Increased Insulin Resistance in Hepatitis-C Infection—Association with Altered Hepatic Function Testing
Round 1
Reviewer 1 Report
In this study, the authors discussed Insulin Resistance in Hepatitis C. Tey used a cross-sectional observational study to test their hypothesises. They correlated it with some of the traditional metabolic parameters, including liver and kidney function, lipid profile, and serum ferritin level. Finally, they concluded an increased incidence of insulin resistance in the patients with hepatitis-C infection.
Aim of the work: The authors stated their objective as follows; This study aimed to assess the Insulin Resistance in Hepatitis C and its correlation with various metabolic parameters. Which lack the novelty as many published research and review articles discussed the high incidence of insulin states in chronic hepatitis C infection patients; some of the references are listed down. So the authors should reformulate the aim of the work to fulfil the novelty of the study
Del Campo JA, Romero-Gómez M. Steatosis and insulin resistance in hepatitis C: a way out for the virus? World J Gastroenterol. 2009 Oct 28;15(40):5014-9. doi: 10.3748/wjg.15.5014. PMID: 19859993; PMCID: PMC2768879.
Basaranoglu M, Basaranoglu G. Pathophysiology of insulin resistance and steatosis in patients with chronic viral hepatitis. World J Gastroenterol. 2011 Sep 28;17(36):4055-62. doi: 10.3748/wjg.v17.i36.4055. PMID: 22039318; PMCID: PMC3203355.
Bose SK, Ray R. Hepatitis C virus infection and insulin resistance. World J Diabetes. 2014 Feb 15;5(1):52-8. doi: 10.4239/wjd.v5.i1.52. PMID: 24567801; PMCID: PMC3932427.
Methods:
1- The authors used a cross-section observation study to test their hypothesis, and the population selected all are diabetics, which means they all are with various degrees of insulin resistance states then they later on subclassified into Diabetic with or without HCV
The method of population sample is an improper way to test their hypothesis
It is better to select all with chronic HCV infection, investigate the metabolic parameters that diagnose and dected the development of insulin resistant state, and then calculate the nicdence among all HCV-positive patients.
2- The authors used ALT,AST,GGT,HbA1c,and HOMA -IR as well as the traditional lipid profile to confirm the metabolic disorders that proposed to be associated with IR state
To verify their results, it is better to use more specific parameters for the development and the metabolic effects of IR as Triglyceride /HDL ratio and small dense LDL and oxidized LDL.
Discussion:
The authors presented their discussion as a description of the results with minimal explanation.So, the discussion should improve their discussion with more explanation of their results.
Author Response
Thank you very much for reviewing my work and bringing up some suggestions.
I am answering you all of them below:
1. Aim of the work: The authors stated their objective as follows; This study aimed to assess the Insulin Resistance in Hepatitis C and its correlation with various metabolic parameters. Which lack the novelty as many published research and review articles discussed the high incidence of insulin states in chronic hepatitis C infection patients; some of the references are listed down. So the authors should reformulate the aim of the work to fulfill the novelty of the study
Answer: - Our aim is not only to find the Insulin resistance in Hepatitis C which has been done by a number of studies but to correlate with other parameters of insulin resistance so as to further approve the previous studies as some other studies are shown that mechanism of hepatitis c related liver steatosis is different than NAFLD.
2. The authors used a cross-section observation study to test their hypothesis, and the population selected all are diabetics, which means they all are with various degrees of insulin resistance states then they later on subclassified into Diabetic with or without HCV
The method of population sample is an improper way to test their hypothesis
It is better to select all with chronic HCV infection, investigate the metabolic parameters that diagnose and detected the development of the insulin-resistant state, and then calculate the incidence among all HCV-positive patients.
Answer: - I have changed this.
3.
The authors used ALT,AST,GGT,HbA1c,and HOMA -IR as well as the traditional lipid profile to confirm the metabolic disorders that proposed to be associated with IR state
To verify their results, it is better to use more specific parameters for the development and the metabolic effects of IR as Triglyceride /HDL ratio and small dense LDL and oxidized LDL.
Answer: - I have added TG/HDL ratio but I cannot add two other parameters this time as it takes a lot of time.
4.
Discussion:
The authors presented their discussion as a description of the results with minimal explanation. So, the discussion should improve their discussion with more explanation of their results.
Answer: - I have improved the discussion section.
Reviewer 2 Report
Mishra PR et al. reported that insulin resistance in hepatitis C and its correlation with various metabolic parameters.
1. In Discussion section, authors had better mention about PNPLA3 and discuss more. See the reference: Nakamura M, et al. No correlation between PNPLA3 rs738409 genotype and fatty liver and hepatic cirrhosis in Japanese patients with HCV. PLoS One. 2013 Dec 11;8(12):e81312. doi: 10.1371/journal.pone.0081312. PMID: 24349054
Author Response
Thank you very much for reviewing my article. i am very grateful that you told me to add this point in my discussion.
In Discussion section, authors had better mention about PNPLA3 and discuss more. See the reference: Nakamura M, et al. No correlation between PNPLA3 rs738409 genotype and fatty liver and hepatic cirrhosis in Japanese patients with HCV. PLoS One. 2013 Dec 11;8(12):e81312. doi: 10.1371/journal.pone.0081312. PMID: 24349054
Answer: - I have added it in the discussion section.
Reviewer 3 Report
In the article ‘Insulin Resistance in Hepatitis C and its Correlation with Various Metabolic Parameters’, the author tries to study the relationship between Hepatitis and Insulin Resistance. It is a valuable clinical study. However, there are some shortcomings and questions.
1) In the line 154-156: Blood sugar levels measured before meals as well as after meals were not substantially different between the two groups of patients…, we commonly use blood glucose instead of blood sugar.
2) The English language should be improved overall.
3) In the line 118: Figure 1. Showing the presence of insulin resistance among patients with hepatic fibrosis. In the figure, there is no error bar.
Author Response
Thank you very much for reviewing my manuscript.
1) In the line 154-156: Blood sugar levels measured before meals as well as after meals were not substantially different between the two groups of patients…, we commonly use blood glucose instead of blood sugar.
Answer: - I have changed it.
2) The English language should be improved overall.
Answer: - Done
3) In the line 118: Figure 1. Showing the presence of insulin resistance among patients with hepatic fibrosis. In the figure, there is no error bar.
Answer:- Error bar has been added.
Round 2
Reviewer 1 Report
Accepted
