Effect on Weight Loss of an Oral Supplement Containing Cinnamon Bark (Cinnamomum cassia) and Withania somnifera in Adult Patients with Overweight and Obesity: A Pilot Study

Round 1

Reviewer 1 Report

See the attached file

Comments for author File: Comments.pdf

Author Response

We would like to thank the reviewer for his/her thoughtful comments, which improve the clarity of the manuscript. The raised issues have been addressed as hereafter detailed.

General comments: the reviewer highlights that the word oral association is not clear enough. We have now changed the title. Also the reviewer questions whether using "overweight or obesity" reflects the characteristics of the patients. As suggested, we changed "or" into "and". The reviewer also suggests to describe the role of the GLP-1 receptor, which is now briefly included in the text.

Other comments

1. Abbreviations in the Introduction have been spelled
2. No previous study tested the combination CC and WS. This is now mentioned in the Introduction
3. The word association in the aim has been replaced as suggested
4. Inclusion and exclusion criteria are now more formally reported
5. Yes, both extracts were included in one capsule. This is now openly stated in the manuscript.
6. Waist circumference was reduced by 2,8% in the study group vs 1,7% in the control group. This is now stated in the manuscript.
7. The common names of the plants are now given in the manuscript.
8. The antimicrobial activity of cinnamon and Withania are now presented in the manuscript
9. No bacteria have been used in the study
10. The discussion has Beene xpanded by adding the possible role of changes in the microbiota. However, we would like to remind that this is a pilot study and we should be cautious in over interpreting the results.
11. Due to the limited number of patients enrolled in this pilot study, further stratification to assess whether sex predicts greater effects would be statistically weak.
12. We mentioned the possible role of the specific antimicrobial activity on the effects observed
13. Actually, as mentioned in the Introduction, the literature reports trials on the use of single agents on the metabolic effects of polycystic ovary syndrome, but not on obesity.
14. The conclusion highlights that the supplement containing both extracts appears a safe and effective strategy to enhance weight loss induced by caloric restriction. This is now highlighted in the text.
15. The file has been published online on feb 13, 2020. The file has been accessed again on Jul 28, 2023. This is now reported in the manuscript.

Reviewer 2 Report

It is a simple and well-written manuscript. I would like to suggest a few improvements to the manuscript.

1.    The title “Effect on weight loss of an oral association of cinnamon bark (cinnamomum cassia) and withania somnifera in adult patients with overweight or obesity: a randomized, prospective, placebo-controlled, multicenter, cross-over, pilot study" is lengthy and need not to be included all the metrices in title. Kindy consider to revise and can be modified as “ Effect on weight loss of an oral association of cinnamon bark (cinnamomum cassia) and withania somnifera in adult patients with overweight or obesity: a pilot study”.

2.    There has been a specification of the herbal names on page 1, line 19. A common name has been used for one and a scientific term has been used for the other. It would be appreciated if you could make it uniform.

3.    The biochemical parameters relating to the health of the subjects during weight loss have not been examined. In any case, it can be regarded as one of the study's limitations.

4.    It may be possible to enhance the weight of the study by providing an expanded scope of the study.

My greetings and best wishes are extended to the authors.

Minor changes are needed.

Author Response

We thank the reviewer for his/her thoughtful comments. Regarding the title, we had modified it according to the suggestions of both reviewers.

The herbal names are now reported uniformly.

The lack of biochemical indices in the evaluation of the effects is now acknowledged as a limitation of the study.

The scope of the study has now been expanded to highlight the potential of the results

Round 2

Reviewer 1 Report

* Italicized all species names.

How effective is this cinnamon species compared to Asian species?

* compare results with previous studies.

Author Response

We thank reviewer #1 for his/her comments, which were addressed in the revised draft of the manuscript. In particular:

1. All species names have been italicized
2. There is no available evidence in the literature comparing the effects of cinnamon species, despite the difference in their content of active components. This is now reported in the Discussion and a relevant new reference (i.e., n. 57) has been added
3. Considering that our study is the first exploring the effect of the combination CC/WS on weight loss, we compared our results with those obtained with cinnamon supplementation. To this end, a new paragraph has been added and a new reference included (i.e., n. 56)