Plant-Forward Dietary Approaches to Reduce the Risk of Cardiometabolic Disease Among Hispanic/Latinx Adults Living in the United States: A Narrative Review

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

   The manuscript addresses a timely and important public health topic by synthesizing evidence on dietary patterns and cardiometabolic risk among Hispanic/Latinx adults in the United States.

• The focus on dietary pattern–based approaches rather than single nutrients is conceptually sound and enhances the relevance and interpretability of the findings.

• The literature search strategy, inclusion criteria, and risk-of-bias assessment are clearly described and methodologically appropriate.

• The authors present a balanced interpretation of the evidence, appropriately acknowledging heterogeneity across Hispanic/Latinx subgroups and the observational nature of the included studies.

   Minor revisions focused on streamlining repetitive discussion points and clarifying terminology (e.g., RCII) would further improve clarity without altering the overall conclusions.

Author Response

Comment:
Minor revisions focused on streamlining repetitive discussion points and clarifying terminology (e.g., RCII) would further improve clarity without altering the overall conclusions.

Response:
Thank you for this helpful suggestion. We agree with the reviewer and have revised the Discussion section to streamline repetitive points and improve clarity. Specifically, we consolidated overlapping interpretations related to traditional dietary patterns and cardiometabolic risk, and clarified terminology throughout the Discussion, including explicitly defining and consistently using abbreviations. These revisions were made to improve readability while preserving the interpretation and conclusions of the review.
These changes can be found in the revised manuscript on page 21 of version 4 of the manuscript. 

Reviewer 2 Report

Comments and Suggestions for Authors

This narrative review effectively synthesizes evidence from 10 high-quality observational studies on dietary patterns and cardiometabolic risk (CMR) among U.S. Hispanic/Latinx adults, highlighting consistent benefits of plant-forward diets.

Major Strengths
The methodology is robust, featuring a comprehensive librarian-assisted search across multiple databases through August 2025, clear PICO criteria, dual-reviewer screening via Covidence, and risk-of-bias assessment with an adapted Newcastle-Ottawa Scale , rating 6 studies very good and 4 good. Tables 1-3 provide detailed summaries of quality, sociodemographics, and key findings by subgroup  facilitating subgroup-specific synthesis. The discussion thoughtfully contextualizes findings with acculturation, socioeconomic factors, and lifestyle confounders beyond diet alone.Areas for Improvement
The tables are overly text-dense and would benefit from simplification: use shorter bullet-like entries, abbreviations footnotes, or supplemental online versions to enhance readability without losing detail (e.g., Table 2’s lengthy inclusion/exclusion and characteristic descriptions span multiple lines per cell). Cross-sectional designs limit causality; explicitly state this in the abstract and conclusions, emphasizing need for longitudinal/intervention data. Heterogeneity in pattern derivation and small convenience samples warrant caution on generalizability—consider a forest plot or meta-summary for adiposity/lipids where feasible.

Minor Revisions
Standardize abbreviations. Update references for recency . Ensure PRISMA flowchart includes exact exclusion reasons at full-text stage. In results, quantify effect sizes more prominently.

Author Response

Response:
We thank the reviewer for these thoughtful and constructive suggestions.

Table simplification and readability.
Table 2 has been substantially revised to improve readability. We streamlined text-dense cells by using shorter entries and standardized abbreviations, with all abbreviations now defined in a table footnote. Where appropriate, detailed inclusion/exclusion criteria and sample characteristics were condensed, and non-essential descriptive detail was minimized while preserving key methodological information.

PRISMA flow diagram.
The PRISMA flowchart has been updated to include explicit reasons for full-text exclusions, with exact counts provided for each exclusion category, in accordance with PRISMA reporting guidelines.

Causality and study design limitations.
We have explicitly strengthened language throughout the Abstract and Discussion to clarify that the included studies are predominantly cross-sectional and therefore do not permit causal inference. We now emphasize the need for longitudinal and intervention studies to better establish temporal relationships between dietary patterns and cardiometabolic outcomes.

Heterogeneity and generalizability.
We acknowledge heterogeneity in dietary pattern derivation methods and the presence of small or convenience samples as important limitations. This caution has been more clearly articulated in the Discussion, particularly with respect to generalizability across Hispanic/Latinx subgroups.

Quantification of effects and forest plot.
To address the reviewer’s suggestion to more prominently quantify effect sizes, we added a forest plot summarizing adiposity outcomes (BMI) where sufficient and comparable data were available. This meta-analytic visualization complements the narrative synthesis and highlights the magnitude and consistency of associations across studies. Lipid outcomes and other heterogeneous measures continue to be summarized narratively where pooling was not appropriate.

Additional minor revisions.
Abbreviations have been standardized throughout the manuscript, and references were reviewed and updated for recency where applicable.

We believe these revisions substantially improve clarity, transparency, and interpretability while maintaining the integrity and scope of the review.