Relative Hand Grip and Back Muscle Strength, but Not Mean Muscle Strength, as Risk Factors for Incident Metabolic Syndrome and Its Metabolic Components: 16 Years of Follow-Up in a Population-Based Cohort Study

Round 1

Reviewer 1 Report

The assumptions of the research were clearly specified in the introduction. The research was carried out on a large study group , which guarantees the reliability of the obtained results. The parameters used by the authors are well described. The obtained results are presented in the form of tables. However, an error appeared in Table 1. In the column devoted to men, there are two groups described as normal. One of them should be labeled iMetS. In the sentence "Men were significantly more likely to have experienced iMetS than women (41.4% vs. 36.4%) " the wrong percentage value for men seems to be given. The discussion is described briefly and with strict reference to the obtained results.

Author Response

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Author Response File: Author Response.docx

Reviewer 2 Report

Summary:

A longitudinal study of adults Koreans was performed to assess risk factors for incident metabolic syndrome. These included strength assessments and body anthopometrics, as well as social behaviors, economic status, and employment.

Comments:

The authors have provided a link for understanding the relationship between MetS and strength. This is currently missing in the literature. However, there are items that the authors need to address in order to effectively convey their research.

 

Introduction:

• The opening statement should be ore declarative. For example, Metabolic syndrome is a significant health risk in societies around the world…then the authors can expand upon the risk factors.
• The prevalence of MetS being 10-45% - can the authors indicate specific populations where these numbers are lower and higher? This is a very large range, so the authors are advised to provide relevant data to support this statement
• DM is used to abbreviate diabetes. It is suggested that the full name, diabetes mellitus, be used before the abbreviation
• The use of WC is not consistant. WC is first defined as waist circumference, and later in the section it is defined as waist circulation. Which definition are the authors using? Also, when the abbreviation is given use the abbreviation throughout the remainder of the document
• The relationship of MetS with HGS has been shown in the literature. However, it is not clear why back muscle strength is included in this assessment. The link between back muscle strength and MetS was not synthesized in background information – especially is the emphasis is the longitudinal testing of the relationship between HGS and MetS

Methods:

• Under definition of metabolic syndrome, the TG (assuming triglycerides) has not been defined
• Many different measures were used with these individuals, so why was body composition not measured in this population?
• 2.2 muscle strength. The authors mention that participants were separated into quartiles based upon muscle strength. How was this procedure performed, and is this a good indicator of partitioning individuals who are more lilkely to have MetS? The explanation in the narrative is not clear. In the next sentence, the authors mention quintile groups. Whiich is it, quartile or quintile, and why is this being performed? Why not perform a correlation analysis?
• 2.5 statistical analysis. Line 1: “deminstated” should be “demonstrated”. There are other abbreviation which need to be defined in this paragraph, such as FHH, FHD, and KRW
• “The iMetS, according to the increase in HGS, was shown as a linear trend p.” Does this mean the authors used the p-value to indicate a trend? If so, what was the p-value?
• It is also not clear which variables were treated as continuous and what variables were treated as categorical

Results

• 3.1 Demographic and clinical characteristics. Were these data at the beginning of the longitudinal study? This is not clear in the narrative
• Table 1: this table needs to be reviewed. There are many errors/inconsistencies, especially for the men (normal vs. normal, and percentages), family history of hypertension, the p-values do not look correct based upon the mean (sd) values, for example
• Table 2 needs further explanation and consistency in reporting. What do the p-values represent for comparisons that were performed?

 

Discussion

• The authors state that a 16-year follow-up was performed on these individuals, but it is not clear whether the data are presented as a comparison from the initial measures or the follow-up measures. The authors mention baseline, but it is not clear what measures were at baseline, and the authors used references within quartiles and quintiles for comparisons making it difficult to follow how the data were assessed
• The relationship between adjacent sentences is unclear: “Body composition and body size were highly relative to muscle strength. Therefore, muscle strength shows a difference based on ethnicity [37].” How are these related with the current data being presented? There is no relationship present here and the authors need to make this clear.
• References are needed for this sentence: “Pathway analysis using significant genes showed involvement of immunity pathway, inflamma-tion, endosomal/vacuolar and ER-phagosome, and regulation of lipids and lipoprotein.”
• Last sentence of the Discussion: “Thrid” should be “Third”

Author Response

"Please see the attachment"

Author Response File: Author Response.docx