Review Reports

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Overall evaluation:
The aim of this study was to assess hospitalised patients awareness of foods for special medical purposes and to  determine the perception of the dietitian's role in the hospital treatment process. The sample size of the survey is sufficient and the question design is reasonable. The survey results have certain guiding significance for the clinical nutrition of FSMP. However, the manuscript still has some problems and needs to be improved.

Specific modification suggestions:
1.Line6, there are two "1" in the serial number, please modify.
2.Line29, "Nestle was the most popular brand", it is suggested not to reflect the specific brand name, so as not to cause commercial interests.
3.Line41, it is suggested to add two more Keywords.
4.Line44-66, since malnutrition also includes the problem of excess nutrients, it is recommended to add the health problems caused by excess nutrients.
5.In the Introduction part, as this Study belongs to a Survey Study, the research progress on the understanding of FSMP should be introduced in terms of the research background.
6.Line107-112, please state whether there are any conditions for Participation in this study, such as education, health status, etc.
7.Table2-11, the contents of each table are small and should be combined into one table.
8. The analysis and discussion of the findings need to be strengthened.

Author Response

Dear Reviewers,

We would like to sincerely thank you for the time and effort dedicated to thoroughly reviewing our manuscript and providing valuable comments and suggestions for its improvement. We greatly appreciate your insights and have addressed all the comments by implementing the recommended corrections.

We believe that the changes and enhancements introduced in the revised manuscript align with the journal's requirements and meet the standards for acceptance. All modified sections in the revised manuscript have been highlighted in yellow for your convenience.

The journal's self-citations have also been reduced as indicated by the Editor.

Thank you for your consideration.

Author's reply to the Review Report Reviewer 1

Comment 1: Line6, there are two "1" in the serial number, please modify.

Response: It is corrected.

Comment 2: Line29, "Nestle was the most popular brand", it is suggested not to reflect the specific brand name, so as not to cause commercial interests.

Response: It is deleted.

Comment 3: Line41, it is suggested to add two more Keywords.

Response: It is added in lines 42-43; foods for special medical purposes; malnutrition; nutritional treatment, hospitalized patients, oral nutritional supplements.

Comment 4: Line 44-66, since malnutrition also includes the problem of excess nutrients, it is recommended to add the health problems caused by excess nutrients.

Response: It is added in lines 49-58: Excessive nutrient intake leads to overweight and obesity. These are diseases that are one of the causes of metabolic disorders such as hyperlipidemia and hyperglycemia. Attention should be paid to substances secreted by adipose tissue (in people with excessive hypertrophy) such as leptin, resistin or TNF-α, other cytokines and hormones. These substances act through many mechanisms, contributing to insulin resistance, improper appetite regulation, and increased proinflammatory cytokine secretion. Chronic excessive energy intake and visceral obesity can lead to type 2 diabetes, fatty liver disease, cardiovascular disease, and cancer.

Comment 5: In the Introduction part, as this Study belongs to a Survey Study, the research progress on the understanding of FSMP should be introduced in terms of the research background.

Response: It is added, lines: 109-151.

Comment 6: Line107-112, please state whether there are any conditions for Participation in this study, such as education, health status, etc.

Reponse: It is added in lines 161-166;  Participation in the research was anonymous and voluntary. The survey included patients hospitalized in the internal medicine and surgery department with a sub-department of oncological, the condition excluding participation in the study was the patient's lack of awareness or refusal. No data was obtained on education or place of residence, but respondents provided information on age, gender and comorbidities. Also it is added in limitation lines: 458-460

Comment 7: Table2-11, the contents of each table are small and should be combined into one table.

Response: Modified as it was directed in lines 400-401.

Comment 8: The analysis and discussion of the findings need to be strengthened.

Response: It is added in lines: 412-416, 443-447, 451-453.

 

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Thank you for your work. But the article needs more details and corrections. 

The manuscript addresses a clinically relevant topic; however, several methodological and interpretative issues substantially limit its scientific contribution.

The study is based on a small, single-center sample of exactly 100 respondents, without justification of sample size calculation or description of the sampling strategy. This raises concerns regarding representativeness and potential selection bias.

Furthermore, important variables that may significantly influence knowledge levels — such as education, socioeconomic status, previous contact with a dietitian, length or type of hospitalization, or prior exposure to FSMP — were not collected or adjusted for in the analysis.

As a result, the reported association between age and knowledge is difficult to interpret and may be confounded. The questionnaire appears to be author-developed, yet no information is provided regarding validation, pilot testing, or internal consistency. The knowledge scoring system and its cut-offs seem arbitrary and require justification.

The statistical analysis is basic and limited to bivariate testing, without multivariable modeling or correction for potential confounders. In several places, the interpretation overreaches the data. For example, the statement that it is “crucial” that 87% of respondents believe FSMP may be beneficial is not scientifically substantiated. Similarly, conclusions regarding marketing effectiveness or the need for educational interventions are speculative, as no data were collected on hospital education practices or information pathways. 

The manuscript would benefit from clearer methodological justification, more cautious interpretation of results, and a strengthened limitations section explicitly acknowledging the restricted generalizability and absence of key confounders.

Author Response

Dear Reviewer,

We would like to sincerely thank you for the time and effort dedicated to thoroughly reviewing our manuscript and providing valuable comments and suggestions for its improvement. We greatly appreciate your insights and have addressed all the comments by implementing the recommended corrections.

We believe that the changes and enhancements introduced in the revised manuscript align with the journal's requirements and meet the standards for acceptance. All modified sections in the revised manuscript have been highlighted in yellow for your convenience.

The journal's self-citations have also been reduced as indicated by the Editor.

Thank you for your consideration.

Author's reply to the Review Report Reviewer 2

Comment 1: The study is based on a small, single-center sample of exactly 100 respondents, without justification of sample size calculation or description of the sampling strategy. This raises concerns regarding representativeness and potential selection bias. Furthermore, important variables that may significantly influence knowledge levels — such as education, socioeconomic status, previous contact with a dietitian, length or type of hospitalization, or prior exposure to FSMP — were not collected or adjusted for in the analysis

Response: Thank you for your comment. We understand that the single-center design and relatively small sample size may limit generalizability. Because the study is completed and these aspects cannot be changed, this information is described in the limitations, lines 454–465, and the exploratory nature of the study is emphasized.

Comment 2: As a result, the reported association between age and knowledge is difficult to interpret and may be confounded. The questionnaire appears to be author-developed, yet no information is provided regarding validation, pilot testing, or internal consistency. The knowledge scoring system and its cut-offs seem arbitrary and require justification.

Response: The conclusions drawn from the study were summarized and the need for further research to confirm the hypotheses was emphasized. The lack of questionnaire validation is described in the limitations of the study lines: 168-169, 464. The scoring system was established based on other studies available in the literature of a similar nature and scale. Literature sources is added line 186.

Comment 3: The statistical analysis is basic and limited to bivariate testing, without multivariable modeling or correction for potential confounders. In several places, the interpretation overreaches the data. For example, the statement that it is “crucial” that 87% of respondents believe FSMP may be beneficial is not scientifically substantiated. Similarly, conclusions regarding marketing effectiveness or the need for educational interventions are speculative, as no data were collected on hospital education practices or information pathways. 

Response: The revised version of the article emphasizes the preliminary nature of the study requiring further investigation. Information about some missing data has been added to the limitations section. The few variables obtained and the relatively small sample size might not have been sufficient for reliable model estimation. This information has been added to the study limitations lines 454-465. Sections containing overly categorical or speculative formulations have been corrected. I hope these changes have increased caution in interpreting the work.

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

Thank you for the revised version of the manuscript. The methodological limitations previously raised are now clearly and explicitly acknowledged, and the conclusions have been appropriately moderated to reflect the exploratory nature of the study. While the inherent constraints of the design remain, the manuscript is now more transparent and balanced in its interpretation of the findings.

Author Response

Dear Reviewer,

We would like to thank you for all your suggestions and comments, which directly contributed to improving the substantive quality of our publication. Thank you for your time and effort.

Sincerely,

Aleksandra Raczyńska-Holińska