Low Serum 25-Hydroxyvitamin D Levels Are Related to Frailty and Sarcopenia in Patients with Chronic Liver Disease

Round 1

Reviewer 1 Report

I would like to congratulate the authors of the study their interesting and important findings resulting from the reviewed manuscript.

Author Response

RESPONSES TO THE REVIEWER

We are most grateful for the critical comments and helpful suggestions made by reviewers, and applaud the reviewer’s careful scrutiny of our manuscript. We have responded point-by-point to the comments raised by the reviewers, as described below.

Reviewer 1:

I would like to congratulate the authors of the study their interesting and important findings resulting from the reviewed manuscript.

Responses: We are deeply grateful for the reviewer’s encouraging comments.

Reviewer 2 Report

Usually in elderly people with sarcopenia a depressed mood is observed and drugs from the group of antidepressants are commonly used. Some of them in their side effects reduce muscle strength. The study does not specify what drugs are administered in the studied groups.

The conclusions should emphasize the need for vitamin D supplementation in the studied groups.

Author Response

RESPONSES TO THE REVIEWER

We are most grateful for the critical comments and helpful suggestions made by reviewers, and applaud the reviewer’s careful scrutiny of our manuscript. We have responded point-by-point to the comments raised by the reviewers, as described below.

Reviewer 2:

(1) Usually in elderly people with sarcopenia a depressed mood is observed and drugs from the group of antidepressants are commonly used. Some of them in their side effects reduce muscle strength. The study does not specify what drugs are administered in the studied groups.

Responses: We are deeply grateful for the reviewer’s critical comments. Serum vitamin D levels inversely correlate with the severity of depression in patients with CLD, and supplementation of vitamin D improves depressive symptoms in such patients (Stokes CS, et al. Clin Nutr. 2016). Sarcopenia is closely associated with depression in elderly people and patients with CLD (Kilavuz A, et al. Arch Gerontol Geriatr. 2018; Nishikawa H, et al. J Clin Med 2019). In addition, antidepressant use is associated with an increase in the risk of limitations in physical mobility, muscle function, and activities of daily living (An R, et al. J Psychosom Res. 2016). In the present study, however, we did not screen all patients for depression and the use of antidepressants. In the future, we are willing to investigate depression status and the use of antidepressants to clarify the association between sarcopenia, depression/antidepressant use, and vitamin D levels in patients with CLD. We newly added these descriptions and several references to the revised limitation paragraph and reference list (lines 294–296).

(2) The conclusions should emphasize the need for vitamin D supplementation in the studied groups.

Responses: We are deeply grateful for the reviewer’s kindly suggestions. As suggested by the reviewer, we added a new phrase to the revised conclusions to emphasize the need for vitamin D supplementation (lines 303–304).