Review Reports

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This study addresses an important and timely topic and benefits from a large longitudinal dataset and a thoughtful conceptual framework linking socioeconomic status, lifestyle factors, and healthy longevity.

Some improvements/changes should be:

• Clarify and temper causal language throughout the manuscript to better reflect the observational study design.

• Provide stronger theoretical justification for the construction of latent variables -  “Healthy Longevity.”

• Expand the description of the diet and lifestyle scores and explicitly discuss their limitations (e.g., lack of nutrient and energy intake data).

• Improve the description of the methodology, including model selection, fit indices interpretation and consideration of alternative models.

• Simplify and improve the readability of figures and tables; consider moving large tables to supplementary materials.

• Reorganize and shorten the Introduction and Discussion to reduce repetition and improve focus on the study’s main contribution.

• Revise the manuscript with professional English-language editing to improve clarity, grammar, and scientific precision.

Thank you for the opportunity to review this manuscript. I hope my comments are helpful to the authors, 

 

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

This is certainly an interesting study, confirming the relationship between lifestyle habits, including diet, and physical, mental, and social health. Furthermore, the study defines the causal relationship between socioeconomic factors, health components, and any related pathologies. It is undoubtedly a well-conducted study, considering only the analysis of socio-environmental factors. It is clear that the subjects interviewed were not subsequently examined by a medical team, nor did they undergo blood sampling to assess their actual clinical conditions, since the questionnaires were self-administered, in addition to the main anthropometric and biochemical parameters. This constitutes a major limitation of the study and should be clearly stated in the discussion.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

This manuscript is a valuable datarich and thought-provoking contribution that conveys an important message: healthy aging is not merely the result of individual lifestyle choices but is deeply embedded in broader socioeconomic structures. The large sample size, long term follow-up, and application of structural equation modeling represent clear strengths of the study.

The diet score is based exclusively on the frequency of food consumption and does not incorporate information on total energy intake or macro- and micronutrient composition. Although this limitation is acknowledged by the authors, a more explicit discussion would be warranted regarding how this operationalization may influence the interpretation of the associations between the diet score and survival or long-term care dependency. In particular, clarification would be helpful as to whether the diet score should be interpreted as an independent, potentially modifiable nutritional exposure, or rather as a proxy reflecting broader socioeconomic conditions that shape dietary patterns.

The strong effects observed for long term care status and the Three Health Factors also raise the possibility of reverse causality, especially given that declining functional status may itself influence lifestyle behaviors and dietary habits rather than solely resulting from them. A more detailed justification of how the temporal structure of the study mitigates this concern would strengthen the causal interpretation, as would a discussion of where residual bidirectionality may still remain.

Finally the manuscript would benefit from a clearer articulation of the concrete, actionable public health or nutrition policy implications that follow from the proposed model, particularly in light of the limited direct effects of lifestyle factors and the prominent role of socioeconomic structures highlighted by the findings.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

The authors have addressed all my comments.
I am satisfied with the revisions and have no further concerns.
I recommend acceptance of the manuscript.