Analysis of Correlation between the Socioeconomic Environment and Level of Nutrition in the Population of Serbia: A Part of the National Survey
, Natasa Zdravkovic 4, Vladan Markovic 5, Jagoda Gavrilovic 6, Mirjana Veselinovic 4, Jelena Vuckovic-Filipovic 4, Katarina Nikolic 7, Olivera Milovanovic 8, Branimir Radmanovic 9, Bojan Milosevic 10, Rada Vucic 4, Stefan Jakovljevic 10, Vesna Ignjatovic 11 and Snezana Radovanovic 12Round 1
Reviewer 1 Report
This is a good work that adds evidence on the existing correlation between the degree of nutrition and socioeconomic factors. However, some points are not clear:
1. What is the study design? Is it an ecological study?
2. How was the sample size calculated? How was the sampling done? Was it probabilistic?
3. What were the inclusion and exclusion criteria?
4. For ease of reading, the authors could show the logistic regression scatterplot for the most important results.
Author Response
Dear reviewer,
Thank you on your valuable comments.We have answered on all your questions and all changes are done in the newly submitted Manuscript like you suggested. They are all marked on yellow so they can be more visible.
- What is the study design? Is it an ecological study?
Answer: It is a descriptive analytic, cross-sectional study based on the national data. Study investigates the socioeconomic environment influence on the nutrition levels and similar studies that investigates the impact of the nutrition were published in this section: https://www.mdpi.com/2071-1050/15/3/2382, https://www.mdpi.com/2071-1050/15/10/8226, https://www.mdpi.com/2071-1050/15/13/9865, https://www.mdpi.com/2071-1050/14/17/10589
- How was the sample size calculated? How was the sampling done? Was it probabilistic?
Answer: As this is a descriptive, analytical study based on the National data from 2019 it wasn’t necessary to calculated sample size. Sample size in the national data is calculated according to the recommendations of European Health Interview Survey – ЕHIS wave 3. These precision requirements for all data sets of EHIS wave are expressed in standard errors and are defined as continuous functions of the actual estimates and of the size of the statistical population in a country (https://ec.europa.eu/eurostat/documents/3859598/8762193/KS-02-18-240-EN-N.pdf/5fa53ed4-4367-41c4-b3f5-260ced9ff2f6). Each member state assures that the national sample size chosen fulfills the precision desired under the estimation strategy used.
- What were the inclusion and exclusion criteria?
Answer: Inclusion criteria were all adults older than 20 years who gave their informative consent and exclusion criteria were people under the age of 20, uncompleted survey and people with health problems where they were not being able to stand up.
- For ease of reading, the authors could show the logistic regression scatterplot for the most important results.
Answer: There were a lot of statistically significant results so there would be a lot of scatterplots, that’s why we have decided to show results only through the tables.
Reviewer 2 Report
Obesity is one of the significant health problems of our time, contributing to lifestyle-related diseases.
This paper is meaningful, although it is only an analysis of Serbia.
In general, there is nothing to suggest any modification, but the following points may be helpful in your discussion．
1) One of the reasons for the high percentage of obesity among married people may be stressed about work, partners, and family.
2) In the analysis by age, the distribution of BMI appears to be different for both men and women below and above the age of 44. How about mentioning this point?
This may be due to factors such as differences in the amount of exercise, stress levels, and stress relief methods.
The following are minor remarks.
1) L113 purpous → purpose?
infomative → informative?
2) L151 Tabel 2 → Table 2
3) L194 oveweight → overweight
Author Response
1) One of the reasons for the high percentage of obesity among married people may be stressed about work, partners, and family.
Answer: Yes, we agree with this statements and it is added through discussion part.
Other factors that are mentioned as the results of overweigh are stress about work, partner and family problems highlighting the importance of healthy social environment on the obesity but also on the overall health.
2) In the analysis by age, the distribution of BMI appears to be different for both men and women below and above the age of 44. How about mentioning this point?
Answer: This will be mentioned in the discussion.
Both men and women are less obese in age group below the age of 44 which can be explained due to different life-styles and activities people undergo when they are younger, they have difference in the amount of exercises but also have more active time, different stress levels and stress relief methods.
This may be due to factors such as differences in the amount of exercise, stress levels, and stress relief methods.
The following are minor remarks.
1) L113 purpous → purpose?
infomative → informative?
2) L151 Tabel 2 → Table 2
3) L194 oveweight → overweight
Answer: Thank you for these suggestions, they are changed.
Reviewer 3 Report
A minor revision is required before this manuscript was accepted for publication.
1. It is suggested that the author introduce more about the current situation of obesity and overweight in Serbians and previous similar analysis, so that readers can better understand the value of the manuscript
2. Introduction: As mentioned by the authors in the introduction, the obesity rate of the population in developed countries may increase with the decrease in income, but the authors did not delve into its causes and effects. It is recommended that the authors conduct a comprehensive analysis based on the situation in Serbia.
3. L123: More necessary details should be given about how to obtain body height and weight.
4. Three-line tables are more common in a scientific manuscript.
5. Basis for setting age groups like this.
6. How to distinguish different “Index of well beings”.
7. Discussion: The authors should provide more in-depth explanations of the phenomenon rather than just describing and comparing it.
Minor editing of English language required.
Author Response
- It is suggested that the author introduce more about the current situation of obesity and overweight in Serbians and previous similar analysis, so that readers can better understand the value of the manuscript
Answer: It has been added into the text.
Previous research articles that dealt with this subject showed similar trend in the rising number of overweighed people in Serbia where women were more likely to be obese and man were more likely to be overweighed. In 2017 the results showed significant correlation of obesity and socio-economic factors with obesity and overweight in the people older than 50 years. Researches expressed the concerning facts about this pandemic trend in the overweighed people in the European countries and its connection to the global aging and impact on the health spending. Obesity in adults and children in Serbia are reaching epidemic proportions, as is the case with other countries in transition.In Serbia, in 2019, based on the measured BMI value, more than half (57.1%) of the population were overweighed, pre-obese (36.3%) and obese (20.8%). In contrast to obesity, which was approximately equally prevalent in both sexes (men 21.7%, women 20.0%), pre-obesity was more common in men (43.4%) than in women (29.9%).
- Introduction: As mentioned by the authors in the introduction, the obesity rate of the population in developed countries may increase with the decrease in income, but the authors did not delve into its causes and effects. It is recommended that the authors conduct a comprehensive analysis based on the situation in Serbia.
Answer: Causes and certain effects were added into the introduction, and the more detailed analysis of the factors that influences the overweight is presented through the discussion part. All changes are marked in the Manuscript.
- L123: More necessary details should be given about how to obtain body height and weight.
Answer: Formula for BMI: weight (kg) / [height (m2)]
With the metric system, the formula for BMI is weight in kilograms divided by height in meters squared. Body weight was measured using electronic balance for medical use. Body height was measured using an adjustable altimeter SECA.
- Three-line tables are more common in a scientific manuscript.
Answer: It is changed as suggested.
- Basis for setting age groups like this.
Answer: Investigations that were done in Serbia used this pattern in setting the age groups so for the better comparison we used the same. They were cited through the Manuscript.
- How to distinguish different “Index of well beings”.
Answer: We have changed Index of wellbeing to household income and changed the classification levels to Low income, middle income and High income.
- Discussion: The authors should provide more in-depth explanations of the phenomenon rather than just describing and comparing it.
Answer: It is added on the places where the explanations were not written enough.
Round 2
Reviewer 1 Report
The authors did a good job responding to my previous concerns.
