Advancements in Understanding and Treating NAFLD: A Comprehensive Review of Metabolic-Associated Fatty Liver Disease and Emerging Therapies

Round 1

Reviewer 1 Report

Great job. Prevalence of NAFLD contiue to increase. Paper very relevant at this time

Abstract- If not required by journal, keep abstract unstructured. You mentioned mehtods section outlines... However, there is no methods sections in the journal. Your method should be how you conducted the review. Its should summarize and how you selected the articles used for your manuscript.

Section 1. last paragraph, Iine one- I would consider adding the word excess prior to fat desposition. NAFLD is more of an excess fat deposition.

Section 3. Prevalence. Prevalence is a measure used in epidemiology and as susch this section should be merged with section 2. epidemiology. This will also prevent repetition of some the information.

Figure 1. Consider adding another arrow head to show the bidirectionalty of NAFLD and NASH ( <--------------->).

Great discussion on section 6 (Treatment). You have two section 6. You may have to renumber the section on emerging therapeutic options. I will not consider semaglutide an emerging therapeutic option as studies have already shown that benefits of this medication in patients with NASH. You can delete section 6.1 semaglutidde as you already discussed GLP-1 in the treatment section.

Author Response

Please see the attachment

Author Response File: Author Response.docx

Reviewer 2 Report

This study aims to provide a comprehensive review of the current understanding of non-alcoholic fatty liver disease (NAFLD) and its progression to non-alcoholic steatohepatitis (NASH), focusing on key factors influencing its pathogenesis and emerging therapeutic strategies. I believe that the study has sufficient merit, although major revisions are required.

MAJOR COMMENTS

-       The abstract provides a succinct overview of the article's content.

-       The introduction should provide a more detailed rationale for the study, highlighting the importance of NAFLD and NASH, especially in the context of metabolic syndrome and the global burden. I recommend to the authors this reference that I think is important and that can be of great help when modifying the manuscript (DOI: 10.26402/jpp.2022.1.05).

Consider adding a statement about the objectives of the review, i.e., to provide an up-to-date overview of the understanding and treatment of NAFLD, addressing key factors and emerging therapies.

-       Discussion: When discussing medications, provide more context on why certain drugs faltered in trials and what lessons can be learned.

Further elaborate on the mechanistic rationale behind the effects of GLP-1 agonists on liver fat content and function. Explain how these mechanisms are relevant to the treatment of NAFLD/NASH. Expand on the limitations of drugs like orlistat, sympathomimetics, and combination drugs in the context of NAFLD treatment. Discuss their potential benefits and risks in more detail. Regarding bariatric surgery and endoscopic procedures, provide a concise overview of their mechanisms and how they are being integrated into treatment strategies.

-       Check typos in the text, many were found while reading. The article's language is generally clear, but there are areas where the wording could be refined for precision and clarity.

Use consistent terminology throughout the article. For instance, stick to either "NAFLD" or "MAFLD" but not both, and provide a brief explanation when introducing new terms. Avoid overly complex sentence structures, and break down complex concepts into more digestible sentences.

Future Research Directions: The conclusion could also touch on potential avenues for future research, such as areas where more investigation is needed or potential developments in treatment strategies.

Moderate editing of English language required

Author Response

Please see the attachment

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

Great job. The unstructured abstract looks better, 

For the section on treatment- you have GLP-1 or semaglutide in the treatment section and you also included it in the emrging therapys. Please consider keeping semaglutive under Treatmnent section  and take it out of emeging therapy.

Reviewer 2 Report

I believe that the study has sufficient merit to be considered for publication