All reviews of published articles are made public. This includes manuscript files, peer review comments, author rebuttals and revised materials. Note: This was optional for articles submitted before 13 February 2023.
Peer reviewers are encouraged (but not required) to provide their names to the authors when submitting their peer review. If they agree to provide their name, then their personal profile page will reflect a public acknowledgment that they performed a review (even if the article is rejected). If the article is accepted, then reviewers who provided their name will be associated with the article itself.
We are grateful to you for publishing your current manuscript and we look forward to receiving additional high quality work from you and your colleagues in the future.
I do not have anything to add.
I do not have anything to add.
I do not have anything to add.
I do not have anything to add.
I invite you to resubmit your manuscript after addressing all reviewers' comments and suggestions. When resubmitting your manuscript, please carefully consider all issues mentioned in the reviewers' comments, outline every change made point by point, and provide suitable rebuttals for any comments not addressed.
[# PeerJ Staff Note: It is PeerJ policy that additional references suggested during the peer-review process should only be included if the authors are in agreement that they are relevant and useful #]
Review line 72 "being overweight'
Raw data was not shared
No comment
Explain the use of threshold stated in line 201 as standard for inclusion in multiple regression model i.e. reference
Assuming that the variable used in models are confounders of the association-how was this determined?
Indicate significant pvalue in Tables
Indicate p values in Table 4
Gender should be separated from Age group in Table 4
OBJECTIVE & COMMENT
Clear and unambiguous, professional English used throughout.
English is clear and unambiguous and professional. Authors are urged to refrain from using multiple terms to describe one topic throughout (i.e. cardiovascular risk). See comments below.
The article must be written in English and must use clear, unambiguous, technically correct text. The article must conform to professional standards of courtesy and expression.
English is used properly. Authors are urged to used concise statements throughout to improve reader understanding.
Literature references, sufficient field background/context provided.
Literary references are sufficient but not optimal. See commentary within each recommendation.
The article should include sufficient introduction and background to demonstrate how the work fits into the broader field of knowledge. Relevant prior literature should be appropriately referenced.
Sufficient introduction and background are provided. Authors are reminded that these sections should stay highly focused on the topic of interest and should not sway from the specific objective.
Professional article structure, figs, tables. Raw data shared.
Figures are appropriate and legible. Recommendations regarding study model are made below. Primary raw data was not provided.
The structure of the article should conform to an acceptable format of ‘standard sections’ (see our Instructions for Authors for our suggested format). Significant departures in structure should be made only if they significantly improve clarity or conform to a discipline-specific custom.
Standard sections are appropriate. The authors are urged to consider including a concise ‘conclusion’ to the abstract.
Figures should be relevant to the content of the article, of sufficient resolution, and appropriately described and labeled. Figures are appropriate.
All appropriate raw data has been made available in accordance with our Data Sharing policy. Raw data was not provided; authors provide appropriate explanation as to why.
Self-contained with relevant results to hypotheses. Hypotheses are clearly stated but may need improved fluidity. See comments below.
The submission should be ‘self-contained,’ should represent an appropriate ‘unit of publication’ and should include all results relevant to the hypothesis. The manuscript fulfills this requirement. Comments regarding hypothesis representation are made below.
Coherent bodies of work should not be inappropriately subdivided merely to increase publication count. Although it is no required to remove, it is evident there are some unnecessary subdivisions (i.e. perceptions data).
The following statements are agreeable to the reviewer and should not be removed from the manuscript if possible:
Agreeable: Authors use appropriate source for recommended child screen time.
American Academy of Pediatrics is an excellent and appropriate source choice for establishing the recommended screen time for children. Authors appropriately describe how data falls into categorization based off these recommendations. See lines 147- 151.
Agreeable: Authors clearly define hypothesis to prepare readers for analysis.
Authors provide an excellent tool for communicating the purpose of the article. Further, the hypotheses are appropriately placed within the articles. Although hypothesis should not be changed after commencement or completion of the research, authors are encouraged to read statements on track changes document for suggestions on further study hypothesis. See lines 82-89.
The following are recommendations listed from most recommended to less recommended:
Recommendation: Change the title to reflect the findings. It is important to keep terms “Hispanic children” but “cardiometabolic risks” should be replaced.
The manuscript title should reflect the data findings and appropriate context. Consider replacing “cardiometabolic risks” with “healthy lifestyles” or “physical activity, blood pressure, and body mass index”. Cardiometabolic risks are not fully represented in this article. See the clinical application, diagnosis, and definitions for cardiometabolic risks. You may consider using the term “atherosclerotic risks”. The concern here is that the conclusions may be considered invalid if the cardiovascular risks and/or atherosclerotic risks have not been fully and properly being assessed. BMI may be used as a screening tool but cannot be used alone to classify a child for cardiometabolic risk entirely. Suggested titles include:
• The influence of maternal BMI on physical activity of preadolescent Hispanic children
• Hindrances to physical activity in Hispanic children
• The relationship between maternal BMI and healthy lifestyles in preadolescent Hispanic children
Nichols GA, Horberg M, Koebnick C, Young DR, Waitzfelder B, Sherwood NE, et al. Cardiometabolic Risk Factors Among 1.3 Million Adults With Overweight or Obesity, but Not Diabetes, in 10 Geographically Diverse Regions of the United States, 2012–2013. Prev Chronic Dis 2017;14:160438. DOI: http://dx.doi.org/10.5888/pcd14.160438
US Endocrinology, 2007;(1):60-3 DOI: http://doi.org/10.17925/USE.2007.00.1.60
Wilson PW, Meigs JB. Cardiometabolic risk: a Framingham perspective. Int J Obes (Lond). 2008 May;32 Suppl 2:S17-20. doi: 10.1038/ijo.2008.30. Review. PubMed PMID: 18469835.
Kelly, A.S., S.E. Barlow, G. Rao,et al. 2013. Severe obesity inchildren and adolescents: identification, associated healthrisks, and treatment approaches: a scientific statement from the American Heart Association. Circulation 128: 1689–1712.
Flegal, K.M., R.Wei, C.L. Ogden,et al. 2009. Characterizing extreme values of body mass index-for-age by using the 2000 Centers for Disease Control and Prevention growth charts. Am. J. Clin. Nutr. 90: 1314–1320.
Recommendation: Terms ‘cardiovascular’, ‘cardiometabolic’, ‘obesogenic’ [, ‘metabolic syndrome’, and ‘atherosclerotic’] should not be used interchangeably.
The authors should pick a term and hone in on it. Try to refrain from introducing new terms into the article unless they are essential to the article. See title, lines 1, 24, 27, 53, table 1, 2.
Similarly, authors should be wary of terms ‘overweight’, ‘obese’, ‘severely obese’, and ‘BMI’. Consider using clinical vernacular to define these terms at the beginning of the article and choose one or two variables to assess throughout the course of the manuscript.
Another example of this is words ‘height’ and ‘weight’ being used concurrently with BMI. Define the variable and choose one. That is, if authors decide to study BMI relationships, define how BMI is calculated and discuss BMI. Discussions and statements regarding ‘height’ and ‘weight’ are hence redundant and should not be included unless defining another variable of the study.
https://www.cdc.gov/obesity/adult/defining.html
Recommendation: Replace ‘children’ and ‘young children’ with ‘preadolescent’.
The authors target a very intriguing child age range. Authors should state specifically what range that is within the abstract and introduction. Nevertheless, age ranges of child subjects are disclosed analyzed appropriately.
Recommendation: Consider including best practices for the subject matter from credible sources in the introductory area of the article.
Best practices are essential for providing the reader with the appropriate knowledge and context. Authors may also consider the prevention strategies recommended by the Center for Disease Control and Prevention (https://www.cdc.gov/obesity/resources/strategies-guidelines.html). CDC statements on obesity are included but strategies, guidelines, and recommendations are not.
American Heart Association. (2013). Healthy Way to Grow. Retrieved from http://www.healthywaytogrow.org/HWTG/ and https://www.heart.org/idc/groups/heart-public/@wcm/@adv/documents/downloadable/ucm_473791.pdf
Kumanyika, S.K., et al. (2008). Population-based prevention of obesity: The need for comprehensive promotion of healthful eating, physical activity, and energy balance. Circulation, 118(4), 428-464. doi: 10.1161/circulationaha.108.189702.
Pate, R.R., Davis, M.G., Robinson, T.N., Stone, E.J., McKenzie, T.L., & Young, J.C. (2006). Promoting physical activity in children and youth a leadership role for schools: A scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism (Physical Activity Committee) in collaboration with the councils on Cardiovascular Disease in the Young and Cardiovascular Nursing. Circulation, 114(11), 1214- 1224
Recommendation: State the increase of obesity prevalence among Hispanics and/or entire US population.
Authors should consider presenting the relevance to this problem by providing a numerical value of increased incidence and prevalence over the past 10-20 years. Authors mention prevalence values, but this does not represent the increased incidence over a long period of time. Although not necessary, authors may consider providing values specific for Tennessee, US, non-Hispanic, Hispanic, age-specific onset and others.
Recommendation: ‘Discussion’ portion of the abstract should be edited.
Please see track changes document submitted. The discussion portion should either reflect a broad overview of the findings and a concise conclusion or only a broad overview of the findings. If the latter, authors should consider including a ‘Conclusion’ subsection to the abstract containing 40 letters or less.
Recommendations: Delineate from whom ‘negative perceptions’ are being assessed early in the manuscript.
Delineating this terminology is important for readers to understand early on. If not described early, the reader may remain uncertain whether the authors are discussing negative perceptions of community stakeholders, of the child subjects, of the mothers, of the parents, and so forth. Noteworthy, the assessment of community perceptions is complex and difficult to interpret. A recommendation to omit several, if not, all variables regarding maternal negative perceptions is expressed. See considerations below. The article is not suitable for submission to a survey research journal nor journals with a high degree of reliance on survey research methods.
The following are comments on considerations for the authors. No action necessary unless otherwise decided by authors:
Consideration: Include a ‘Purpose’ subsection within the abstract to state the scope of the article in 1 or 2 sentences.
The background and methods section may be perceived as discombobulated. There are several variables being discussed, some of which are not represented in the data. Consider making a short and concise statements such as “This study will analyze if maternal BMI, PA, and perceptions pose risks for adolescent BMI, PA, and BP in a Hispanic subject set”. Although this is described in depth in the abstract and other areas, it may be difficult for the reader to understand what the author’s goals are after reading the abstract. See track changes document lines 78-81 to see how purpose may be reworded in a clear and concise manner.
Consideration: Include a statement on inheritability, or absence thereto, of atherosclerotic disease and obesity.
Because the authors are claiming that there is existing research on obesogenic factors and their correlation to the health of older children, it may be appropriate to state whether genetics may play a role. If the influence of environment plays a greater role, authors should state so and why.
Consideration: Avoid the use of double negative and double/triple “less-more-than-most-at least” terminology.
Although such terminology must be used for statistical analysis and study structure sometimes, authors should strive to avoid it, if possible. Extensive use of double negative variables, analysis, and phrases lend to decreased clarity. Although this is not means for omission, nor is it incorrect, authors should be wary of such writing techniques. See lines 40-44, 216, 219-226, 227-233, 234-236.
Consideration: Stay mindful of citation style and requirements of the choice journal.
OBJECTIVE & COMMENT
Original primary research within Aims and Scope of the journal.
Not applicable. Aims and scope not shared.
Research question well defined, relevant & meaningful. It is stated how research fills an identified knowledge gap. Sufficient.
The submission should clearly define the research question, which must be relevant and meaningful. Sufficient.
The knowledge gap being investigated should be identified, and statements should be made as to how the study contributes to filling that gap. Sufficient.
Rigorous investigation performed to a high technical & ethical standard. Sufficient but needs improvement.
The investigation must have been conducted rigorously and to a high technical standard. The research must have been conducted in conformity with the prevailing ethical standards in the field. Sufficient.
Methods described with sufficient detail & information to replicate. Excellent. Consider condensing information in this section. Authors do an excellent work in describing the methods, especially inclusion and exclusion criteria.
Methods should be described with sufficient information to be reproducible by another investigator. Sufficient.
The following statements are agreeable to the reviewer and should not be removed from the manuscript if possible:
Agreeable: Inclusion of age-based pediatric growth reference charts are an excellent tool used by the investigators.
The authors use the appropriate CDC Aged-based Pediatric Growth Reference Charts to characterize their subjects. This tool provides a quantitative value that can be used in a myriad of statistical analysis.
Agreeable: Raw data receives appropriate adjustments.
Authors report appropriate adjustments to raw data set characterizations such as maternal education and child age and gender.
Agreeable: Maternal blood pressure is not included in analysis.
Because maternal BP may be highly variable due to pharmacological use, pregnancy, or other, it’s understandable that they authors did not include this highly fluctuating variable as part of their analysis.
Agreeable: Statistical methods utilizes are acceptable.
The use of chi-squared, Fisher’s exact tests, for sociodemographic characterization of the data set and bivariate analysis is appropriate for this study. Noteworthy, authors should consider how categorization of quantitative variable values are represented in this statistical analysis.
Agreeable: Authors exclude patients with existing serious physical or mental illness.
Because authors state they’ve excluded patients with serious and mental illness, the reader can understand that subjects used for this study are less likely to have confounding biases and the like.
The following are recommendations listed from most recommended to less recommended:
Recommendation: Inclusion criteria should specify maternal ethnicity.
Whether or not all mothers identified as Hispanic, it is important to specify such to the reader. If subject dyads include non-Hispanic mothers to Hispanic preadolescents this renders a different conclusion than if subject dyads include only Hispanic mothers to Hispanic preadolescents. That is, it should be stated if there is a possible paternal factor involved. If the latter is how the data qualifies, consider using ‘Hispanic households’ to identify the parental subjects instead of ‘maternal’ or ‘mother’. If such is the case, households should be screened for single-parent households.
Recommendation: State the existing research.
Maternal obesity and lifestyles have been researched regarding their effects on infant and child atherosclerotic risk. Positive family history, and the presence of dyslipidemia in parents, children or adolescents has been previously investigated. One such example is given below. Although the article aims to discuss other items, it is important to inform the reader that maternal atherosclerotic factors have been associated with childhood atherosclerotic risk. If the authors decide to omit terminology such as ‘cardiometabolic’ and the like, this recommendation may be dismissed.
Napoli C, Glass CK, Witztum JL, Deutsch R, D'Armiento FP, Palinski W. Influence of maternal hypercholesterolaemia during pregnancy on progression of early atherosclerotic lesions in childhood: Fate of Early Lesions in Children (FELIC) Study. Lancet 354, 1234-1241 (1999).
Recommendation: Omit neighborhood ratings variable.
The authors do not report any perceptions below ‘somewhat good/average’ satisfaction and, therefore, should not be used to contribute to hypothesis number one. That is, if there are no subjects that report a negative perception, the data cannot be used to test for a correlation to child physical activity, BP, and BMI. See Table 2. Because the authors state in their first sentence that “negative perceptions of neighborhoods have been identified as obesogenic”, the authors should revisit those findings to create questionnaire that are in alignment with what is considered “negative perceptions”. Similar dilemmas -may be found in maternal BMI, see lines 175-177.
Recommendation: Condense confidentiality and informed consent statements.
Consider condensing this statement found in lines 109-115 to, for example, “Mother-child dyads were provided written and oral information on the study protocols and purpose and thereto were requested to provide written voluntary informed consent; all of which consented. Children seven years or older and mothers were required to provide written informed consent to proceed with the study.”
The following are comments on considerations for the authors. No action necessary unless otherwise decided by authors:
Consideration: If possible, include odds ratio values in the Table 3. Bivariate associations between children’s physical activity, TV viewing, blood pressure, and BMI.
Consideration: The authors may find it relevant to state that multiple logistic regression models were used specifically to calculate respective odds ratios.
Consideration: Authors may consider removing perceptions as a variable.
First, the perceptions measured are numerous; this quantity may supersede the necessary measures for communicating the intended analysis. It may cause confusion to the reader as to what the core variables studied are. Secondly, the significance, or insignificance, of maternal perceptions of their community are not stated within the conclusions. Because this was presented as a pinnacle of the study in the abstract and introductory statements, authors should consider including a concluding statement or removing the variable. Third, the questionnaires, although acceptable, are not structured to the maximum benefit to the study. Because the study has been completed, data cannot be modified but authors should be wary of how the survey methodology may result in unintended data results that do not reflect the purpose of the article. Lastly, there are three questionnaire variables that pertain to neighborhood perceptions. Authors can consider omitting all three, condensing these three, or omitting two of the three. This would allow the reader to assess Table 2 much more fluently. It is unclear why three perception variables are included
Consideration: TV screen time should be discussed further.
TV screen time is a progressively growing measure within the field of public health because of the increased use of screens in today’s children. This shows that the authors have a good understanding of the issue at hand. Although, data and the importance of TV screen time presented to the reader is only lightly discussed. Consider replacing ‘TV screen time’ to ‘screen time’ since authors used TV and video as a measure of screen time.
OBJECTIVE & COMMENT
Impact and novelty not assessed. Negative/inconclusive results accepted. Meaningful replication encouraged where rationale & benefit to literature is clearly stated. Impact is stated clearly. Authors are urged to discuss why non-Hispanic groups were not used further and how future longitudinal studies including non-Hispanic groups would be beneficial.
Decisions are not made based on any subjective determination of impact, degree of advance, novelty, being of interest to only a niche audience, etc. Replication experiments are encouraged (provided the rationale for the replication, and how it adds value to the literature, is clearly described); however, we do not allow the ‘pointless’ repetition of well known, widely accepted results. Sufficient.
The data on which the conclusions are based must be provided or made available in an acceptable discipline-specific repository. The data should be robust, statistically sound, and controlled. Data not available to reader, authors provide appropriate explanation why and willingness to share upon specific request.
Conclusion are well stated, linked to original research question & limited to supporting results. Conclusion needs modification to reflect pinnacle results of the data and hypothesis findings.
The conclusions should be appropriately stated, should be connected to the original question investigated, and should be limited to those supported by the results. Conclusion is clearly stated but needs improvement. See comments below.
The following are recommendations listed from most recommended to less recommended:
Recommendation: Authors should state the purpose behind using categorical statistical analysis for quantitative values, such as BMI.
The readers should be well informed on why BMI ranges were used for statistical analysis instead of numerical BMI values. This could potentially be affecting statistical outcomes especially since four categories were grouped into two for analysis. See lines 136-138. Similar categorization is found for adolescent age groups one and two. See lines 184-186.
Recommendation: Authors should state how longitudinal studies remain necessary for further investigating the correlation between mentioned maternal factors and mentioned preadolescent factors.
The association between various maternal atherosclerotic predisposing factors, such as physical activity, and child body weight, particularly obesity, has been investigated. Although, sufficient longitudinal studies have yet to be published. This and other similar future studies should be mentioned in attempt to clarify the remaining gap of knowledge.
Recommendation: Briefly discuss the lack of multicultural analysis for this topic and how it would further contribute to the issue.
Recommendation: Future studies with different statistical analysis and inclusion of control groups.
It is important for the authors to recognize that, although thorough, the data cannot make assumptions regarding inclined risk of any of the mentioned variables in Hispanic children, as compared to their White non-Hispanic peers. Although past studies have established several of these correlations, this article does not provide sufficient controls to make such conclusions.
The following are comments on considerations for the authors. No action necessary unless otherwise decided by authors:
Consideration: Clarify whether the 118 subjects had or had not metabolic syndrome.
It appears the data that was used for this manuscript as extracted from a previous study. This is a useful method for clinical research, namely because existing data set may be difficult to obtain in select communities. Having said this, it is unclear whether the data set that was used in this study was extrapolated from an existing set of subjects for whom which all had metabolic syndrome. If so, it is important to state that subjects that reported pre-existing or diagnosed metabolic syndrome were included in this study and that no non-metabolic syndrome subjects were used in this study.
Consideration: Explain that this article is only representative of Hispanic adolescent physical activity over the past 7 days and TV screen time over the past 30 days.
Although the authors state that this is a cross-sectional data set, the reader only learns that the questionnaire data only represents maternal perceptions of 7-day and 30-day periods. For future studies, authors should consider including “on average” with relevant questions and refrain from ‘within the past X days’ to improve sampling.
Authors clearly state the lack of any conflicts of interests. Similarly, I, Gwendolyn A. Quintana, do not have any conflicts of interests to report.
Although not directly representative of this study here are some articles that may be of use for the authors for assessing the application of their study to the broader topics mentioned.
Cui, Z; Truesdale, K P; Bradshaw, P T; Cai, J; Stevens, J. International Journal of Obesity; London Vol. 39, Iss. 8, (Aug 2015): 1203-1208. DOI:10.1038/ijo.2015.56
Oliveira, F. L. C., Patin, R. V., & Escrivão, M. A.,Meil Schimith. (2010). Atherosclerosis prevention and treatment in children and adolescents. Expert Review of Cardiovascular Therapy, 8(4), 513-28. doi:http://dx.doi.org/10.1586/erc.09.170
I would like to thank the authors for their contributions to maternal and adolescent public health through the work done in this manuscript and more to come. Please do not hesitate to request additional information or clarification regarding the review of this manuscript.
This paper is clear and with proper English used.
Literature references provided sufficient context to te work.
The experimental design is very well explained. This investigation has a rigorous methodology and complies with ethical standards.
I would only suggest explaining in a more detailed way "A trained research staff".
Further, please add the missing abbreviations in all tables (eg."BMI").
Although data is not so high, its statistics are sound and controlled, conclusions are fair within the results and, eventually, will hamper a future larger study.
All text and materials provided via this peer-review history page are made available under a Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.