Impact of Gender on Cardiovascular Risk Factors in Post-COVID-19 University Students
Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsThe research results presented in the manuscript are highly relevant, as they reflect an analysis of both the prevalence of major cardiovascular risk factors, which significantly reduce the quality of life and worsen the prognosis of university students, and the relationship between lifestyle factors and risk factors for cardiovascular diseases, depending on the gender of students.
The article is written in clear language, the data presented in the tables are correct, reflect the scientific results presented in the text.
The data presented in the manuscript may be of particular interest to a wide range of readers of the journal.
However, in the process of reviewing the submitted manuscript, I had some questions and comments.:
- Section 2.1 does not specify the study period.
- Section 2.3. The authors do not indicate which equipment was used in the study.
- 2.3.1 – The subtitle can be changed to "Parameters under study". The BMI criteria are incorrectly specified (lines 86-87).
- 2.3.2 – There are no references to the questionnaires that were used to analyze physical activity, sleep quality, and stress levels.
- It is not clear what criteria were used to analyze alcohol consumption and smoking. Did you use your own original or validated questionnaires?
- It is necessary to post links to the questionnaires or submit them in the appendix to the manuscript.
- Section 3 – Did the authors evaluate the levels of lifestyle factors and cardiovascular risk factors studied before and after the COVID-19 pandemic? In this regard, how correct are the conclusions about the impact of the pandemic on the factors under study?
- The conclusion about "... increased risks in the post-COVID-19 context" is not supported by the study data.
- The revealed relationships between cardiovascular risk factors, gender, and lifestyle factors undoubtedly require correction and preventive interventions, especially in the student population.
The English could be improved to more clearly express the research.
Author Response
Por favor consulte el archivo adjunto.
Reviewer 2 Report
Comments and Suggestions for AuthorsI suggest that the conclusions be more cocrete, as it is redundant to read what was described in the discussion.
Author Response
Please refer to the attached file.
Author Response File: 
Author Response.pdf
Reviewer 3 Report
Comments and Suggestions for AuthorsGeneral Comment: This is a cross-sectional study design looking at the relationship between lifestyle factors and CVD parameters among university students post-COVID-19. Gender differences is important to understand.
Comment 1: Lines 30-31. The authors stated that CVD disproportionately affect younger population. This is not accurate, as the prevalence of CVD increases with age. The authors may have been trying to say that CVD risk factors are increasing in younger populations OR that there's a need to help young people who are disproportionately affected by CVD risk?
Comment 2: line 123. “…trend did not reach….” It is unclear what trend is being looked at here since this is a cross-sectional study looking at one point (May- December 2023). Same issue with drug consumption trend. Table 1 is showing whether there’s a significant difference between men and women and trend doesn’t fit in here.
Comment 3: Table 1. The significance column is not needed
Comment 4: Table 1. Alcohol consumption in this table seems to be defined as AUDIT score 6/8 (hazardous or harmful alcohol consumption). Please relabel it as such as can be interpreted as any alcohol consumption, which may have been reference later in the discussion. (see comment 9)
Comment 5: Table 2: Did the authors looked at all the associations and these are they ones that came out as significant? Or is there a particular reason why these are highlighted here as important correlations?
Comment 6: Table 2/line 162-163. Drug consumption seems to come out of nowhere. It is not defined in the methods, but the abbreviation DASH-10 is listed at the very end. Also, the inclusion of drug consumption in Table 2 doesn’t make sense because there is no associated CVD parameter.
Comment 7: Table 2. Column names are not lined up correctly. Significance column not needed.
Comment 8: lines 180-181 and Discussion in general. While COVID shutdown measures may have led to unhealthy lifestyle behaviors, these behaviors may have been “reversed” post-COVID. Given that there are no other datapoints to compare to (pre-COVID, during COVID) The authors cannot state that this study highlighted how these risks have been accentuated in post-COVID-19. The authors should avoid making statements that make direct comparison before, during, and after COVID. Instead, the authors should focus on how unhealthy behaviors adopted during COVID-19 may have persisted after COVID-19, even after healthier food options, outdoor activities, social interactions are readily available again.
Comment 9: line 194. The alcohol consumption in this context with close to 70% for men and women, appears to be talking about any alcohol consumption, rather than based on the AUDIT score of 6/8 (as specified in the methods). This makes it confusing. Please clearly state how alcohol consumption is defined if it changed from the original definition.
Author Response
Please refer to the attached file.
Author Response File: Author Response.pdf
Round 2
Reviewer 1 Report
Comments and Suggestions for AuthorsI would like to thank the authors for their work in correcting the manuscript, which allowed them to present the results better.
I was satisfied with the authors' answers to the questions, however, in the discussion section it would be useful to include a comparative analysis with other studies conducted before the pandemic in order to better understand the changes caused by the pandemic.
In my opinion, the authors could offer more specific recommendations on the development of targeted prevention programs and intervention strategies based on the results of the study, in particular, taking into account gender differences.
Comments on the Quality of English LanguageThe English could be improved to more clearly express the research.
Author Response
Please refer to the attached file.
Author Response File: Author Response.pdf
Reviewer 3 Report
Comments and Suggestions for AuthorsComment 1: The authors stated that they added this to caption “Note” under Table 1. “"Alcohol consumption (hazardous or harmful use) was defined as an AUDIT score of ≥6 for women and ≥8 for men." But I am not seeing this text (please add)
Comment 2: Lines 212-213 . This last bullet on Drug consumption should not be under the results presented in Table 2 text. Drug consumption is not presented in Table 2, apart from the Note. The Note should also be deleted. Instead, this bullet should be combined with the Note under Table 2 and added as a separate non-bulleted sentence. For example: “Drug consumption showed a correlation with cardiovascular parameters. Although this correlation is not significant, drug consumption has potential relevance that warrant further longitudinal analyses.”
Comment 3: This sentence in lines 235-236 need needs to be reworded. “ This study does not establish a causal link between COVID-19 and the observed cardiovascular risk factors” While this is true, this is not an objective of this study, as this study is not looking at the effect of COVID -19 itself on CVD risk factors, but is looking at how COVID-era practices affect CVD risk factors. One example of the reword could be: “ As a result………., this study cannot compare changes in lifestyle habits and cardiovascular disease risk factors during and after the COVID-19 era."
Comment 4: Even though a disclaimer is added in the beginning of the discussion, the sentences after that needs to be modified to not state that there’s a change during and after COVID-era practices.
For example: Line 239 “The increase in sedentary behavior and abdominal obesity among women during and after confinement…..” is referencing a before/after relationship, even though no measurement was taken during the confinement. Also, the comparison with abdominal obesity is really between women and men. Therefore, this sentence is still incorrectly stated. It should be reworded to something like “Women were more likely than men to have abdominal obesity and sedentary behavior, which underscores the need for targeted interventions in this group. “
Another example: Lines 244-246 “For men, the higher prevalence of hypertension and elevated glycemia appears to be linked to unhealthier dietary habits, such as excessive sodium intake—a trend exacerbated during the pandemic due to confinement “ Should be reworded to something like “For men, the higher prevalence of hypertension and elevated glycemia appears to be linked to unhealthy dietary habits, such as excessive sodium intake—a trend that was likely exacerbated during the pandemic due to confinement and persisted after confinement ended.” Adding that last part brings the reader back to the study time frame (post pandemic confinement)
Comment 5: There are some corrections that can be made to the English. Such as “unhealthier dietary habits” , which should be “unhealthy dietary habits”. Can have an editor go through it to catch them.
Author Response
Please refer to the attached file
Author Response File: Author Response.pdf
