Obesity Parameters as Predictor of Poor Outcomes in Hospitalized Patients with Confirmed Mild-to-Moderate COVID-19

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This study assessed the correlation between multiple anthropometric parameters including visceral fat values, waist circumference (WC),  body mass index (BMI), and body fat percentage and poor outcomes during 2021 COVID-19 patients’ hospitalization.

The major limitation of this study is that these data describe a clinical spectrum of COVID disease  which is no longer existing, therefore generalizability in the present COVID era where COVID is primarily affecting  immunocompromised individuals,  is not obvious.

These results are not fully original, but confirm  the predictive value of waist circumference with adverse health outcomes in Indonesia.

 The paper is well organized ad witten

Then following minor issues should be changed:

Page 3 line 131-133: please describe average waist circumference and body fat %,  separately in men and women

Page 11 line 241: it is not true that this is the first examined various obesity parameters and their associations with poor  outcomes in hospitalized COVID-19 . Other studied used even more sophisticated anthropometric variables to predict mortality (e. G. https://pubmed.ncbi.nlm.nih.gov/36145141/)

Author Response

Comment 1: Page 3 line 131-133: please describe average waist circumference and body fat %, separately in men and women.

Response 1: Thank you for the reviewer's valuable insights. In this revised manuscript, we conducted a new analysis of average waist circumference and body fat percentage, separately for men and women. Our findings revealed an average waist circumference of 94.9 cm in men and 91.5 cm in women. Similarly, the average body fat percentage was 26.0% in men and 38.7% in women. Additionally, we have included these supplementary results (Page 4, Lines 152-155) and a corresponding table (Page 7, Table 2) in the revised manuscript.

Comment 2: Page 11 line 241: it is not true that this is the first examined various obesity parameters and their associations with poor outcomes in hospitalized COVID-19. Other studied used even more sophisticated anthropometric variables to predict mortality (e. G. https://pubmed.ncbi.nlm.nih.gov/36145141/)

Response 2: Thank you for the reviewer's feedback. In response, we have removed the statement claiming that our study was the first to examine various obesity parameters and their associations with poor outcomes in hospitalized COVID-19 patients.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Line 25 - what is BIA? 

Line 47- Obesity is associated with MASLD (former term NAFLD) and vitamin D deficiency. This influence also development of other infections such as UTI, bacterial pneumonia Clostridioidis difficile colitis etc. Please include paragraph about it. Some literature to review: NAFLD and Infection, a Nuanced Relationship - PubMed (nih.gov) and Association between Average Vitamin D Levels and COVID-19 Mortality in 19 European Countries—A Population-Based Study - PMC (nih.gov)

3. Line 105- BIA was used to measure fat percentage but normal values were not reported?

4. Please explain in methodology what was mild vs moderate covid infection? Did all patients have pneumonia? 

 

5. Please explain if you controlled for the treatment that patients received? were all patients treated with same protocol based on severity of the disease?

6. Did you control for development of secondary bacterial pneumonia, DVT etc

7. Limitations of the study are that vitamin D level was not measured and compared between the groups 

 

Comments on the Quality of English Language

moderate editing needed

Author Response

Comment 1: Line 25 - what is BIA? 

Response 1: Thank you for the reviewer’s feedback. BIA is abbreviation of bioimpendance analyzer (Page 1, Line 25).

Comment 2: Line 47- Obesity is associated with MASLD (former term NAFLD) and vitamin D deficiency. This influence also development of other infections such as UTI, bacterial pneumonia Clostridioidis difficile colitis etc. Please include paragraph about it. Some literature to review: NAFLD and Infection, a Nuanced Relationship - PubMed (nih.gov) and Association between Average Vitamin D Levels and COVID-19 Mortality in 19 European Countries—A Population-Based Study - PMC (nih.gov)

Response 2: We appreciate the reviewer’s valuable insights. We have included an explanation of the intricate relationship between obesity, MASLD, vitamin D deficiency, and infections in the revised manuscript (Page 2, Lines 53-62).

Comment 3: Line 105- BIA was used to measure fat percentage but normal values were not reported?

Response 3: We appreciate the valuable insights provided by the reviewer. We have added BIA normal values of fat percentages in the revised manuscript. BIA normal values of fat percentages for men were 10-21% for 18-39 years old, 11-22% for 40-59 years old, and 13-24% for ≥ 60 years old; and for women, 20-34% for 18-39 years old, 21-35% for 40-59 years old, and 22-36% for ≥ 60 years old (Page 3, Line 114-117).

Comment 4: Please explain in methodology what was mild vs moderate covid infection? Did all patients have pneumonia? 

Response 4: Thank you for the reviewer's feedback. We have added an explanation of mild and moderate COVID-19 infection, clarifying that not all individuals have pneumonia. Mild disease severity was defined as symptomatic patients who met the COVID-19 case definition without evidence of viral pneumonia or hypoxia. Moderate severity was defined as patients who met the COVID-19 case definition and exhibited clinical signs of pneumonia (fever, cough, dyspnea, rapid breathing) but did not show signs of severe pneumonia, with SpO2 ≥ 90% on room air (Page 3, Lines 89-94)..

Comment 5: Please explain if you controlled for the treatment that patients received? were all patients treated with same protocol based on severity of the disease?

Response 5: Thank you for reviewer's In this study, we did not control for the treatment protocols, as patients were treated according to the severity of their disease and the clinical judgment of their healthcare providers.

Comment 6: Did you control for development of secondary bacterial pneumonia, DVT etc

Response 6: Thank you for reviewer's In this study, we did not control for the development of secondary infections such as bacterial pneumonia or complications like DVT.

Comment 7: Limitations of the study are that vitamin D level was not measured and compared between the groups

Response 7: We appreciate the reviewer’s feedback. We have now included the limitation that vitamin D levels were not measured in this study (Page 13, Line 271).

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

I would like to thank authors for addressing some of my points. Since you did not control for different treatments, DVT prophylaxis, development of secondary bacterial infection, and all of these might affect the outcome, I would suggest adding all of these in the limitations

Comments on the Quality of English Language

minor edits

Author Response

Comment 1: I would like to thank authors for addressing some of my points. Since you did not control for different treatments, DVT prophylaxis, development of secondary bacterial infection, and all of these might affect the outcome, I would suggest adding all of these in the limitations.

Response 1: Thank you for the reviewer's feedback. We have now included the limitation that we did not control for variations in treatment regimens, DVT prophylaxis, or the occurrence of secondary bacterial infections, which could have influenced the outcomes (Page 12, Line 262-269).

 

Comment 2: Comments on the quality of English language: minor edits.

Response 2: We appreciate the reviewer’s valuable insights. In response, we have done a minor English language editing in our revised manuscript.

 

Author Response File: Author Response.pdf