabia” (Manuscript ID: PONE-D-25-22005R2). We truly appreciate the time and thoughtful effort you put into addressing the earlier editorial and reviewer comments.

After carefully reviewing your revised manuscript and your detailed response to reviewers, I’m pleased to let you know your work has improved substantially and is now very close to meeting the journal’s publication standards. Your study benefits from a large national sample, greater methodological transparency, and clearer reporting of questionnaire development and validation. The discussion is now more balanced and avoids causal overinterpretation. These changes have strengthened both the scientific rigor and clarity of your work.

However, there are still a few important points to address before your manuscript can be accepted.

First, while the structural equation modeling section is now clearer, some concerns remain about the measurement model’s robustness and reporting. Specifically, the relatively low factor-loading threshold, borderline fit indices, and the inclusion of a demographic latent construct with a non-significant path need clearer justification. You might want to strengthen your reporting of the CFA and reliability for each construct, or consider simplifying your analytical approach if that makes sense. Addressing this will help readers have more confidence in your model and its interpretation.

Second, the data availability statement, though expanded, may still need more clarity for full compliance with PLOS ONE policy. Please clearly state the ethical or legal reasons for restricting public access to the dataset and make sure they align with your institution’s regulations. If possible, let us know whether a de-identified or partial dataset could be shared, or clarify exactly under what conditions data access can be granted.

Third, your manuscript would benefit from a careful language edit. While your content is generally clear, there are still a few grammatical errors, typos, and minor inconsistencies in terminology to address for a polished, professional presentation.

In light of these points, the editorial decision is Minor Revision. We encourage you to address the issues above and submit a revised manuscript along with a brief, point-by-point response explaining how you handled each concern.

I believe these final refinements will make your work even stronger and ready for publication in PLOS ONE. We look forward to your revised submission.

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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.]

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.

-->

-->PONE-D-25-22005R3-->-->Dietary supplement consumption among active individuals in Saudi Arabia-->-->PLOS One

Dear Dr. Alsayegh,

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 Apr 05 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.

Please include the following items when submitting your revised manuscript:-->

• 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 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,

Jordan Llego, PhD ELM, D. Hon. Ex., PhDN, RN

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.

Additional Editor Comments:

Thank you for sending in the revised version of your manuscript, “The consumption of dietary supplements among active individuals in Saudi Arabia” (Manuscript ID: PONE-D-25-22005R3). I appreciate the time and care you’ve put into addressing the previous editorial comments.

After reviewing your latest submission and response letter, I’m glad to see the manuscript has improved even further and is now very close to meeting the journal’s publication standards. Your updates to the measurement model and SEM reporting directly address the earlier concerns, and the overall writing is clearer and more consistent.

Before I can give a final acceptance, there are just a few small issues to sort out to make sure everything meets PLOS ONE’s policies and to avoid any last-minute delays. Most importantly, please double-check that your Data Availability statement in the manuscript matches what you’ve selected in the submission system. Right now, the manuscript says an anonymized dataset is available in the Supporting Information, but the submission metadata suggests there may be restrictions—these need to be consistent. If the data are fully available, please say so clearly in both places and indicate there are no restrictions. If there are restrictions, please explain the ethical or legal reasons, say who can be contacted for data access, and clarify exactly what can be shared and under what circumstances.

Also, please do a final check to make sure that ethics approval numbers, funding information, institutional names, and any reference codes are listed the same way throughout your manuscript and submission materials. Although the writing is much improved, it’s a good idea to do one last careful edit for typos, consistent use of terms and abbreviations, and to make sure all supplementary files are correctly named, uploaded, and referenced in the text.

With these final points in mind, the editorial decision is Minor Revision. Please send your revised manuscript along with a short point-by-point response explaining how you addressed each issue.

[Note: HTML markup is below. Please do not edit.]

[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.

-->

-->PONE-D-25-22005R4-->-->Dietary supplement consumption among active individuals in Saudi Arabia-->-->PLOS One

Dear Dr. Alsayegh,

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 May 31 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.

Please include the following items when submitting your revised manuscript:-->

• 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 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.

As the corresponding author, your ORCID iD is verified in the submission system and will appear in the published article. PLOS supports the use of ORCID, and we encourage all coauthors to register for an ORCID iD and use it as well. Please encourage your coauthors to verify their ORCID iD within the submission system before final acceptance, as unverified ORCID iDs will not appear in the published article. Only   the individual author can complete the verification step; PLOS staff cannot   verify ORCID iDs on behalf of authors.

We look forward to receiving your revised manuscript.

Kind regards,

Jordan Llego, PhD ELM, D. Hon. Ex., PhDN, RN

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.

Additional Editor Comments:

Thank you for submitting the fourth revised version of the manuscript entitled “Dietary supplement consumption among active individuals in Saudi Arabia.” The manuscript demonstrates improvement and continues to address a relevant public health topic with a substantial national sample. However, following editorial assessment, the manuscript is not yet ready for acceptance in its current form. A further round of major revision is required before the paper can be reconsidered for publication.

The primary reason for this decision is the presence of unresolved issues regarding internal consistency. Specifically, the manuscript does not present a coherent interpretation of the role of demographic factors. In the abstract, demographic factors are reported as not exhibiting a significant effect. In the Results section, several demographic variables in the bivariate analysis are reported as statistically significant. In the SEM section, the demographic domain is described as non-significant. In the Conclusion, sociodemographic factors are again described as significantly associated with dietary supplement consumption. These statements are not interchangeable and should not be presented together without clear explanation. It is essential to distinguish between variables significant in the bivariate analysis and those remaining significant in the structural model, and this distinction must be maintained consistently across the Abstract, Results, Discussion, and Conclusion. Address this concern with precision, ensuring that the manuscript reflects only what the analyses support.

A second major concern involves the description and interpretation of the measurement and modeling procedures. In the abstract, the questionnaire is described as a self-developed Likert-scale instrument, while in the Methods section it is characterized as adapted from validated local and international tools with minor modifications. This inconsistency should be resolved to ensure a single, accurate, and consistent description of the instrument. Furthermore, the manuscript states that good model fit is indicated by RMSEA <0.05, CFI ≥0.92, and a non-significant chi-squared statistic, yet the reported SEM results do not fully meet these criteria. Additionally, the manuscript claims that construct validity was supported by CFA, although the reported fit indices are only modest rather than unequivocally strong. These sections require revision to provide a more precise and methodologically defensible interpretation of the model fit and validation results.

The manuscript also requires a more rigorous final editorial review. Visible formatting and presentation issues persist, including unresolved currency notation and wording that indicate the manuscript has not undergone a thorough final proofread. Although these issues may seem minor compared to the conceptual concerns, they affect the overall credibility and polish of the submission. Terminology, symbols, table labels, and sentence-level wording should be fully standardized throughout the revised manuscript. I strongly encourage you to respond to each remaining issue directly and precisely. A persuasive revision will not simply say that concerns have been addressed; it must show exactly how the interpretation has been corrected, where the text has been revised, and why the final wording now matches the evidence presented. In particular, the revised manuscript must present a coherent analytical story from the abstract to the conclusion, especially with respect to the demographic findings and the interpretation of the SEM results.

[Note: HTML markup is below. Please do not edit.]

[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.

-->

Dietary supplement consumption among active individuals in Saudi Arabia

PONE-D-25-22005R5

Dear Dr. Alsayegh,

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,

Jordan Llego, PhD ELM, D. Hon. Ex., PhDN, RN

Academic Editor

PLOS One

Additional Editor Comments (optional):

Thank you for submitting the revised version of your manuscript entitled “Dietary supplement consumption among active individuals in Saudi Arabia”.

I am pleased to inform you that the manuscript is now accepted for publication. The revised version has adequately addressed the previously raised concerns, particularly the clarification of demographic findings, the consistent description of the questionnaire, and the more appropriate interpretation of the SEM results.

Only routine editorial and proofreading corrections may be made during the production stage to ensure consistency in formatting, terminology, symbols, and sentence-level presentation.

Congratulations to you and your co-authors.

Reviewers' comments: