Review Reports

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The authors of the manuscript have presented results from an original study, involving very large number of patients (>23,000) with atrial fibrillation (Af)/flutter (AF), aiming to evaluate the association between the occurrence of these rhythm disorders and some cardiovascular risk factors such as weight, diabetes, arterial hypertension (HTN), smoking and others. The manuscript is important from clinical point of view. Atrial fibrillation is the most common sustained arrhythmia in humans with lifelong risk for occurence of at least one episode of this arrhythmia estimated as high as 38% in those age >55 years. On the other hand Af and AF are the second most common risk factors for ischemic stroke - 3-5 of every 10 strokes are due to Af/AF. HTN, diabetes, obesity and other traditional risk factor contribute to both Af and stroke risk - clinical studies focused on investigation of the association between all these cardiovascular risk factors/disease will be valuable for both science and clinical practice. 

The manuscript is well-organized and adheres to classical structural requirements. The text is clear, and the figures are highly illustrative. The introduction is concise yet comprehensive. The methods are thoroughly described, and the results are conclusive. The conclusions are strongly supported by the findings. The English language is of high quality. 

Author Response

The authors of the manuscript have presented results from an original study, involving very large number of patients (>23,000) with atrial fibrillation (Af)/flutter (AF), aiming to evaluate the association between the occurrence of these rhythm disorders and some cardiovascular risk factors such as weight, diabetes, arterial hypertension (HTN), smoking and others. The manuscript is important from clinical point of view. Atrial fibrillation is the most common sustained arrhythmia in humans with lifelong risk for occurence of at least one episode of this arrhythmia estimated as high as 38% in those age >55 years. On the other hand Af and AF are the second most common risk factors for ischemic stroke - 3-5 of every 10 strokes are due to Af/AF. HTN, diabetes, obesity and other traditional risk factor contribute to both Af and stroke risk - clinical studies focused on investigation of the association between all these cardiovascular risk factors/disease will be valuable for both science and clinical practice. 

The manuscript is well-organized and adheres to classical structural requirements. The text is clear, and the figures are highly illustrative. The introduction is concise yet comprehensive. The methods are thoroughly described, and the results are conclusive. The conclusions are strongly supported by the findings. The English language is of high quality. 

 

Response: We thank the reviewer for asking no changes in the manuscript and giving us a highly positive review

Reviewer 2 Report

Comments and Suggestions for Authors

Important topic

Would you like to put an image with the different arrhythmic circuit between atrial flutter and atrial fibrillation? Educational

Nice graph figure 1

Graph figure 2 challenging, can't you find better graphic solutions? Important data but it is not immediately understandable to an average non-expert reader

There is not much difference in the OR values ​​between cachexia, overweight and obesity

In my opinion the graph of figure 2 can be improved / integrated

A, B C D in the graph is not immediately understandable without reading the caption of the figure. I would propose a third figure with the data of the 4 categories integrated. Put chachexix, overweight, obese and morbidly obese instead of the letters A, B, C, D.

Can the Caucasian ethnic factor have a dietary background?

I would add some future perspectives: bioimpedance analysis, association of bnp and obesity, role of ultrasound imaging and CT in the evaluation of visceral fat

If you want to quote this paper on the multidisciplinary management of AFIB, specifying that the nutritional aspect is essential

Comments on the Quality of English Language

Nice work. 

I suggest minor graphical improvements 

Author Response

RESPONSE: 

Dear Reviewer 2,

Thank you for the opportunity to revise and resubmit our manuscript, " The Impact of Weight Categories on the Association Between Atrial Fibrillation/ Flutter and Known Risk Factors: A Nationwide Inpatient Data Analysis” (Manuscript ID: jcm-3543327). We sincerely appreciate the valuable feedback provided, which has helped us improve our work. In this response letter, we have addressed the comments and suggestions. Below is a point-by-point response detailing the revisions made in accordance with the feedback.

1. Comment 1: Important topic. Would you like to put an image with the different arrhythmic circuit between atrial flutter and atrial fibrillation? Educational

Response: Sure . We added a new figure called Figure 1 as follows:

 
 

2. Comment 2: Nice graph figure 1

Response: Thank you for noticing this. The authors appreciate your feedback on figure 1 now called figure 2

3. Comment 3: Graph figure 2 challenging, can't you find better graphic solutions? Important data but it is not immediately understandable to an average non-expert reader

Response: To improve Figure 2, we have revised the figure by adding labels to indicate the weight categories directly. This adjustment enhances readability and makes the data more accessible to non-expert readers without requiring them to refer to the caption. We believe this change helps clarify the information while maintaining the figure’s accuracy and completeness.

4. Comment 4: There is not much difference in the OR values between cachexia, overweight and obesity.

Response:  Thank you for pointing this out. The authors agree that this study found that traditional risk factors of Afib and Aflut continued to be associated with the conditions regardless of weight category. This was one of our main findings presented in this paper.

5. Comment 5: In my opinion the graph of figure 2 can be improved / integrated. A, B C D in the graph is not immediately understandable without reading the caption of the figure. I would propose a third figure with the data of the 4 categories integrated. Put cachexia, overweight, obese and morbidly obese instead of the letters A, B, C, D.

Response: Thank you for your thoughtful suggestion. We completely agree that improving the readability of our graph is important. To enhance clarity without requiring readers to refer to the figure caption, we have added labels indicating the weight categories directly in the figure. Since Figure 2 already contains all the necessary information, we have opted not to create an additional figure, as including all categories in a single graph would make it quite large and possibly more complex.

6. Comment 7: Can the Caucasian ethnic factor have a dietary background?

Response: The authors agree that this is an interesting question and worth evaluating in the future. However, based on the information extracted from the database we used, the authors are uncertain about the diet of each group, as this was not easily identifiable in the database.

7. Comment 8: I would add some future perspectives: bioimpedance analysis, association of bnp and obesity, role of ultrasound imaging and CT in the evaluation of visceral fat

Response: This is an amazing addition. The authors really like this perspective and have added it to the conclusion by noting “Moreover, additional exploration into the utility of bioimpedance analysis, the association between B-type natriuretic peptide and obesity, and the role of ultrasound and computed tomography in evaluating visceral fat could further enhance our understanding of the impact of weight on Afib and Aflut.”

8. Comment 9: If you want to quote this paper on the multidisciplinary management of AFIB, specifying that the nutritional aspect is essential

Response: This is a really great point. Thank you for your suggestion. To make note of this, we have added “Furthermore, it emphasizes the importance of a multidisciplinary approach to caring for patients with Afib or Aflut, given the role nutrition may play in weight and subsequent outcomes” at the end of the discussion section.