Health-Associated Nutrition and Exercise Behaviors in Relation to Metabolic Risk Factors Stratified by Body Mass Index

Reviewer 1 Report

Some revision was provided below for refining its readability and contribution.

1.       Introduction: More literature related to the possible existed difference in the effect of health (exercise and nutrition) behavior on reducing MRF for each specifically level of BMI is suggested.

2.       Introduction: The necessary for this study may be clarified more.

3.       Introduction: “Nevertheless, it is unclear whether the effects of nutrition and exercise behaviors on reducing MRF for individuals with other levels of BMI are the same.” Can this study really prove the “cause-effect “ relationship?  Or only prove their correlated relationship?

4.       Materials and Methods: Much more male worker (3286) than female worker (731), is the proportion represent the real situation in Taiwan? As for the workers’ labor type, can it be described more clear?

5.       Materials and Methods: Except using regression analysis to examine if the correlation reached the significant, can the correlation coefficient provided? It will be helpful to understand the correlated level.

6.       Materials and Methods: It was suggested to provide the accuracy and reliability of the questionnaire for health (exercise and nutrition) behavior investigation.

7.       Results: Marginally correlated was suggested to remove from sentence.

8.       Discussion: From the results, not only TG of obese subgroup uncorrelated with exercise behavior, overweight subgroup more uncorrelated with exercise behavior, how to explain these findings?

9.       Discussion: The proposed reasons for increase SBP associated with exercise behavior in ideal weight and obese subgroup seems not sufficient to convincing the readers.

 Author Response

Author Response File: Author Response.docx

Reviewer 2 Report

Dear authors,

Overall, the manuscript “Health-Associated Nutrition and Exercise Behaviors in Relation to Metabolic Risk Factors Stratified by Body Mass Index” is clearly written and results are clearly presented. However, I think that this manuscript can be improved by making some adjustments and providing some additional analyses. Please see my comments listed below.

ABSTRACT

Line 33: please be careful with using words like “reducing“ that suggest a longitudinal design. In cross-sectional studies we should write it like: associated with lower  

INTRODUCTION

Line 70-71: for me, this statement comes a little out of the blue; in the preceding paragraphs it is not explained why it may be of importance to examine the associations of nutrition and exercise behavior in different BMI groups. I would suggest to introduce this problem, for instance by moving the information provided in the section below (lines 73-83) to before this problem statement.

METHODS

Population: please clarify if the workers included in the study where all performing similar types of work. For instance, was physical work load similar?

Assessment of nutrition and exercise behavior: could you clarify if all items have the same weight? Further, I can imagine that some of the individual items correlate strongly with MRF and other items do not. I think it would be interesting to see which items are most strongly associated with MRF. Perhaps you could add these associations in a supplemental table.

Statistical analysis:  where any potential confounders (e.g. smoking, alcohol consumption) measured in this study? If so, I strongly suggest to add these factors in the models. If not, I recommend stating the possibility for residual confounding as a limitation in the discussion.

RESULTS

Table 2: I wonder if TG is normally distributed. If not, I suggest to use log transformation or provide median (IQT) instead of mean (SD). Further, consider adding trend analyses to emphasize that MRF is increasingly worse with higher BMI groups.

DISCUSSION

Line 261: I would suggest to use the term biased instead of confounded

Author Response

Author Response File: Author Response.docx

Round  2

Reviewer 1 Report

The reviewer's suggestion was revised in the manuscript accordingly.

Author Response

Response to Reviewer 1 Comments

1. The reviewer's suggestion was revised in the manuscript accordingly.

Ans: Thank you very much for your time.

Author Response File: Author Response.docx

Reviewer 2 Report

Dear authors, 

Thank you for the updated version of your manuscript. I am very content to see that you have addressed my concerns/suggestions. I don't have any substantial remarks at this stage, only some minor remarks/suggestions:

Table 1: It would be helpful to interpret the results of the regression analyses if data on the metabolic outcomes is presented here as well.

table 2: It would be helpful to indicate in the footnote what is represented by F and p. 

Author Response

Response to Reviewer 2 Comments

1. Table 1: It would be helpful to interpret the results of the regression analyses if data on the metabolic outcomes is presented here as well.

Ans: Thank you very much for your time on our manuscript. The suggestion you proposed is indeed important. The data on metabolic outcomes by the BMI levels and the analysis results by one way ANOVA F-tests have been shown in Table 2. Please check page 6 in the manuscript. Hopefully Tab 2 provides sufficient results you meant. Many thanks again.

2. Table 2: It would be helpful to indicate in the footnote what is represented by F and p.

Ans: Thank you very much for the valuable suggestion. The footnote of Table 2 has been modified according to your suggestions. The changes are as follows: “Relationships between BMI levels and metabolic risk factors were examined by one way ANOVA F-tests with p-value significant level, followed by Scheffe’s post-hoc multiple comparisons.” The footnotes of Table 1, Table 3 and Table 4 have also been revised accordingly. “p-value indicates significant level” (in Table 1), “…with p-value significant level” (in Table 3) and “p-value indicates significant level” (in Table 4) have been presented on page 4, and pages 7-8.

Author Response File: Author Response.docx

This manuscript is a resubmission of an earlier submission. The following is a list of the peer review reports and author responses from that submission.