Fermented Beverages, Ethanol and Health: A Critical Appraisal of Meta-Analytical Studies

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The manuscript entitled Fermented Beverages, Ethanol and Health: A Critical Appraisal 2 of Meta-Analytical Studies is an interesting review that analyses with a meta approach the real problem liked to the alcoholic beverages.  To my opinion, this manuscript is well designed and mostly is clear its message. The only point that Would like that could be improved is the meta-approach, that could be better explained with an appropriate paragraph, in order to clarify to the reader the powerful of the method used.

Author Response

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Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

This manuscript presents a critical analysis of meta-analytic studies used to support public health recommendations that "there is no safe level of alcohol consumption." The authors analyze the methodological aspects of the meta-analysis and discuss selected studies related to WHO reports and the European Heart Network position paper. The article's topic is relevant to the fields of fermentation science, nutrition, and public health and falls within the scope of the journal Fermentation.The  article is well organized and provides an overview of the methodological foundations of the meta-analysis, followed by a discussion of the Global Burden of Disease analyses and epidemiological studies on cardiovascular disease. The authors attempt to integrate the perspectives of fermentation researchers with a clinical epidemiological approach.

However, several significant methodological issues may question the validity of the work. In some sections, the text shifts from methodological criticism to polemical statements, weakening its scientific neutrality. Some interpretations of the epidemiological literature appear selective, and the evidence base supporting the conclusions should be strengthened.

Overall, the article raises an interesting discussion but requires significant revisions before publication.

This article relies primarily on a limited number of studies, specifically:

• Global Burden of Disease (GBD) analyses
• Stockwell et al.'s meta-analysis
• Selected WHO reports.

However, the literature on alcohol epidemiology is much broader and includes numerous cohort studies and analyses using Mendelian randomization.

To improve the completeness of the analysis, the authors should include additional publications, including:

• recent large cohort studies on alcohol and mortality
• current meta-analyses on cardiovascular disease
• systematic reviews examining the role of confounding factors in alcohol research.

Without this broader context, conclusions may appear selective or biased.

Some sentences require stylistic revision to maintain a neutral and academic tone.

Examples:

• "Absurd it may sound..."
• "scientific alchemy."

Such phrases should be replaced with more formal scientific lang

Author Response

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Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

This manuscript addresses an actual highly relevant topic: the consumption of fermented beverages and alcohol in relation to health, from a clear and balanced perspective. The authors contextualize alcohol intake and its potential health risks by considering a comprehensive range of parameters, including age, type of alcoholic beverage, origin, consumption patterns, quantity, and other relevant variables. This multidimensional approach strengthens the overall analysis.

A major strength of the manuscript lies in its reliance on meta-analytical studies. The methodology is presented in a transparent and structured manner, and the interpretation of the data is explained clearly, facilitating readers’ understanding of complex epidemiological evidence. The didactic presentation enhances the accessibility of the work without compromising scientific rigor.

The results provide a well-supported and nuanced assessment of the association between alcohol consumption, fermentation-derived products, and potential health damage. It is noteworthy to mention that the conclusions are consistent with the recommendations of the World Health Organization (WHO) and the ENHs current guidelines.

Overall, the manuscript makes a valuable contribution to the ongoing discussion on alcohol consumption and public health.

Due to the above, this referee would like to congratulate the authors for this piece of work.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf