Dietary Fatty Acids Predicting Long Term Cardiovascular Mortality in a Cohort of Middle-Aged Men Followed-Up until Extinction
Round 1
Reviewer 1 Report
Comments and Suggestions for Authors
The article is very relevant and interesting and is devoted to the important problem of the influence of nutrition on cardiovascular death. The study design is cohort and this makes the data obtained very important. In my opinion, the article should be in the top list of articles based on the relevance and importance of the problem.
My comments:
1. In Table 1 you must also indicate the values of the Median and the 25% and 75% percentiles.
2. The Discussion section needs to be redone. It contains most of the description of the results obtained (lines 200-255). The descriptive part of the results should be moved to the Results section. In the Discussion section, you should leave only generalized results and then describe their discussion in comparison with the data of other studies, as well as the possible mechanisms of these changes.
3. A Limitations of the Study section is needed. It should indicate that only 3 groups of fatty acids were assessed (1 - saturated, 2 - monounsaturated, 3 - polyunsaturated) without dividing into individual fatty acids, including without dividing into omega 3, -6 fatty acids. This is due to how long ago the study began. This is important, since in modern research, of course, there is a more detailed and individual division into fatty acids.
4. It is necessary to expand the list of literary sources with publications from the last 5 years. So far there are only 6 out of 32 (18.7%). It is necessary that there be at least 30% of modern cited sources.
Author Response
MDPI. Journal HEARTS, Manuscript Hearts-2888570
Dietary Fatty Acids Predicting Long Term Cardiovascular Mortality In a Cohort Of Middle-Age Men Followed Until Extinction
By Alessandro Menotti and Paolo Emilio Puddu
NOTE from Authors to Reviewers: Additions and changes are marked in yellow; Location in green. Reference numbers in the Text in violet.
REVIEWER 1.
Comments and Suggestions for Authors
The article is very relevant and interesting and is devoted to the important problem of the influence of nutrition on cardiovascular death. The study design is cohort and this makes the data obtained very important. In my opinion, the article should be in the top list of articles based on the relevance and importance of the problem.
REPLY
The authors thank for the appreciation of their work.
QUESTION 1. In Table 1 you must also indicate the values of the Median and the 25% and 75% percentiles.
REPLY 1
Table 1 has been complemented with medians and percentiles as requested.
QUESTION 2. The Discussion section needs to be redone. It contains most of the description of the results obtained (lines 200-255). The descriptive part of the results should be moved to the Results section. In the Discussion section, you should leave only generalized results and then describe their discussion in comparison with the data of other studies, as well as the possible mechanisms of these changes.
REPLY 2
The suggestion is right and the additional results of former lines 200-255 have been moved into the Result chapter (lines 247 to 300 in the revised text).
QUESTION 3. A Limitations of the Study section is needed. It should indicate that only 3 groups of fatty acids were assessed (1 - saturated, 2 - monounsaturated, 3 - polyunsaturated) without dividing into individual fatty acids, including without dividing into omega 3, -6 fatty acids. This is due to how long ago the study began. This is important, since in modern research, of course, there is a more detailed and individual division into fatty acids.
REPLY 3
The comment is correct. The fact is that the Seven Countries Study was started in the late 1950’s, early 1960’s when clear notions and technical procedures for the identification of single fatty acids were not yet available. A note about this limitation has been given in the DISCUSSION chapter (lines 331-338 of the revised text).
QUESTION 4. It is necessary to expand the list of literary sources with publications from the last 5 years. So far there are only 6 out of 32 (18.7%). It is necessary that there be at least 30% of modern cited sources.
REPLY 4
A number of recent publications have been added and now the specific ones cover more than 30% of all references (lines 41-50, and 413-456 of the revised text).
Note from the authors.
A small number of marginal changes and correction were also added.
Reviewer 2 Report
Comments and Suggestions for Authors
Recommendations:
please describe the methodology in detail (the description raises my reservations). How long do the observations last (how many years)?
How was the research archived?
To be supplemented with an introduction and discussion of literature on ischemic heart disease caused by diet.
Please send the publication for re-evaluation.
Best Regards
Author Response
MDPI. Journal HEARTS, Manuscript Hearts-2888570
Dietary Fatty Acids Predicting Long Term Cardiovascular Mortality In a Cohort Of Middle-Age Men Followed Until Extinction
By Alessandro Menotti and Paolo Emilio Puddu
NOTE from Authors to Reviewers: Additions and changes are marked in yellow; Location in green. Reference numbers in the Text in violet.
REVIEWER 2.
QUESTION 1. Please describe the methodology in detail (the description raises my reservations). How long do the observations last (how many years)?
REPLY 1
Some parts of Methodology have been expanded, (lines 74-90, 94-96) of the revised text) but the authors were uncertain which parts of methodology were lacking of details.
In line 122 of the present version (as in a different row in the original version) it is said that the follow-up was of 61 years, (until the practical extinction of the cohort.)
QUESTION 2
How was the research archived?
REPLY 2
Due to the time elapsed from the beginning of the study, the original paper material is not anymore available since largely destroyed. The present archives consist of computer files containing coded data useful for analysis.
QUESTION 3. To be supplemented with an introduction and discussion of literature on ischemic heart disease caused by diet.
REPLY 3. Some references were moved or added in the Introduction together with brief comments (lines 41-50 of the revised text). This operation, together with the addition of more references requested by Reviewer N.1 determined large changes in the text of Discussion.
Note from the authors.
A small number of marginal changes and correction were also added.
Reviewer 3 Report
Comments and Suggestions for Authors
Dear Authors,
Your manuscript is well written and it deals with a very interesting topic.
However,I have a few suggestions to improve it:
- family history for premature CHD and for hypercholesterolemia should be included in the population characteristics and confounding factors;
- food matrices and food items should be better analyzed;
- total macronutrients intake should be reported;
- BMI of the study population should be reported;
Best regards,
Comments on the Quality of English Language
Minor check needed
Author Response
MDPI. Journal HEARTS, Manuscript Hearts-2888570
Dietary Fatty Acids Predicting Long Term Cardiovascular Mortality In a Cohort Of Middle-Age Men Followed Until Extinction
By Alessandro Menotti and Paolo Emilio Puddu
NOTE from Authors to Reviewers: Additions and changes are marked in yellow; Location in green. Reference numbers in the Text in violet.
REVIEWER 3.
Note from the Authors about Report of Reviewer 3.
Reports from Reviewers 1 and 2 were available on March 7th 2024 and we were informed about the possible late arrival of another Report from Reviewer 3. Only on March 11th 2024 we were informed by the Editorial Office that the Report from Reviewer 3 was available since March 8th 2024. This has created great difficulties in handling the consequent changes, after having already completed those requested by Reviewers 1 and 2. We believe this policy unacceptable!
COMMENT. Your manuscript is well written and it deals with a very interesting topic.
REPLY
The authors thank for the appreciation.
QUESTION 1.
Family history for premature CHD and for hypercholesterolemia should be included in the population characteristics and confounding factors.
REPLY 1
More than 60 years ago, when the baseline examination was held, most people (in a rural environment) did not have knowledge of technical-scientific-medical terms of diseases and morbid conditions. The attempts to obtain reliable information of this type (like premature CHD and hypercholesterolemia and others) were unsuccessful.
Moreover, even nowadays, the term of hypercholesterolemia does not mean the same thing for everybody and it depends on the arbitrary cut-off limits chosen for the purpose.
In conclusion, this type of characteristics could not be used as confounding factors.
QUESTION 2
Food matrices and food items should be better analyzed.
REPLY 2
The list of food groups was already inserted in Material and Methods following a generic request of Reviewer 2. Now we have added the quantities of the 18 food groups in the 3 categories of Dietary Score (new Table 2 in the revised text), and a description in the revised text (lines 154-159).
QUESTION 3
Total macronutrients intake should be reported.
REPLY 3
Total macronutrients have been added in the modified Table 1 of the revised text.
QUESTION 4
BMI of the study population should be reported.
REPLY 4.
Body mass index is now reported in the modified Table 1 of the revised text. We decided however not to use it in the multivariate models as confounding factor since in a great number of previously published papers, it was never associated with significant coefficients except in models dealing with all-cause mortality at the condition to add a quadratic term useful for the description of a parabolic relationship with events. In fact addition of this useless term would have imposed re-running of all multivariate solutions (of Tables 3-6) and we decided not to do this effort for a contribution that has a high pre-test probability (based on our previous analyses) to be not fully unsignificant.
Last note from the authors.
A small number of marginal changes and correction were also added.
Round 2
Reviewer 1 Report
Comments and Suggestions for Authors
Dear editor,
The authors corrected the article according to my comments. The article has improved.
I repeat that the article is very important and significant and deserves to be on the top list of scientific publications.
Reviewer 2 Report
Comments and Suggestions for Authors
Recommends publishing the article.
The authors made corrections,
Best Regards,
Reviewer 3 Report
Comments and Suggestions for Authors
I m satisfied with the revised version of the manuscript
Comments on the Quality of English Language
Minor English editing needed
