The Significance of Plant-Based Foods and Intense Physical Activity on the Metabolic Health of Women with PCOS: A Priori Dietary-Lifestyle Patterns Approach

Round 1

Reviewer 1 Report

General comments: The manuscript is very interesting and fits in the scope of the Applied Sciences journal. Includes information on the effects of plant and animal foods consumption and dietary lifestyle patterns on the risk of polycystic ovary syndrome. The division of the text into subsections is appropriate. The Authors thoroughly discussed the subject and fully achieved the assumed aim of the study. The manuscript is very carefully written. I read the manuscript with real pleasure. However, some changes are required.

Specific comments:

1.       Abstract: I have no comments

2.       Key words: I suggest removing "PCA; DXA", these abbreviations may be unfamiliar to many readers, besides they are not the most important information regarding the manuscript in my opinion, should be added „Polycystic ovary syndrome”

3.       Introduction: introduces the issue very well and presents the causes of PCOS and factors related to women's lifestyles, including nutrition; I understand that the priority for the authors is the glycemic index of food, but I think that, when discussing the Mediterranean diet and the benefits of eating plants, it is worth mentioning oxidative stress, which is, after all, related to PCOS and vegetables and fruits.

4.       Materials and Methods: Very carefully described, I have no comments

5.       Results: I have no comments

6.       Discussion: 4.3 Meat Intake: the effect of eating red meat on the occurrence of inflammation should be mentioned, how does this relate to PCOS?

7.       Tables: I have no comments

8.       Figures: I have no comments

9.       References: I have no comments

Ref. 1 – shouldn't it be „Sirmans SM, Pate KA, 2013”?

Author Response

Dear Reviewers,

Thank you for revising our manuscript titled: “The significance of plant-based foods and intense physical activity on the metabolic health of women with PCOS: a priori lifestyle-dietary pattern approach”

We greatly appreciate the time and efforts to review our manuscript and agree that the proposed changes will contribute to improving our manuscript. We have addressed all issues indicated in the review, and we believe that the revised version can meet the journal publication requirements.

Please find our responses to your comments in the table attached.

Author Response File: Author Response.docx

Reviewer 2 Report

The paper is related to plant and animal foods intake in dietary lifestyle patterns as  modulators of metabolic health among women with polycystic  ovary syndrome (PCOS) which is very interesting topic, but there are a lot of limitations in the paper. 

First of all the language style must be changed in order to provide the better perception of the concept. For instance the title of the paper is confusing.  A dietary pattern is defined as the quantity, variety, or combination of different foods and beverage in a diet and the frequency with which they are habitually consumed. So for me it's not clear  what is the difference between plant and animal origin food intake and dietary lifestyle pattern. 

Despite that fact that the authors mentioned, that the study had some limitations especially the sample size, the fact that the physical activity was self-reported, FFQ, there are very strong limitations:

1) Individual nutritional assessment based on nutritional parameters (total energy, energy density, total macronutrient contents) was not carried out.

2) 24 hour recall method was not used in order to understand dietary patterns. Food group approach was used for analyses, which is not providing high level of precision and accuracy. There are a lot of factors (energy intake access, energy density, GI of diet), so correlating only food groups can not be accurate in order to have a evidence based research outcome.

The fact that only very limited number of participants were involved in experiment it seems that is more case study. In my opinion the title must be changed, it should be mentioned that it is only case study (first attempt) and other limitations must be added.

The novelty of the paper should be added. It is mentioned that the results open up further questions that require verification in subsequent studies concerning the PCOS diet's plant and animal foods ratio. This phrase should be removed from the abstract. In abstract you should include the research outcome and how those results can be used from others, otherwise I will consider that the research is not completed and will reconsider the paper after additional experimental part. 

The introduction must be changed. More relevant articles should be included. The introduction is long. 

The style of the discussion should be changed because additional data analysis is needed.

After adding additional information papers needs significant changes.

 

Author Response

Dear Reviewers,

 

Thank you for revising our manuscript titled: “The significance of plant-based foods and intense physical activity on the metabolic health of women with PCOS: a priori lifestyle-dietary patterns approach”

We greatly appreciate the time and efforts to review our manuscript and agree that the proposed changes will contribute to improving our manuscript. We have addressed all issues indicated in the review, and we believe that the revised version can meet the journal publication requirements.

Please find our responses to your comments in the attachment.

Author Response File: Author Response.docx

Reviewer 3 Report

The manuscript used is very interesting, the methodology used is adequate and sufficient. The results support the discussion. However, I have the following comments.

I. Major comments:

1. The results are solid regarding the consumption of meat and other foods of meat origin. But with dairy it is different. In this regard, the consumption of fermented dairy products (yogurt and cheese) would probably have a protective effect. This point should be discussed by the authors. PMID: 21696306; PMID: 30452699; PMID 32512787

2. The discussion is good, but I suggest including molecular mechanisms that could favor a better understanding of the results. For example, oxidative stress, increased inflammation or insulin resistance.

3. It would be great if the authors include a figure summarizing the main results of the study, and include that figure in the discussion.

II. Minor comments:

1. Improve the title, the title should be more specific. Considering the results and the conclusion "Concluding, plant-based foods related to PDLP and intense physical activity offer a significantly higher chance of improving metabolic health in women with PCOS."

2. Improve the wording of the objective of the study.

Author Response

Dear Reviewers,

 

Thank you for revising our manuscript titled: “The significance of plant-based foods and intense physical activity on the metabolic health of women with PCOS: a priori lifestyle-dietary pattern approach”

We greatly appreciate the time and efforts to review our manuscript and agree that the proposed changes will contribute to improving our manuscript. We have addressed all issues indicated in the review, and we believe that the revised version can meet the journal publication requirements.

Please find our responses to your comments in the attachment.

Author Response File: Author Response.docx

Round 2

Reviewer 2 Report

The authors made an effort in order to improve the paper. Although there are some limitations in the paper, but it can be published in current version. But the authors should take into consideration the comments for future investigations. 

Reviewer 3 Report

Authors answered all my comments. Therefore, the manuscript can be accepted.