Serum Ferritin in Metabolic Syndrome—Mechanisms and Clinical Applications

Round 1

Reviewer 1 Report

The present paper conducted observational study in 100 patients with metabolic syndrome and100 healthy control subjects and validated serum ferritin as an important marker for metabolic syndrome, which has already been widely discussed. There is a lack of novelty in the study design. Most of the results are just description of serum ferritin, fasting insulin, fasting blood glucose and post-prandial blood glucose, lipid profile, the waist-hip ratio in metabolic syndrome patients and healthy controls. The data visualization can be improved. It is recommended to generate the correlation heatmap for the clinical characteristics. More specific comments are shown below:

1. Statistic analysis: the data should be tested for normal distribution before analysis of variance.
2. In the material and method, are the patients of metabolic syndrome take any drug or receive any treatment? These factors may also affect the serum ferritin.
3. Table 1. P values are shown as .000. Either show as, *, **, *** or show as specific values. How do you describe insulin resistance?
4. In Figure 1, It is not recommended to show different clinical index in the same plot. Scatter plots are better than bar plots as we can get a better idea of the distribution. Do not use case and control, use Metabolic syndrome and healthy controls.
5. In table 2 and 3, it is recommended to generate the correlation heatmap for the different clinical characteristics.
6. Why there is only ‘3.1.Components of Metabolic Syndrome’ in the results part? What is Components of Metabolic Syndrome?
7. Figure 2 is redundant.
8. ‘As shown in table 4, the individual components of the metabolic syndrome had a significant correlation with an increasing number of components of metabolic syndrome.’ There is significant difference among the 3 components, 4 components, and 5 components does not mean there is significant correlation with an increasing number of components of metabolic syndrome.
9. In the discussion part, the authors compare the difference between their cohorts with literature, which is not that relevant to importance of serum ferritin as an marker for metabolic syndrome.

Author Response

Thank you very much for reviewing my article and having some important changes. 

1. Statistic analysis: the data should be tested for normal distribution before analysis of variance. Answer: - I have done 
2. In the material and method, are the patients of metabolic syndrome take any drug or receiving any treatment? These factors may also affect the serum ferritin. Answer: - We have not taken patients having any history of drug intake and I have written this in limitations.  
3. Table 1. P values are shown as .000. Either show as, *, **, *** or show as specific values. How do you describe insulin resistance?. Answer: - I have changed this. Insulin resistance is characterized by a decrease in tissue sensitivity to the effects of insulin, resulting in a compensatory increase in insulin secretion and its calculated by using the homeostasis model assessment formula IR (HOMA-IR). Line no 29 & 67.
4. In Figure 1, It is not recommended to show different clinical index in the same plot. Scatter plots are better than bar plots as we can get a better idea of the distribution. Do not use case and control, use Metabolic syndrome and healthy controls. Answer: - I have deleted the fig as its mentioned in Table. Also, I changed it.
5. In table 2 and 3, it is recommended to generate the correlation heatmap for the different clinical characteristics. Answer: - I am sorry, I need more time to generate heatmaps. 
6. Why there is only ‘3.1.Components of Metabolic Syndrome’ in the results part? What is Components of Metabolic Syndrome?. Answer: - According to U.S. population (NHANES III) there are five components of metabolic syndrome. Also according to NCEP:ATPIII 2001, minimum of 3 should be present to diagnose it. Harrison internal medicine vol 2, edition 20th page no. 2903.
7. Figure 2 is redundant. Answer: - Deleted. 
8. As shown in table 4, the individual components of the metabolic syndrome had a significant correlation with an increasing number of components of metabolic syndrome.’ There is significant difference among the 3 components, 4 components, and 5 components does not mean there is significant correlation with an increasing number of components of metabolic syndrome. Answer: - Changed .
9. In the discussion part, the authors compare the difference between their cohorts with literature, which is not that relevant to importance of serum ferritin as an marker for metabolic syndrome. Answer: - Title changed

Author Response File: Author Response.docx

Reviewer 2 Report

With the manuscript „Serum Ferritin as an Important Marker in Metabolic Syndrome“, Srivastav et al describe the positive association of serum ferritin levels with “metabolic syndrome”, a heterogeneous condition consisting of different symptoms and severity degrees.

The manuscript describes in detail and with emphasis on the objective, statistical measures, the statistical analysis of serum levels of patient and control group to deduce the above mentioned association. I suggest the following aspects to be considered and/or reflected on, before this manuscript can be considered for publication:

 

1.      Title: Suggestion: To reflect on the use of the word “important”, important is very relative, rather to leave out this word or use a word like “reliable” or “confident”, which gives an impression of the good quality of your suggested marker.

2.      Abstract: Should be improved. Sentences like lane10-11 don’t contain useful information. Consider reformulating. Also avoid using abbreviations (T2DM) without explaining what it is in an abstract.

3.      Aims & Objectives / Conclusion: The reader is confronted with insufficient explanation on the “scope” of this research, where should this discovery strategically lead to? From the pure result and conclusion, what do you suggest to do with this or where do you see further studies necessary? The overall context and positioning of the manuscript.

4.      It would help the reader to add 1 sentence of explanation on the used statistics, considering the interpretation of (r=…)

5.      Figure 2 could be improved, the title for me does not well communicate a message and optically the columns take a lot of space.

In the following some typos or sentences with unclarities:

6.      Lane 72: “If the value > is 2.5”: change to “If the value is > 2.5”

7.      Lane 88: “mean age between the groups” : Is here a word lacking? Do you want to say “mean age difference between the groups?

8.      Table 1: Please check if it is according to the rules of the journal that p-values .are indicated as .000

9.      Lane 112: Refrase

1.   Lane 220: citation is missing, just link is present.

Author Response

Thank you very much for reviewing my manuscript.

1. Title: Suggestion: To reflect on the use of the word “important”, important is very relative, rather to leave out this word or use a word like “reliable” or “confident”, which gives an impression of the good quality of your suggested marker. Answer: I have changed my Title name 

 

2. Abstract: Should be improved. Sentences like lane10-11 don’t contain useful information. Consider reformulating. Also avoid using abbreviations (T2DM) without explaining what it is in an abstract.

Answer: - I have changed it 

3. Aims & Objectives / Conclusion: The reader is confronted with insufficient explanation on the “scope” of this research, where should this discovery strategically lead to? From the pure result and conclusion, what do you suggest to do with this or where do you see further studies necessary? The overall context and positioning of the manuscript.

Answer: - I have added some more points in discussion section. 

4.  It would help the reader to add 1 sentence of explanation on the used statistics, considering the interpretation of (r=…)

Answer: - Added in that section

5. Figure 2 could be improved, the title for me does not well communicate a message and optically the columns take a lot of space.

Answer: - Deleted

6.

In the following some typos or sentences with unclarities:

6. Lane 72: “If the value > is 2.5”: change to “If the value is > 2.5”
7. Lane 88: “mean age between the groups” : Is here a word lacking? Do you want to say “mean age difference between the groups?
8. Table 1: Please check if it is according to the rules of the journal that p-values .are indicated as .000
9. Lane 112: Refrase
10. Lane 220: citation is missing, just link is present.

Answer: - all these corrections done. 

 

 

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

The revisions looks good to me

Author Response

Thanks very much for accepting my review.