The Role of Very Low Calorie Ketogenic Diet in Sympathetic Activation through Cortisol Secretion in Male Obese Population
, Anna Valenzano 2, Alessia Scarinci 3, Ines Villano 4, Marcellino Monda 4, Giuseppe Cibelli 2, Chiara Porro 2, Daniela Pisanelli 2, Vincenzo Monda 4 and Antonietta Messina 4Round 1
Reviewer 1 Report
I had one major criticism/suggestion, and several very minor suggestions. The major one is that the only description of the intervention was "a commercial dietary ketosis program for weight loss" I was curious about what it was? were they eating regular food? were they eating "specialized commercial food" what was the fat/carb/protein ratio etc etc I was also curious about how many patients were in this program. Did this study only address those who were successful? who maintained ketosis? If not, were the others studied? How many were there? If it studied only those who achieved success, that is fine, but it should be stated. The minor points are "picky" suggestions to use more exact language. Specifically
line 62 rather than "improved" say "lead to higher" or "increased"
line 70 you imply obesity and hunger are opposites
line 72 you note a "proper diet" but that implies a judgement I do not understand, and it is poorly defined
line 85 you note obesity subjects but I think you meant obese subjects
line 95 you say VAT by DEXA but should spell out visceral adipose tissue and dual energy Xray absorption, because it is not clear.
In general though, this paper was very good.
Author Response
In attached our poin-by-oint response.
Author Response File: 
Author Response.docx
Reviewer 2 Report
This is a very interesting study with a good design, but it has a serious problem, the sample. The authors will have to convince that the small sample of the study is representative.
Below are my comments and suggestions for the authors.
Title
The title should make it clear that the study was conducted in a male population only.
- Materials and Methods
2.1. Subjects, anthropometric and biochemical measurements
In this part of the paper, the authors should explain how the sample was selected: why only a male population? Was there any randomized selection from a larger sample?
2.2. Study Protocol
I would like to ask you to add a small paragraph here, describing the basic elements of the diet.
2.5. Statistical Analysis
Please add which statistical methods were used other than correlation.
Which of your variables followed a normal distribution, which ones used Pearson's correlation and which ones used Spearman's test?
- Results
Line 132-135: Add which statistical method you used, references to be removed.
Table 1: From which statistical method did the p , fill in the table.
Line 142-146: Which correlation method was used and on which variables? It is useful to add the r value in addition to p.
Figure 3: I think they should be replaced with a single table to show the correlations of all variables.
- Discussion
Line 165: ".... after VLCKD surgery" what is meant?
Line 203-204: I think the sentence should be deleted, if you choose to keep it add a reference.
5 Limitations of the Study: I think it should be added.
Author Response
In attached point-by-point response.
Author Response File: Author Response.docx
