Review Reports
- Grace N. Gathungu1,*,
- Daniel N. Frank2 and
- Anupama Chawla1
- et al.
Reviewer 1: Anonymous Reviewer 2: Marion Korach-André Reviewer 3: Anonymous
Round 1
Reviewer 1 Report
The relationship between microbial profiles and diagnosis of MetS among children with obesity is very important. The study is well written and very interesting. We need more information about connection of microbiota and obesity. Thank You for Your study.
Author Response
Comments and Suggestions for Authors
The relationship between microbial profiles and diagnosis of MetS among children with obesity is very important. The study is well written and very interesting. We need more information about connection of microbiota and obesity. Thank You for Your study.
Response: Thank you for your feedback. We are happy to contribute our findings. We agree that there is a need for larger and more rigorous studies among children with obesity and metabolic syndrome.
Reviewer 2 Report
The study by Gathungu et al. compares the intestinal microbiome composition in a small cohort of children aged 10-18 with moderate (BMI<30) to severe obesity (BMI>30) and with or without MedS. The study is of interest in the field as obesity and MedS is dramatically increasing among children and microbiome composition has been previously defined as an important factor.
The study is well designed, and the data well presented. The manuscript is clearly written. Some additional reflection on sex/gender and age could improve the current version of the manuscript.
Indeed, the authors claimed that « There were no gender, race….. differences between the two groups» line 164. However, the authors show only males’ data which reduce the number of subjects included and the power of the study. Including female participants would bring novel information in the field.
Similar approach could be also developed on age. Children before puberty and after puberty (circulating sex hormones) might show differences in microbiome composition and sex hormones might be an important factor. This should be better developed in the result section or at least further discussed. The authors often refer to studies in adults (often senior over 60) to support their finding. Microbiome composition is highly age and diet sensitive, therefore it is difficult to compare large age difference groups.
Author Response
Comments and Suggestions for Authors
The study by Gathungu et al. compares the intestinal microbiome composition in a small cohort of children aged 10-18 with moderate (BMI<30) to severe obesity (BMI>30) and with or without MedS. The study is of interest in the field as obesity and MedS is dramatically increasing among children and microbiome composition has been previously defined as an important factor.
Response 1: Thank you for your feedback. We are pleased to contribute our findings.
The study is well designed, and the data well presented. The manuscript is clearly written. Some additional reflection on sex/gender and age could improve the current version of the manuscript.
Response 2: Our data set included 2 cohorts. The Obese cohort included 18 males and 15 females. The Metabolic syndrome cohort had 11 males and 6 females. The mean age was very similar between the two cohorts. We incorporated all clinical and demographic variables when we analyzed the composition and diversity of microbiota between cohorts and when cohorts were stratified by BMI. Ultimately age and sex/gender did not have a significant impact on the findings as outlined in the section tilted 3.2. Analysis of gut microbiota composition. We were limited by the small sample sizes in both cohorts.
Indeed, the authors claimed that « There were no gender, race….. differences between the two groups» line 164. However, the authors show only males’ data which reduce the number of subjects included and the power of the study. Including female participants would bring novel information in the field.
Response 3: Please find the details pertaining to female participants in Response 2.
Similar approach could be also developed on age. Children before puberty and after puberty (circulating sex hormones) might show differences in microbiome composition and sex hormones might be an important factor. This should be better developed in the result section or at least further discussed. The authors often refer to studies in adults (often senior over 60) to support their finding. Microbiome composition is highly age and diet sensitive, therefore it is difficult to compare large age difference groups.
Response 4: We concur with the reviewer that the effect of puberty is an important factor. We did not collect data such as tanner stage. That would help us to stratify our cohorts by pubertal development. We can consider this in future studies with larger sample sizes.
Reviewer 3 Report
1. Author Contribution and Funding should be included in the manuscript.
2. Why did the authors focus on children? It should be demonstrated in the Introduction and Discussion.
Minor editing of English language is required.
Author Response
Comments and Suggestions for Authors
- Author Contribution and Funding should be included in the manuscript.
Response 1: Please find the information on author contributions and funding in the section titled Acknowledgments.
- Why did the authors focus on children? It should be demonstrated in the Introduction and Discussion.
Response 2: The two principal investigators Dr. Robert Woroniecki and Dr. Anupama Chawla are pediatric subspecialists in Pediatric Nephrology and Pediatric Gastroenterology, respectively. As such they chose to focus on the population they serve.
Comments on the Quality of English Language
Minor editing of English language is required.
Response 3: We will complete proof reading to improve the grammar.
Round 2
Reviewer 3 Report
1. What is the difference between the gut microbiota profiles of children with obesity or metabolic syndrome and adults with these diseases? It should be demonstrated in the Introduction and Discussion.
no
Author Response
Response: Thank you for your feedback. Please note that in the introduction we summarized the statistics regarding the rising rates of metabolic syndrome among children. After our analysis of the diversity and composition of the microbiome among children, we noted that the most critical finding was that children with a BMI above 30 have ratios of Bacteroidetes, Actinobacteria, and Firmicutes that closely resemble adults with obesity. Our sample size is limited and we feel larger studies are needed to make more detailed comparisons.