The impact of energy releasing B-vitamin intake on indices of obesity and cardiac function: a cross-sectional study

Lana M. Agraib; Islam Al-Shami; Buthaina Alkhatib; Hanan Hasan

doi:10.12688/f1000research.139672.3

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Research Article

Revised

The impact of energy releasing B-vitamin intake on indices of obesity and cardiac function: a cross-sectional study

[version 3; peer review: 2 approved]

Lana M. Agraib¹, Islam Al-Shami², Buthaina Alkhatib ², Hanan Hasan³

PUBLISHED 06 Aug 2024

Author details Author details

¹ Department of Food Technology and Nutrition, Faculty of Agriculture, Jerash University, Jerash, Jerash Governorate, Jordan
² Department of Clinical Nutrition and Dietetics, Faculty of Applied Medical Sciences, The Hashemite University, Zarqa, Jordan
³ The University of Jordan, Amman, Jordan

Lana M. Agraib
Roles: Conceptualization, Data Curation, Funding Acquisition, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Islam Al-Shami
Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Methodology, Software, Validation, Visualization, Writing – Review & Editing

Buthaina Alkhatib
Roles: Conceptualization, Investigation, Methodology, Software, Supervision, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Hanan Hasan
Roles: Data Curation, Formal Analysis, Funding Acquisition, Investigation, Resources, Software, Writing – Original Draft Preparation

OPEN PEER REVIEW

REVIEWER STATUS

This article is included in the Global Public Health gateway.

Abstract

Background

B vitamins play a crucial role in the balance and metabolism of energy. Energy metabolism mainly benefits from the B-complex vitamins. Specifically, decarboxylation, transamination, acylation, oxidation, and reduction of substrates that are ultimately employed in energy intake require thiamin, riboflavin, niacin, and vitamin B6. Vitamin deficiency could lead to chronic disease occurrence.

Objectives

To assess the impact of energy-releasing B-vitamins intake (B1, B2, B3, and B6) on selected indices of obesity and cardiac function.

Methods

A cross-sectional study was performed on 491 apparently healthy adults (18-64 years old) between January and May 2019 at Hashemite University, Jordan. Anthropometric measurements were taken, lipid profiles were analyzed, and indices of obesity and cardiac function were calculated. The typical dietary intake of B1, B2, B3, and B6 vitamins was calculated.

Results

Conicity index (CI) and abdominal volume index (AVI) scores significantly decreased with the increased adjusted vitamin B1 and B6 intake. Also, body roundness index (BRI), weight-adjusted-waist index (WWI), lipid accumulation product (LAP), and atherogenic index of plasma (AIP) scores were decreased with the increase of adjusted B6 intake (p<0.05). The total sample showed a significant inverse weak correlation between energy-adjusted intake of B1 and AVI (r= -0.156, p=0.001) and BRI (r= 0.111, p=0.014). Similar correlations were detected among male participants between energy-adjusted B1 intake and BAI, AVI, and BRI. Female participants had a significant weak inverse correlation between BAI and energy-adjusted B2 (r= -0.180, p=0.029) and B6 intake (r= -0.212, p=0.010). Only B1, the vitamin, significantly explained 2.43 and 1.24% of changes observed in the AVI and BRI scores, respectively (p<0.05).

Conclusions

Increasing the consumption of B1, B2, and B6 may significantly lower values of indices of obesity and cardiac function regardless of sex differences. Thus reducing the occurrence of obesity and related coronary heart diseases.

Keywords

energy-releasing vitamins, obesity indices, cardiac function indices, abdominal volume index, body roundness index

Corresponding author: Buthaina Alkhatib

Competing interests: No competing interests were disclosed.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright: © 2024 Agraib LM et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Agraib LM, Al-Shami I, Alkhatib B and Hasan H. The impact of energy releasing B-vitamin intake on indices of obesity and cardiac function: a cross-sectional study [version 3; peer review: 2 approved]. F1000Research 2024, 12:1382 (https://doi.org/10.12688/f1000research.139672.3) First published: 20 Oct 2023, 12:1382 (https://doi.org/10.12688/f1000research.139672.1) Latest published: 06 Aug 2024, 12:1382 (https://doi.org/10.12688/f1000research.139672.3)

Revised Amendments from Version 2

A sentence about sample size calculation was added; an exclusion criterion was also added, a reference 11 had been added, also a sentence was added to the limitations.

See the authors' detailed response to the review by Mehran Rahimlou
See the authors' detailed response to the review by Małgorzata Szczuko

Introduction

Micronutrients work as coenzymes, cocatalysts, and buffers and are essential for various cellular and biochemical processes, such as releasing energy for synthesis, movement, and other processes.¹ Due to their impact on intracellular homocysteine concentration and oxidative stress, subclinical deficiencies in several micronutrients have the potential to significantly slow the development of chronic disease.² When the consumption of a micronutrient falls below the current recommended dietary amount, a significant chronic metabolic disturbance may result from the nutrient deficiencies such as polycystic ovarian syndrome (PCOS), insulin resistance, obesity, and metabolic syndrome.³^–⁵ In recent years, many studies approved that nutrients could play a vital role in obesity and metabolic syndrome prevention. Also, energy-dense foods with deficit nutrients contribute to the development of obesity, metabolic syndrome, and inflammation.⁴^,⁶

B vitamins play a crucial role in the balance and metabolism of energy.⁷ Energy metabolism mainly benefits from the B-complex vitamins. Specifically, decarboxylation, transamination, acylation, oxidation, and reduction of substrates that are ultimately employed in energy intake require thiamin, riboflavin, niacin, and vitamin B6. One or more of these are also necessary for synthesizing steroids, fatty acids, cholesterol, amino acids, and glucose.⁸ B-vitamin deficiency may impact energy metabolism, and cause insulin resistance, chronic inflammation, obesity, and elevated oxidative stress, which may contribute to the pathophysiology of metabolic syndrome.⁹^–¹¹ B-vitamin deficiency has been approved in individuals with obesity and metabolic syndrome.²^,¹² Moreover, thiamin (B1) and riboflavin (B2) intake are inversely associated with body mass index (BMI).²^,⁷ As energy metabolism may be affected by deficiencies in biotin, niacin (B3), folate, and vitamins B6 and B12, which may enhance the generation of reactive oxidants and inflammatory reactions, lipogenesis may also be promoted, which may increase obesity.¹³^,¹⁴ Additionally, B vitamins play a vital role (methyl group donor and act as a coenzyme) in DNA methylation, which is important for body adiposity regulation¹⁵ and is associated with BMI.¹⁶

Wu et al.,⁶ suggested that a higher intake of vitamins B1, B2, B3, B6, and dietary folate were associated with a reduced risk of metabolic syndrome. Also, numerous cardiovascular diseases (CVDs), and risk factors, such as type 1 and type 2 diabetes, obesity, chronic vascular inflammation, dyslipidemia, heart failure, myocardial infarction, and depression, have been linked to B1, B3, and B6 deficiency.¹²^,¹⁷

Dietary intake of B vitamins has been found to be inversely related to CVD, as their attribution in lowering CVD risk factors, such as plasma homocysteine, serum triglycerides, and C-reaction protein.¹⁸ These risk factors have been linked to the atherosclerotic process¹⁹ and endothelial dysfunction,²⁰ which engage in CVD development. B vitamins play a role in the metabolism of one carbon unit, therefore each of these nutrients may have an impact on the pathological development of CVD by reducing homocysteine concentrations, methylation processes, and oxidative stress.²¹^,²²

Furthermore, nicotinamide adenine dinucleotide (NAD) and nicotinamide adenine dinucleotide phosphate (NADP) are redox mediator coenzymes that are precursors of B3,²³ which has also been demonstrated to enhance levels of high-density lipoprotein cholesterol (HDL), lower levels of triglycerides (TG), very low levels of low-density lipoprotein cholesterol (VLDL-C), and dramatically diminish the risk of CVD and the progression of atherosclerosis.²⁴ Based on the aforementioned, not enough data are available to cover the association between energy-releasing vitamins with indices of obesity and cardiac function. So, this study aimed to assess the impact of energy-releasing B-vitamins intake (B1, B2, B3, and B6) on selected indices of obesity and cardiac function.

Methods

Study design, participants, and ethical approval

A cross-sectional study design was used and conducted on 491 apparently healthy randomly selected male and female adults, university employees and students, aged between 18-64 years old (between January and May 2019) at The Hashemite University, Jordan. The participants were asked to sign informed consent before participation; an example of the consent form can be found as Extended data.²⁵ Exclusion criteria were pregnant or lactating women, subjects with incomplete anthropometric measurements and/or biochemical data. The Raosoft calculator (online) was used to calculate the sample size based on the Department of Statistics in 2020. Adults represented 52.2% (5,621,970) of Jordan's population (10,806,000). With a 5% error margin, 95% CI, and 50% response distribution, the minimum sample size was 385 participants.

The study was approved by The Hashemite University Ethics Committee, which authorized the protocols, tools, and procedures. All procedures were carried out according to the Declaration of Helsinki and the Institutional Board Review (IRB) (No.7/13/2018/2019; date approved 13/7/2018).

Data collection

Demographic data, including age, sex, marital status, education level, lifestyle data (such as smoking status and physical activity), medical history, and family history of diseases were gathered through conducting a face-to-face structured interview in a private room using closed-ended questions, which can be found as Extended data.²⁶ The interviewer asked the participants questions and then filled out the data form with the participants responses to ensure the accuracy of the filled data (took place over 15-18 minutes). The participants were asked to provide verbal and written consent before participation. Subjects who consumed nutritional supplements like multivitamins or subjects who adhered to restrictive diets such as weight loss diets or have food allergies, pregnant and lactating women were excluded.

Qualitative variables

Socio-demographic data, including age, sex, marital status, education level, lifestyle data (such as smoking status and physical activity), medical history, and family history of diseases, were gathered through professional staff face-to-face interviews. These data were collected using a designed list of questions created for the study and put through a reliability test, after completion by 25 participants in a pilot study (α=0.77). The first 24 hours of dietary intake were recorded during these interviews. Moreover, participants were asked to schedule another meeting for fasting blood sample testing and collecting the second 24-hour dietary recall.

Quantitative variables

Each participant had a fasting blood sample drawn after 8-12 hours of fasting, which was subsequently examined using a standardized procedure. A biochemical autoanalyzer (SEAL - AA3 HR - Colorimeter) was used to analyze the triglyceride (TG) and high-density lipoprotein (HDL). Using standardized techniques, well-trained examiners measured anthropometric indices. Participants were measured for body weight and height, wearing light clothing and bare feet, to the nearest 0.1 kg and 0.1 cm, respectively. With the individual standing, the waist circumference was measured using a flexible anthropometric tape on the horizontal plane halfway between the lowest rib and the iliac crest. At the place where the buttocks are at their widest comprehensive hip circumference was measured over thin clothing. The measurements of both circumferences were made to the nearest 0.1 cm. BMI was computed as weight divided by height square (kg)/(m²). The waist-to-height ratio was calculated (waist measurement divided by height measurement). Furthermore, in this study, five obesity indices were considered and calculated using standard formulas as follows: conicity index (CI) = WC (m)/(0.109 × √ (Bodyweight (kg)/Height (m))²⁷; body adiposity index (BAI) = hip circumference (cm)/height (m)1.5–18)²⁸; abdominal volume index (AVI) = (2 cm (waist)² + 0.7 cm (waist-hip)2)/1,000)²⁷; body roundness index (BRI0 = 365.2 − 365.5 × √(1 − ((WC/2π)²)/((0.5 × height))²))²⁹; and weight-adjusted-waist index (WWI) = WC (cm) divided by the square root of weight (kg).³⁰

Moreover, cardiac function indices were considered and calculated, including an atherogenic index of plasma (AIP), lipid accumulation product (LAP), and cardiometabolic index (CMI), based on the following equations: LAP for males = (waist (cm)−65) × TG concentration (mmol/l), and for female = (waist (cm)−58) × TG concentration (mmol/l); CMI = TG/HDL-C ×(waist-to-height); AIP = Log (TG/HDL-C).³¹

Dietary assessment

Two nonconsecutive 24-hour day recalls measured dietary intake (weekday and weekend). The participants were instructed to recollect and list all foods and beverages they had from midnight to midnight the day before, along with their quantity, cooking technique, and the names of brands. To ascertain the typical dietary intake of B1, B2, B3, and B6 vitamins, the database of ingested items was connected to ESHA Food Processor Nutrition Analysis (RRID: SCR_022528) Software (version 11:0; ESHA Research). The average total intake of the selected vitamins after adjustment for energy intake was calculated, then using percentiles (33% and 66%); the subject intake was categorized as tertiles (T1 presents the lower intake, T3 presents medium intake, and T3 presents the higher intake). T1 was a value less than the 33 percentiles (B1: <1.6536; B2: <1.4200; B3: < 25.6736; B6: < 1.3700), T2 was the value between 33 and 66 percentiles (B1: 1.6536-2.2800; B2: 1.4200-1.9400; B3: 25.6736-36.6252; B6: 1.3700-1.9300), and T3 was the value above the 66 percentiles (B1: >2.2800; B2: >1.9400; B3: >36.6252; B6: >1.9300).

Bias

To prevent sample bias, we selected a representative sample size, which was calculated based on the total Jordanian population using online software Raosoft (Raosoft Inc., free online software, Seattle, WA, USA). Also, the incomplete anthropometric measurements and/or biochemical data were excluded to eliminate information bias. However, there were no self-reporting data to bypass recall bias, the interviewers were trained for data collection.

Study size

The sample size was calculated using the calculator Raosoft based on the Department of Statistics in 2020, adults represented 52.2% (5,621,970) of the total population (10,806,000) in Jordan. With a 5% error margin, 95% CI, and 50% response distribution, and after addition of 10%, the minimum sample size was 424 participants. The total number of final participants was 491.

Statistical analysis

Shapiro–Wilk test was used to verify the normality of variables. To describe the sample, descriptive statistical tests were used. Means and standard deviations (means± SD) were used to express continuous variables. Categorical variables, on the other hand, are displayed as frequencies and percentages (n (%)). Age groups stratified this analysis.

Means and standard deviation to present the continuous variables were calculated using an ANOVA test. Based on the sample distribution and test statistics, inferential statistics were applied, including the student’s t-test, chi-squared test, and independent samples t-test. The energy-adjusted intakes of B-vitamins were calculated by adding the expected mean nutrient intake of the study population to the residual derived from the regression analysis.³² This energy adjustment method was computed from the residuals of the regression model with total energy intake as the independent variable and the nutrient as the dependent variable. Pearson correlation coefficient was performed to determine the correlation between obesity indices and macronutrient intake. The percentage change in the index explained by nutrient intake was calculated using r-square from linear regression analysis considering age and sex as confounding factors. The statistical significance was set at p < 0.05. IBM SPSS Statistics (RRID: SCR_016479) version 25 (IBM, Chicago, IL, USA) was used.

Results

Descriptive data

From the total sample, 198 participants were aged between 20-34 years old, 169 were aged 35-44 years old, and 124 were aged 45-65 years old. Participants aged between 20-34 years old had a mean weight of 74.04 ± 15.72 kg, WC 89.69 ± 13.15 cm, HC 102.98 ± 10.09 cm, and BMI 25.68 ± 4.96 kg/m². The participants aged between 35-44 years old had a mean weight of 79.48 ± 15.32 kg, WC 97.18 ± 12.65 cm, HC 106.26 ± 9.62 cm, and BMI 28.00 ± 4.58 kg/m². While participants aged between 45-65 years old had a mean weight of 84.40 ± 15.51 kg, WC 105.18 ± 15.59 cm, HC 108.22 ± 12.02 cm, and BMI 30.21 ± 5.94 kg/m². Most of the participants in the different age groups were male (66.2, 68.0 and 79.0%, respectively) (Table 1).³³ A total of 51.5% of participants aged 20-34 years old had a school-level education, while 57.4% and 50.8% of participants aged 35-44 and 45-65 years old, respectively, had a university-level education. Most of the participants aged 35-44 and 45-65 years old were single, whereas 43.9% of participants aged 20-34 years old were married and 55.6% were single. Participants aged 20-34 years old were either normal or overweight (49.5% and 30.3%, respectively). Participants aged 35-44 and 45-65 years old were either overweight (40.2% and 42.7%, respectively) or obese (32.0% and 41.1%, respectively). In addition, a larger proportion of the participants of all ages were physically active and smokers. Almost all the participants of different ages were disease-free (Table 1).

Table 1. The general characteristics of the study population (n=491).

Variables	Mean ± SD			p-value*
Variables	20-34 y (n = 198)	35-44 y (n = 169)	45-65 y (n = 124)	p-value*
Weight (kg)	74.04 ± 15.72	79.48 ± 15.32	84.40 ± 15.51	<0.001**
Waist circumference (WC) (cm)	89.69 ± 13.15	97.18 ± 12.65	105.18 ± 15.59	<0.001**
Hip circumference (HC) (cm)	102.98 ± 10.09	106.26 ± 9.62	108.22 ± 12.02	<0.001**
Body mass index (BMI) (kg/m²)	25.68 ± 4.96	28.00 ± 4.58	30.21 ± 5.94	<0.001**
	n (%)
Sex
Male	131 (66.2)	115 (68.0)	98 (79.0)	0.038
Female	67 (33.8)	54 (32.0)	26 (21.0)	0.038
Education level
School education level	102 (51.5)	72 (42.6)	61 (49.2)	0.221
University education level	96 (48.5)	97 (57.4)	63 (50.8)	0.221
Marital status
Married	87 (43.9)	148 (87.6)	118 (95.2)	<0.001**
Single	110 (55.6)	18 (10.7)	4 (3.2)
Divorced	1 (0.5)	2 (1.2)	1 (0.8)
Widow	0 (0.0)	1 (0.6)	1 (0.8)
Body mass index categories
Underweight	8 (4.0)	1 (0.6)	0 (0.0)	<0.001**
Normal weight	98 (49.5)	46 (27.2)	20 (16.1)
Overweight	60 (30.3)	68 (40.2)	53 (42.7)
Obese	32 (16.2)	54 (32.0)	51 (41.1)
Physical activity
Active	128 (65.6)	90 (53.3)	63 (50.8)	0.022
Inactive	70 (35.4)	79 (46.7)	61 (49.2)	0.022
Smoking
Yes	82 (41.4)	61 (36.1)	57 (46.0)	0.002**
No	63 (31.8)	67 (39.6)	32 (25.8)
Ex-smoker	9 (4.5)	15 (8.9)	19 (15.3)
Passive smoking	44 (22.2)	26 (15.4)	16 (12.9)
Having diabetes multiuse
Yes	0 (0.0)	6 (3.6)	22 (17.7)	<0.001**
No	198 (100.0)	163 (96.4)	102 (82.3)	<0.001**
Having dyslipidemia
Yes	1 (0.5)	11 (6.5)	16 (12.9)	<0.001**
No	197 (99.5)	158 (93.5)	108 (87.1)	<0.001**
Having hypertension
Yes	2 (1.0)	7 (4.1)	18 (14.5)	<0.001**
No	196 (99.0)	162 (95.9)	106 (85.5)	<0.001**
Having heart disease
Yes	1 (0.5)	3 (1.8)	8 (6.5)	0.003**
No	197 (99.5)	166 (98.2)	116 (93.5)	0.003**

* p-value < 0.05 considered statistically significant (2-tailed).

** p-value is significant at the 0.01 level (2-tailed).

Main results

The average total intake of the macronutrients and selected B vitamins were 3,050.09 ± 914.90 Kcal for energy, 364.32 ± 118.76 g for carbohydrate, 98.28 ± 41.29 g for protein, 134.89 ± 58.84 g for fat, 2.09 ± 0.82 mg for unadjusted B1 vitamin, 1.79 ± 0.83 mg for unadjusted B2 vitamin, 32.84 ± 14.16 mg for unadjusted B3 vitamin, and 2.02 ± 6.29 mg for unadjusted B6 vitamin. The mean intake and tertiles range for adjusted B vitamins were: 2.09 ± 0.59 mg (T1: <1.89; T2: 1.89-2.38; T3: >2.38) for energy-adjusted B1 vitamin, 1.79 ± 0.70 mg (T1: <1.54; T2: 1.54-1.88; T3: >1.88) for energy-adjusted B2 vitamin, 32.8 ± 12.34 mg (T1: <26.11; T2: 26.11-36.33; T3: >36.33) for energy-adjusted B3 vitamin, and 2.02 ± 6.22 mg (T1: <1.47; T2: 1.47-2.06; T3: >2.06) for energy-adjusted B6 vitamin.

The mean score of indices of obesity and cardiac function among the adjusted B vitamins tertiles are shown in Table 2. Among adjusted vitamin B1 intake tertiles, the CI and AVI index score significantly decreased as the intake of B1 intake increased (CI: T1 = 1.31 ± 0.01 vs. T3 = 1.28 ± 0.01, p = 0.031; AVI: T1=20.75 ± 0.64 vs. T3 = 18.14 ± 0.43, p = 0.02). Among adjusted B6 tertiles the score of the CI (T1 = 1.33 ± 0.01 vs. T3 = 1.27 ± 0.01, p < 0.001), AVI (T1 = 20.62 ± 0.57 vs. T3 = 17.43 ± 0.36, p < 0.001), BRI (T1 = 2.19 ± 0.09 vs. T3 = 1.60 ± 0.06, p < 0.001), WWI (T1 = 11.16 ± 0.09 vs. T3 = 10.71 ± 0.06, p < 0.001), LAP (T1 = 69.29 ± 4.48 vs. T3 = 50.31 ± 3.09, p = 0.048), AIP (T1 = 0.55 ± 0.03 vs. T3 = 0.46 ± 0.02, p = 0.034) decreased significantly as we moved from T1 to T3.

Table 2. The mean scores of indices of obesity and cardiac function among the adjusted B-vitamins tertiles.

Nutrient	Mean ± SEM			p-value*
Nutrient	T1 (n = 165)	T2 (n = 163)	T3 (n = 163)	p-value*
Vitamin B1
Conicity Index (CI)	1.31 ± 0.01	1.31 ± 0.01	1.28 ± 0.01	0.031*
Body adiposity index (BAI)	-17.49 ± 0.01	-17.50 ± 0.01	-17.50 ± 0.01	0.582
Abdominal volume index (AVI)	20.75 ± 0.64	19.14 ± 0.39	18.14 ± 0.43	0.002**
Body Roundness Index (BRI)	2.01 ± 0.11	1.79 ± 0.07	1.72 ± 0.08	0.059
Weight-adjusted-waist index (WWI)	10.90 ± 0.10	10.94 ± 0.07	10.79 ± 0.07	0.275
Cardiometabolic index (CMI)	2.59 ± 0.20	2.44 ± 0.20	2.68 ± 0.28	0.734
Lipid accumulation product (LAP)	61.92 ± 4.78	56.83 ± 3.36	62.47 ± 7.78	0.728
Atherogenic index of plasma (AIP)	0.53 ± 0.03	0.48 ± 0.02	0.48 ± 0.03	0.428
Vitamin B2
Conicity Index (CI)	1.31 ± 0.01	1.29 ± 0.01	1.29 ± 0.01	0.442
Body adiposity index (BAI)	-17.51 ± 0.01	-17.49 ± 0.01	-17.51 ± 0.01	0.259
Abdominal volume index (AVI)	19.51 ± 0.65	18.94 ± 0.37	19.02 ± 0.47	0.693
Body Roundness Index (BRI)	1.82 ± 0.11	1.83 ± 0.06	1.77 ± 0.08	0.816
Weight-adjusted-waist index (WWI)	10.91 ± 0.10	10.89 ± 0.06	10.83 ± 0.07	0.773
Cardiometabolic index (CMI)	2.90 ± 0.48	2.54 ± 0.15	2.34 ± 0.17	0.359
Lipid accumulation product (LAP)	67.85 ± 12.38	59.26 ± 3.21	55.29 ± 3.80	0.400
Atherogenic index of plasma (AIP)	0.48 ± 0.03	0.50 ± 0.02	0.48 ± 0.03	0.832
Vitamin B3
Conicity Index (CI)	1.30 ± 0.01	1.29 ± 0.01	1.30 ± 0.01	0.866
Body adiposity index (BAI)	-17.50 ± 0.01	-17.50 ± 0.01	-17.51 ± 0.01	0.644
Abdominal volume index (AVI)	19.20 ± 0.44	18.92 ± 0.51	19.18 ± 0.44	0.890
Body Roundness Index (BRI)	1.82 ± 0.07	1.80 ± 0.09	1.80 ± 0.07	0.972
Weight-adjusted-waist index (WWI)	10.89 ± 0.06	10.86 ± 0.08	10.87 ± 0.07	0.943
Cardiometabolic index (CMI)	2.33 ± 0.23	2.48 ± 0.17	2.86 ± 0.31	0.292
Lipid accumulation product (LAP)	55.54 ± 4.09	58.57 ± 3.98	65.70 ± 8.41	0.460
Atherogenic index of plasma (AIP)	0.45 ± 0.03	0.50 ± 0.02	0.52 ± 0.03	0.209
Vitamin B6
Conicity Index (CI)	1.33 ± 0.01	1.30 ± 0.01	1.27 ± 0.01	<0.001**
Body adiposity index (BAI)	-17.49 ± 0.01	-17.50 ± 0.01	-17.51 ± 0.01	0.051
Abdominal volume index (AVI)	20.62 ± 0.57	19.09 ± 0.45	17.43 ± 0.36	<0.001**
Body Roundness Index (BRI)	2.19 ± 0.09	1.76 ± 0.08	1.60 ± 0.06	<0.001**
Weight-adjusted-waist index (WWI)	11.16 ± 0.09	10.84 ± 0.07	10.71 ± 0.06	<0.001**
Cardiometabolic index (CMI)	2.78 ± 0.20	2.79 ± 0.36	2.24 ± 0.15	0.163
Lipid accumulation product (LAP)	69.29 ± 4.48	64.63 ± 9.13	50.31 ± 3.09	0.048*
Atherogenic index of plasma (AIP)	0.55 ± 0.03	0.48 ± 0.03	0.46 ± 0.02	0.034*

* p-value < 0.05 considered statistically significant (2-tailed).

** p-value is significant at the 0.01 level (2-tailed).

The association between indices of obesity and cardiac function with the adjusted energy intake of B vitamins among the total sample and based on sex are illustrated in Table 3. The energy-adjusted intake of B1 for the total sample had a significantly inverse weak correlation with AVI (r = -0.156, p = 0.001) and BRI (r = -0.111, p = 0.014). Among male participants, similar correlations were detected between energy adjusted B1 intake and BAI (r = -0.207, p < 0.001), AVI (r = -0.145, p = 0.007), and BRI (r = -0.163, p = 0.002). While, among female participants, there was a significant weak inverse correlation between BAI and energy adjusted B2 (r = -0.180, p = 0.029) and B6 intake (r = -0.212, p = 0.010). Moreover, there was a significant weak inverse association between energy adjusted B6 intake and AVI (r = -0.252, p = 0.002), BRI (r = -0.230, p = 0.005), and LAP (r = -0.179, p = 0.030) indices.

Table 3. The correlation between adjusted for energy vitamin B1, B2, B3, and B6 intake with obesity and cardiac function indices.

B-vitamins	Statistical analysis	Indices of obesity and cardiac function
B-vitamins	Statistical analysis	CI	BAI	AVI	BRI	WWI	CMI	LAP	AIP
Total participants
B1 intake (mg)	Pearson r	-0.078	-0.064	-0.156	-0.111	-0.041	0.040	0.040	-0.022
B1 intake (mg)	p-value	0.084	0.155	0.001**	0.014*	0.362	0.372	0.371	0.631
B2 intake (mg)	Pearson r	-0.047	-0.036	-0.058	-0.040	-0.029	-0.054	-0.051	-0.010
B2 intake (mg)	p-value	0.298	0.421	0.203	0.379	0.518	0.235	0.257	0.823
B3 intake (mg)	Pearson r	-0.001	-0.031	-0.001	-0.010	-0.007	0.049	0.034	0.071
B3 intake (mg)	p-value	0.989	0.500	0.979	0.829	0.875	0.276	0.450	0.115
B6 intake (mg)	Pearson r	-0.064	-0.014	-0.051	-0.055	-0.070	-0.022	-0.028	-0.013
B6 intake (mg)	p-value	0.156	0.756	0.263	0.222	0.120	0.620	0.530	0.772
Male participants
B1 intake (mg)	Pearson r	-0.020	-0.207	-0.145	-0.163	-0.040	0.078	0.079	0.030
B1 intake (mg)	p-value	0.716	<0.001**	0.007**	0.002**	0.465	0.149	0.141	0.583
B2 intake (mg)	Pearson r	-0.038	0.010	-0.014	-0.006	-0.028	-0.019	-0.026	0.037
B2 intake (mg)	p-value	0.488	0.846	0.799	0.916	0.604	0.725	0.629	0.493
B3 intake (mg)	Pearson r	-0.020	-0.042	-0.025	-0.036	-0.027	0.095	0.058	0.093
B3 intake (mg)	p-value	0.706	0.441	0.650	0.502	0.619	0.077	0.281	0.085
B6 intake (mg)	Pearson r	-0.070	-0.015	-0.049	-0.058	-0.076	-0.020	-0.025	-0.007
B6 intake (mg)	p-value	0.194	0.786	0.369	0.280	0.157	0.710	0.650	0.890
Female participants
B1 intake (mg)	Pearson r	0.137	-0.127	0.042	0.048	0.147	0.073	0.080	0.105
B1 intake (mg)	p-value	0.097	0.126	0.618	0.565	0.076	0.381	0.336	0.206
B2 intake (mg)	Pearson r	0.039	-0.180	-0.079	-0.082	0.022	-0.098	-0.093	-0.033
B2 intake (mg)	p-value	0.639	0.029*	0.339	0.322	0.788	0.239	0.263	0.690
B3 intake (mg)	Pearson r	0.039	-0.015	0.046	0.040	0.036	-0.077	-0.065	0.021
B3 intake (mg)	p-value	0.642	0.854	0.584	0.634	0.663	0.357	0.435	0.800
B6 intake (mg)	Pearson r	-0.136	-0.212	-0.252	-0.230	-0.131	-0.111	-0.179	-0.112
B6 intake (mg)	p-value	0.100	0.010**	0.002**	0.005**	0.112	0.179	0.030*	0.175

** Correlation is significant at the 0.01 level (2-tailed).

* Correlation is significant at the 0.05 level (2-tailed).

For more details, the percentage changes in indices of obesity and cardiac function explained by energy-adjusted B vitamins intakes using the linear regression model are presented in Table 4. Among B vitamins, only vitamin B1 significantly explained 2.43% of changes observed in the AVI score and 1.24% of changes observed in the BRI score (p < 0.05).

Table 4. Changes in obesity and cardiac function indices based on B vitamin intake using the linear regression model.

Model	R	R Square change	% change	p-value for change*
Conicity Index (CI)
Adjusted Vitamin B1	0.078	0.006	0.61%	0.084
Adjusted Vitamin B2	0.047	0.002	0.22%	0.298
Adjusted Vitamin B3	0.001	0.000	0.00%	0.989
Adjusted Vitamin B6	0.064	0.004	0.41%	0.156
Body adiposity index (BAI)
Adjusted Vitamin B1	0.064	0.004	0.41%	0.155
Adjusted Vitamin B2	0.036	0.001	0.13%	0.421
Adjusted Vitamin B3	0.031	0.001	0.09%	0.500
Adjusted Vitamin B6	0.014	0.000	0.02%	0.756
Abdominal volume index (AVI)
Adjusted Vitamin B1	0.156	0.024	2.43%	0.001*
Adjusted Vitamin B2	0.058	0.003	0.33%	0.203
Adjusted Vitamin B3	0.001	0.000	0.00%	0.979
Adjusted Vitamin B6	0.051	0.003	0.26%	0.263
Body Roundness Index (BRI)
Adjusted Vitamin B1	0.111	0.012	1.24%	0.014*
Adjusted Vitamin B2	0.040	0.002	0.16%	0.379
Adjusted Vitamin B3	0.010	0.000	0.01%	0.829
Adjusted Vitamin B6	0.055	0.003	0.31%	0.222
Weight-adjusted-waist index (WWI)
Adjusted Vitamin B1	0.041	0.002	0.17%	0.362
Adjusted Vitamin B2	0.029	0.001	0.09%	0.518
Adjusted Vitamin B3	0.007	0.000	0.01%	0.875
Adjusted Vitamin B6	0.070	0.005	0.49%	0.120
Cardiometabolic index (CMI)
Adjusted Vitamin B1	0.040	0.002	0.16%	0.372
Adjusted Vitamin B2	0.054	0.003	0.29%	0.235
Adjusted Vitamin B3	0.049	0.002	0.24%	0.276
Adjusted Vitamin B6	0.022	0.001	0.05%	0.620
Lipid accumulation product (LAP)
Adjusted Vitamin B1	0.040	0.002	0.16%	0.371
Adjusted Vitamin B2	0.051	0.003	0.26%	0.257
Adjusted Vitamin B3	0.034	0.001	0.12%	0.450
Adjusted Vitamin B6	0.028	0.001	0.08%	0.530
Atherogenic index of plasma (AIP)
Adjusted Vitamin B1	0.022	0.000	0.05%	0.631
Adjusted Vitamin B2	0.010	0.000	0.01%	0.823
Adjusted Vitamin B3	0.071	0.005	0.51%	0.115
Adjusted Vitamin B6	0.013	0.000	0.02%	0.772

* p-value < 0.05 considered statistically significant (2-tailed).

Discussion

Obesity is considered to be one of the malnutrition forms, which develops individually and as a result of unbalanced nutrition.² Based on The World Health Organization (WHO), obesity is defined as the “double burden of malnutrition” and indicates that it may occur more frequently in socioeconomically underdeveloped and poorly nourished societies side by side with malnutrition, and in consequence, chronic diseases may develop.³⁴ Vitamins B1 (thiamine), B2 (Riboflavin), B3 (niacin), and B6 (pyridoxine), all of which are vital for the metabolism of energy, carbohydrate, lipid, and amino acid, as well as the regulation of the cellular redox state.¹² Some studies have revealed that obesity is associated with low levels of fruit intake, total diet quality, and micronutrient intake compared to normal BMI, which means that people living with obesity may consume fewer micronutrients due to the foods they eat and subsequently may lead to low levels of water-soluble vitamins.¹²^,³⁵ Also, it has been found that the requirements of B vitamins has been increased for people with obesity, diabetes, and peripheral neuropathy.³⁶^,³⁷

The current study studied the association between dietary intake of B vitamins; specifically, B1, B2, B3, and B6, with indices of obesity and cardiac function were studied. Among these B vitamins, B1 and B6 had a significant association with some of the obesity indices; B2 with BAI indices, and B6 had a significant association with LAP (one of the cardiac function indices) The result revealed that the score of obesity indices CI and AVI decreased with an increase in the dietary intake of vitamin B1. Moreover, the energy-adjusted intake of B1 had a significantly inverse weak correlation with AVI and BRI among the total sample and male participants. Energy-adjusted B1 vitamin significantly explained 2.43% of changes observed in the AVI and 1.24% of changes observed in the BRI indices (p < 0.05). In addition, based on this study result, increasing the intake of B6 led to reductions in the score of obesity (CI, AVI, BRI, WWI) and cardiac function indices (LAP and AIP).

By these results, Kerns et al., reported that 15.5–29% of patients with obesity who seek bariatric surgery have malnutrition disease, specifically, B1 deficiency.³⁸ In line with the present findings, B1 deficiency was found in children with obesity, and most of those cases were subclinical.³⁹ Kardas et al., observed significantly decreased levels of vitamin B2, vitamin B12, and B9 in the obesity and metabolic syndrome groups.² By contrast, they observed an increased level of B1 with a positive correlation with LDL-C and a negative correlation with HOMA-IR and body weight in the target group.² Studies show that vitamin B2 deficiency causes functional alterations in adipocytes, and thus has pro-inflammatory and proinsulin effects, resulting from increased adipocytes.⁴⁰ Moreover, in the subjects with obesity, an inverse correlation was found between vitamin B6 and body weight.² Gunanti et al. (2014) examined the associations between serum B vitamins and vitamin intake with body fat in Mexican American children aged 8–15 years. B1 and B2 intakes were inversely associated with BMI and trunk fat mass (b:21.26, p < 0.05; b: 21.37, p < 0.05).⁷ Different suggested mechanisms have been introduced to describe the correlation between B-vitamin deficiency and obesity occurrence, all are summarized in Figure 1. The interaction mechanism between the reduced serum B-complex level and obesity includes the reduction in B1, B2, B3, and B6 levels associated with an increased risk of metabolic syndrome, which is considered one of the major cases of obesity.⁶ Also, decreases in the levels of B1 and B2 are correlated with increased BMI,⁷ and B6 regulates the expression of peroxisome proliferator-activated receptor gamma (PPARγ), which is a target gene that plays a key role in adipocyte gene expression and adipogenesis.¹⁴ Additionally, decreased B1, B3, and B6 concentrations correlate significantly with an increased risk of insulin resistance, metabolic dysfunction, and obesity.⁴¹ Moreover, generally, B vitamins have a fundamental role in the lipid and lipoprotein metabolism cascade. Therefore, quantitative or qualitative defects in B vitamins will negatively impact the metabolism of lipid derivatives.⁴² Also, B2 plays a vital role in energy-expenditure adipocyte gene regulation at the epigenetic level.⁴³ The final suggested mechanism is that increased body weight leads to the reduction of vitamin B6 levels by inducing systemic oxidative stress, which leads to stimulating adipocytokines dysregulation.⁷^,²⁴

Figure 1. Mechanism of interaction between reduction level of serum B-complex and obesity.

(1) Deficiencies in B7, B6, B9, and B12 lead to energy metabolism disruption, which induces the production of reactive oxygen species, inflammation, and lipogenesis.⁷ (2) Reduced levels of B1, B2, B3, and B6 levels are associated with an increased risk of metabolic syndrome, which is considered one of the major cases of obesity.⁶ (3) Decreased levels of B1 and B2 are correlated with increased body mass index (BMI).⁷ (4) B6 regulates the expression of peroxisome proliferator-activated receptor gamma)PPARg(target genes, which play a key role in adipocyte gene expression and adipogenesis.⁴⁵ (5) Decreased B1, B3, and B6 concentrations are significantly correlated with increased risk of insulin resistance, metabolic dysfunction and obesity.⁴⁶ (6) B vitamins are fundamental in the lipid and lipoprotein metabolism cascade. Therefore, quantitative or qualitative defects in B vitamins will negatively impact the metabolism of lipid derivatives.⁴¹ (7) B2 plays a vital role in energy-expenditure adipocyte gene regulation at the epigenetic level.⁴⁷ (8) Increased body weight leads to the reduction of vitamin B6 levels by inducing systemic oxidative stress, which leads to stimulating cytokines dysregulation.⁷^,⁴²

Studies investigating the prevalence of B1 deficiency among patients with cardiovascular diseases (CVDs) concluded that B1 deficiency could have a role in the development of CVDs.¹⁷ Odum et al. (2012) found that the mean plasma vitamins B1, B3, B6 and C concentrations of subjects with metabolic syndrome were significantly lower than that of controls (p = 0.001, 0.05, 0.045, 0.001, respectively). Also, 14% and 32% of subjects had inadequate vitamin B1 and vitamin C status, respectively.¹² Additionally, Wu et al., found a linear inverse relationship between dietary vitamin B1, niacin, B6, and metabolic syndrome, and a non-linear inverse relationship was found between dietary vitamin B2 and metabolic syndrome.⁶ It was noted that vitamin B6 supplementation is vital in preventing metabolic syndrome and pyridoxine levels were lower in patients with metabolic syndrome compared to those in healthy patients.⁴³ They suggested that a higher intake of vitamin B1, B2, niacin, B6, and dietary folate equivalent was associated with a reduced risk of metabolic syndrome.⁶ Not like other results, Kardas et al., found that B1 levels were high in subjects with obesity and metabolic syndrome; they explained this difference by the fact that these individuals typically consumed large quantities of bread and cereals, which are considered major sources of B1.² Many suggested mechanisms have been introduced to describe the association between B-vitamin deficiency and metabolic syndrome and coronary heart diseases, all are summarized in Figure 2.

Figure 2. Relationship between B-vitamins intake and cardiovascular disease.

(1) B3 intake leads to decreased serum levels of low-density lipoprotein cholesterol (LDL), very low-density lipoprotein cholesterol (VLDL), and triglycerides (TG). Also, increased levels of high-density lipoprotein cholesterol (HDL).²¹ (2) Vitamins B2, B6, B9, and B12 are vital in homocysteine demethylation into methionine, leading to decreased risk of atherosclerosis.¹⁵^,²¹ (3) Decreased levels of folate intake lead to decreased DNA-methylation, which has been detected in atherosclerotic lesions.⁴⁸ Also, B6 is associated with reduced risk of metabolic syndrome.⁶ (4) Low B1, B3, and B6 levels were associated with increased insulin resistance, metabolic dysfunction, and increased risk of atherosclerosis, obesity, metabolic syndrome, diabetes, and cardiovascular disease.¹²^,⁴⁴

B3 intake is suggested to decrease serum levels of LDL, VLDL, and TG, as well as, increase levels of HDL.²¹^,²⁴ Also, vitamins B2 and B6 have a vital role in homocysteine demethylation into methionine, which leads to decreased risk of atherosclerosis.¹⁵^,²¹ Additionally, B6 is associated with a reduced risk of metabolic syndrome.⁶ Lastly, low levels of B1, B3, and B6 are associated with increased insulin resistance, metabolic dysfunction, and increased risk of atherosclerosis, obesity, metabolic syndrome, diabetes, and cardiovascular disease.¹²^,⁴⁴

This study is one of the early studies that placed importance on examining the relationship between inadequate dietary intake of energy-releasing B vitamins, and each of the indices of obesity and cardiac function in healthy individuals. There are not enough studies that clarify the correlation between B vitamins and indices of obesity and cardiac function. This provides the scope to highlight the significance of dietary consumption and the part that nutritional inadequacies play in the prevalence of obesity and heart disease.

The present study had certain limitations. First, because the study was cross-sectional, it was impossible to conclusively establish a causal link between obesity, cardiac function indices, and dietary intake of B vitamins. Second, data were collected from one place, which affects the generalizability of conclusions that cannot reflect the society’s situation. The availability of both conventional and innovative anthropometric measures as well as cardiac function indices is one of our study’s key strengths. Additionally, because the current data were gathered before the COVID-19 pandemic, they can be used to compare studies done before and after the pandemic by researchers in the same field. Another key benefit of the study is the originality of its investigation of the relationship between indicators of cardiac function and several chosen nutrients. We selected a representative sample size to prevent sample bias, which was calculated based on the total Jordanian population using online software. Also, incomplete anthropometric measurements and/or biochemical data have been excluded to eliminate information bias. However, there were no self-reporting data to bypass recall bias, the interviewers were trained for data collection.

Conclusions

In conclusion, after energy adjustment, obesity indices are inversely associated with B1, B2, and B6 vitamins. Specifically, AVI and BRI were inversely associated with B1 and B6 vitamins, whereas BAI was inversely associated with B2 vitamins among female participants. Only the B6 vitamin was inversely associated with LAP and AIP among cardiac function indices. Increasing the intake of these vitamins (B1, B2, and B6) results in reducing the score of obesity (CI, AVI, BRI, WWI) and cardiac function indices (LAP and AIP), which in consequence may help reduce the occurrence of obesity and related coronary diseases.

Data availability

Underlying data

Zenodo: The impact of energy releasing B-vitamin intake on indices of obesity and cardiac function: a cross-sectional study, https://doi.org/10.5281/zenodo.8159117.³³

The project contains the following underlying data:

• Supplementary File 1-Energy releasing B vitamins 13-1-2023.sav (Anonymized participant data used in this study)

Extended data

Zenodo: The impact of energy releasing B-vitamin intake on indices of obesity and cardiac function: a cross-sectional study, https://doi.org/10.5281/zenodo.8167423.²⁶

This project contains the list of interview questions used with 24-hour recall form.

Zenodo: The impact of energy releasing B-vitamin intake on indices of obesity and cardiac function: a cross-sectional study, https://doi.org/10.5281/zenodo.8167442.²⁵

This project contains an example of the consent form used.

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

Acknowledgments

The authors thank the participants for their patience and great help. Grammarly software program has been used to enhance language editing.

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Version 3

VERSION 3 PUBLISHED 20 Oct 2023

Author details Author details

Lana M. Agraib
Roles: Conceptualization, Data Curation, Funding Acquisition, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Islam Al-Shami
Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Methodology, Software, Validation, Visualization, Writing – Review & Editing

Buthaina Alkhatib
Roles: Conceptualization, Investigation, Methodology, Software, Supervision, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Hanan Hasan
Roles: Data Curation, Formal Analysis, Funding Acquisition, Investigation, Resources, Software, Writing – Original Draft Preparation

Competing interests

No competing interests were disclosed.

Grant information

The author(s) declared that no grants were involved in supporting this work.

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Published: 20 Oct 2023, 12:1382

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© 2024 Agraib LM et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Agraib LM, Al-Shami I, Alkhatib B and Hasan H. The impact of energy releasing B-vitamin intake on indices of obesity and cardiac function: a cross-sectional study [version 3; peer review: 2 approved]. F1000Research 2024, 12:1382 (https://doi.org/10.12688/f1000research.139672.3)

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Version 3

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PUBLISHED 06 Aug 2024

Revised

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Reviewer Report 12 Aug 2024

Mehran Rahimlou, Nutrition, Zanjan University of Medical Sciences, Zanjan, Iran

Approved

https://doi.org/10.5256/f1000research.169917.r311209

The authors have been able to make the necessary changes in ... Continue reading

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Version 2

VERSION 2

PUBLISHED 23 Feb 2024

Revised

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Reviewer Report 01 Aug 2024

Mehran Rahimlou, Nutrition, Zanjan University of Medical Sciences, Zanjan, Iran

Approved with Reservations

https://doi.org/10.5256/f1000research.162623.r304462

This study entitled: The impact of energy releasing B-vitamin intake on indices of obesity and cardiac function: a cross-sectional study is interesting. However, I have some comments.

In the introduction section, it would have been better

This study entitled: The impact of energy releasing B-vitamin intake on indices of obesity and cardiac function: a cross-sectional study is interesting. However, I have some comments.

In the introduction section, it would have been better for the researchers to point out why obese people with metabolic syndrome are at risk of deficiency of group B vitamins.
B-vitamin deficiency may impact energy metabolism, and cause insulin resistance, chronic inflammation, obesity, and elevated oxidative stress, which may contribute to the pathophysiology of metabolic syndrome (add more references such as these articles to this sentence: Ghanavati M, et al., 2020 [Ref-1])
"Study design, participants, and ethical approval" It is better to explain information about the type of sampling in this section.
On the other hand, one of the drawbacks of this study is that all people were selected from a university group, and this significantly reduces the ability to generalize the results to the society, because in sampling based on an institution or organization, the factors There are many confounders that have low generalizability compared to population studies.
Researchers should also explain how to calculate the sample size.
"Data collection" what is your approach about subjects who consumed nutritional supplements like multi vitamins or subjects who adherent from restrictive diets such as weight loss diets.
"The first 24 hours of dietary intake were recorded during these interviews" It would have been better if three days dietary recall (including two working days and one off day) were collected.

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Partly
Are sufficient details of methods and analysis provided to allow replication by others?

Partly
If applicable, is the statistical analysis and its interpretation appropriate?

Partly
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

References

1. Ghanavati M, Rahmani J, Clark CCT, Hosseinabadi SM, et al.: Pistachios and cardiometabolic risk factors: A systematic review and meta-analysis of randomized controlled clinical trials.Complement Ther Med. 2020; 52: 102513 PubMed Abstract | Publisher Full Text

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Nutrition and diet

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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Report a concern

Author Response 06 Aug 2024

Buthaina Alkhatib, Department of Clinical Nutrition and Dietetics, Faculty of Applied Medical Sciences, The Hashemite University, Zarqa, Jordan

06 Aug 2024

Author Response

This study entitled: The impact of energy-releasing B-vitamin intake on indices of obesity and cardiac function: a cross-sectional study is interesting. However, I have some comments.
1. In the introduction ... Continue reading This study entitled: The impact of energy-releasing B-vitamin intake on indices of obesity and cardiac function: a cross-sectional study is interesting. However, I have some comments.
1. In the introduction section, it would have been better for the researchers to point out why obese people with metabolic syndrome are at risk of deficiency of group B vitamins.
Response: The core of the study hypothesis was to study the effect of a lower dietary intake of B vitamins, which leads to obesity and metabolic syndrome, rather than approving that obese and metabolic syndrome people are at risk of B vitamin deficiency.

2. B-vitamin deficiency may impact energy metabolism, and cause insulin resistance, chronic inflammation, obesity, and elevated oxidative stress, which may contribute to the pathophysiology of metabolic syndrome (add more references such as these articles to this sentence: Ghanavati M, et al., 2020 [Ref-1])
Response: Done, Thank you.

3. "Study design, participants, and ethical approval" It is better to explain information about the type of sampling in this section.
Response: A random sample.

4. On the other hand, one of the drawbacks of this study is that all people were selected from a university group, and this significantly reduces the ability to generalise the results to the society, because in sampling based on an institution or organisation, the factors There are many confounders that have low generalisability compared to population studies.
Response: It has been added to the study limitations.

5. Researchers should also explain how to calculate the sample size.
Response: Done (The Raosoft calculator (online) was used to calculate the sample size based on the Department of Statistics in 2020. Adults represented 52.2% (5,621,970) of Jordan's population (10,806,000). With a 5% error margin, 95% CI, and 50% response distribution, the minimum sample size was 385 participants.)

6. "Data collection:" What is your approach to subjects who consumed nutritional supplements like multivitamins or subjects who adhered to restrictive diets such as weight loss diets?
Response: Yes, we asked about medications, dietary supplements intake, food allergies, and adhesion to a weight reduction diet, and they were excluded (We added sentence about this)

7. "The first 24 hours of dietary intake were recorded during these interviews." It would have been better if three days of dietary recall (including two working days and one off day) were collected.
Response: Thank you, there many references whom used 2 days 24 hour recalls for the big samples, rather than using 3 days (sure it is better)
This study entitled: The impact of energy-releasing B-vitamin intake on indices of obesity and cardiac function: a cross-sectional study is interesting. However, I have some comments.
1. In the introduction section, it would have been better for the researchers to point out why obese people with metabolic syndrome are at risk of deficiency of group B vitamins.
Response: The core of the study hypothesis was to study the effect of a lower dietary intake of B vitamins, which leads to obesity and metabolic syndrome, rather than approving that obese and metabolic syndrome people are at risk of B vitamin deficiency.

2. B-vitamin deficiency may impact energy metabolism, and cause insulin resistance, chronic inflammation, obesity, and elevated oxidative stress, which may contribute to the pathophysiology of metabolic syndrome (add more references such as these articles to this sentence: Ghanavati M, et al., 2020 [Ref-1])
Response: Done, Thank you.

3. "Study design, participants, and ethical approval" It is better to explain information about the type of sampling in this section.
Response: A random sample.

4. On the other hand, one of the drawbacks of this study is that all people were selected from a university group, and this significantly reduces the ability to generalise the results to the society, because in sampling based on an institution or organisation, the factors There are many confounders that have low generalisability compared to population studies.
Response: It has been added to the study limitations.

5. Researchers should also explain how to calculate the sample size.
Response: Done (The Raosoft calculator (online) was used to calculate the sample size based on the Department of Statistics in 2020. Adults represented 52.2% (5,621,970) of Jordan's population (10,806,000). With a 5% error margin, 95% CI, and 50% response distribution, the minimum sample size was 385 participants.)

6. "Data collection:" What is your approach to subjects who consumed nutritional supplements like multivitamins or subjects who adhered to restrictive diets such as weight loss diets?
Response: Yes, we asked about medications, dietary supplements intake, food allergies, and adhesion to a weight reduction diet, and they were excluded (We added sentence about this)

7. "The first 24 hours of dietary intake were recorded during these interviews." It would have been better if three days of dietary recall (including two working days and one off day) were collected.
Response: Thank you, there many references whom used 2 days 24 hour recalls for the big samples, rather than using 3 days (sure it is better)
Competing Interests: No competing interests were disclosed. Close
Report a concern
Respond or Comment

COMMENTS ON THIS REPORT

Author Response 06 Aug 2024

Buthaina Alkhatib, Department of Clinical Nutrition and Dietetics, Faculty of Applied Medical Sciences, The Hashemite University, Zarqa, Jordan

06 Aug 2024

Author Response

This study entitled: The impact of energy-releasing B-vitamin intake on indices of obesity and cardiac function: a cross-sectional study is interesting. However, I have some comments.
1. In the introduction ... Continue reading This study entitled: The impact of energy-releasing B-vitamin intake on indices of obesity and cardiac function: a cross-sectional study is interesting. However, I have some comments.
1. In the introduction section, it would have been better for the researchers to point out why obese people with metabolic syndrome are at risk of deficiency of group B vitamins.
Response: The core of the study hypothesis was to study the effect of a lower dietary intake of B vitamins, which leads to obesity and metabolic syndrome, rather than approving that obese and metabolic syndrome people are at risk of B vitamin deficiency.

2. B-vitamin deficiency may impact energy metabolism, and cause insulin resistance, chronic inflammation, obesity, and elevated oxidative stress, which may contribute to the pathophysiology of metabolic syndrome (add more references such as these articles to this sentence: Ghanavati M, et al., 2020 [Ref-1])
Response: Done, Thank you.

3. "Study design, participants, and ethical approval" It is better to explain information about the type of sampling in this section.
Response: A random sample.

4. On the other hand, one of the drawbacks of this study is that all people were selected from a university group, and this significantly reduces the ability to generalise the results to the society, because in sampling based on an institution or organisation, the factors There are many confounders that have low generalisability compared to population studies.
Response: It has been added to the study limitations.

5. Researchers should also explain how to calculate the sample size.
Response: Done (The Raosoft calculator (online) was used to calculate the sample size based on the Department of Statistics in 2020. Adults represented 52.2% (5,621,970) of Jordan's population (10,806,000). With a 5% error margin, 95% CI, and 50% response distribution, the minimum sample size was 385 participants.)

6. "Data collection:" What is your approach to subjects who consumed nutritional supplements like multivitamins or subjects who adhered to restrictive diets such as weight loss diets?
Response: Yes, we asked about medications, dietary supplements intake, food allergies, and adhesion to a weight reduction diet, and they were excluded (We added sentence about this)

7. "The first 24 hours of dietary intake were recorded during these interviews." It would have been better if three days of dietary recall (including two working days and one off day) were collected.
Response: Thank you, there many references whom used 2 days 24 hour recalls for the big samples, rather than using 3 days (sure it is better)
This study entitled: The impact of energy-releasing B-vitamin intake on indices of obesity and cardiac function: a cross-sectional study is interesting. However, I have some comments.
1. In the introduction section, it would have been better for the researchers to point out why obese people with metabolic syndrome are at risk of deficiency of group B vitamins.
Response: The core of the study hypothesis was to study the effect of a lower dietary intake of B vitamins, which leads to obesity and metabolic syndrome, rather than approving that obese and metabolic syndrome people are at risk of B vitamin deficiency.

2. B-vitamin deficiency may impact energy metabolism, and cause insulin resistance, chronic inflammation, obesity, and elevated oxidative stress, which may contribute to the pathophysiology of metabolic syndrome (add more references such as these articles to this sentence: Ghanavati M, et al., 2020 [Ref-1])
Response: Done, Thank you.

3. "Study design, participants, and ethical approval" It is better to explain information about the type of sampling in this section.
Response: A random sample.

4. On the other hand, one of the drawbacks of this study is that all people were selected from a university group, and this significantly reduces the ability to generalise the results to the society, because in sampling based on an institution or organisation, the factors There are many confounders that have low generalisability compared to population studies.
Response: It has been added to the study limitations.

5. Researchers should also explain how to calculate the sample size.
Response: Done (The Raosoft calculator (online) was used to calculate the sample size based on the Department of Statistics in 2020. Adults represented 52.2% (5,621,970) of Jordan's population (10,806,000). With a 5% error margin, 95% CI, and 50% response distribution, the minimum sample size was 385 participants.)

6. "Data collection:" What is your approach to subjects who consumed nutritional supplements like multivitamins or subjects who adhered to restrictive diets such as weight loss diets?
Response: Yes, we asked about medications, dietary supplements intake, food allergies, and adhesion to a weight reduction diet, and they were excluded (We added sentence about this)

7. "The first 24 hours of dietary intake were recorded during these interviews." It would have been better if three days of dietary recall (including two working days and one off day) were collected.
Response: Thank you, there many references whom used 2 days 24 hour recalls for the big samples, rather than using 3 days (sure it is better)
Competing Interests: No competing interests were disclosed. Close
Report a concern

Views

Reviewer Report 26 Feb 2024

Małgorzata Szczuko, Department of Biochemistry and Human Nutrition, Pomeranian Medical University, Szczecin, Poland

Approved

https://doi.org/10.5256/f1000research.162623.r249706

Position 24 and 25 in the references ... Continue reading

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Version 1

VERSION 1

PUBLISHED 20 Oct 2023

Views

Reviewer Report 12 Feb 2024

Małgorzata Szczuko, Department of Biochemistry and Human Nutrition, Pomeranian Medical University, Szczecin, Poland

Approved with Reservations

https://doi.org/10.5256/f1000research.152969.r239615

1. The article is clearly written and easy to read. Although it seems that at the same time it does not exhaust the topic in some respects

2. A major advantage of the study is the number of patients examined and the well-described statistics of the results

3. the summary lacks a specific summary and conclusion

4. in the introduction, please also include women with PCOS, in the course of which insulin resistance, metabolic syndrome and obesity develop
ref [1]
5. the age of the examined patients is missing in table 1

6. the following issues should be discussed in the discussion:
- increased demand for B vitamins in people with obesity and diabetes re [2].
- peripheral neuropathy ref [3]
- effects of supplementation and over supplementation of B vitamins
ref [4]

7. It is recommended to use the provided literature to improve and improve the article.

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

Yes
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

References

1. Szczuko M, Hawryłkowicz V, Kikut J, Drozd A: The implications of vitamin content in the plasma in reference to the parameters of carbohydrate metabolism and hormone and lipid profiles in PCOS.J Steroid Biochem Mol Biol. 2020; 198: 105570 PubMed Abstract | Publisher Full Text
2. Nix WA, Zirwes R, Bangert V, Kaiser RP, et al.: Vitamin B status in patients with type 2 diabetes mellitus with and without incipient nephropathy.Diabetes Res Clin Pract. 2015; 107 (1): 157-65 PubMed Abstract | Publisher Full Text
3. Stein J, Geisel J, Obeid R: Association between neuropathy and B-vitamins: A systematic review and meta-analysis.Eur J Neurol. 2021; 28 (6): 2054-2064 PubMed Abstract | Publisher Full Text
4. An P, Wan S, Luo Y, Luo J, et al.: Micronutrient Supplementation to Reduce Cardiovascular Risk.J Am Coll Cardiol. 2022; 80 (24): 2269-2285 PubMed Abstract | Publisher Full Text

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: nutrition, metabolic syndrom, vitamin B

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Report a concern

Author Response 13 Apr 2024

Buthaina Alkhatib, Department of Clinical Nutrition and Dietetics, Faculty of Applied Medical Sciences, The Hashemite University, Zarqa, Jordan

13 Apr 2024

Author Response
1. The article is clearly written and easy to read. Although it seems that at the same time it does not exhaust the topic in some respects
... Continue reading
The article is clearly written and easy to read. Although it seems that at the same time it does not exhaust the topic in some respects

Response: Thank you

2. A major advantage of the study is the number of patients examined and the well-described statistics of the results
Response: thank you

3. the summary lacks a specific summary and conclusion
Response: it has been revised (conclusion: Increasing the consumption of B1, B2, and B6 may significantly lower values of indices of obesity and cardiac function regardless of sex differences. Thus reducing the occurrence of obesity and related coronary heart diseases

4. in the introduction, please also include women with PCOS, in the course of which insulin resistance, metabolic syndrome and obesity develop
ref [1]
Response: it has been added

5. the age of the examined patients is missing in table 1
Response: the table was prepared regarding the age group, as shown in raw 1)

6. the following issues should be discussed in the discussion:
- increased demand for B vitamins in people with obesity and diabetes re [2].
- peripheral neuropathy ref [3]
- effects of supplementation and over-supplementation of B vitamins
ref [4]

Response: it has been provided (references 35, 36). But reference no 4 is not within the scope of discussion.

7. It is recommended to use the provided literature to improve and improve the article.
Response: many thanks for your suggestions, it has been provided

Is the work clearly and accurately presented and does it cite the current literature?

Yes

Is the study design appropriate and is the work technically sound?

Yes

Are sufficient details of methods and analysis provided to allow replication by others?

Yes

If applicable, is the statistical analysis and its interpretation appropriate?

Yes

Are all the source data underlying the results available to ensure full reproducibility?

Yes

Are the conclusions drawn adequately supported by the results?

Yes
The article is clearly written and easy to read. Although it seems that at the same time it does not exhaust the topic in some respects

Response: Thank you

2. A major advantage of the study is the number of patients examined and the well-described statistics of the results
Response: thank you

3. the summary lacks a specific summary and conclusion
Response: it has been revised (conclusion: Increasing the consumption of B1, B2, and B6 may significantly lower values of indices of obesity and cardiac function regardless of sex differences. Thus reducing the occurrence of obesity and related coronary heart diseases

4. in the introduction, please also include women with PCOS, in the course of which insulin resistance, metabolic syndrome and obesity develop
ref [1]
Response: it has been added

5. the age of the examined patients is missing in table 1
Response: the table was prepared regarding the age group, as shown in raw 1)

6. the following issues should be discussed in the discussion:
- increased demand for B vitamins in people with obesity and diabetes re [2].
- peripheral neuropathy ref [3]
- effects of supplementation and over-supplementation of B vitamins
ref [4]

Response: it has been provided (references 35, 36). But reference no 4 is not within the scope of discussion.

7. It is recommended to use the provided literature to improve and improve the article.
Response: many thanks for your suggestions, it has been provided

Is the work clearly and accurately presented and does it cite the current literature?

Yes

Is the study design appropriate and is the work technically sound?

Yes

Are sufficient details of methods and analysis provided to allow replication by others?

Yes

If applicable, is the statistical analysis and its interpretation appropriate?

Yes

Are all the source data underlying the results available to ensure full reproducibility?

Yes

Are the conclusions drawn adequately supported by the results?

Yes
Competing Interests: no competing interest Close
Report a concern
Respond or Comment

COMMENTS ON THIS REPORT

Author Response 13 Apr 2024

Buthaina Alkhatib, Department of Clinical Nutrition and Dietetics, Faculty of Applied Medical Sciences, The Hashemite University, Zarqa, Jordan

13 Apr 2024

Author Response
1. The article is clearly written and easy to read. Although it seems that at the same time it does not exhaust the topic in some respects
... Continue reading
The article is clearly written and easy to read. Although it seems that at the same time it does not exhaust the topic in some respects

Response: Thank you

2. A major advantage of the study is the number of patients examined and the well-described statistics of the results
Response: thank you

3. the summary lacks a specific summary and conclusion
Response: it has been revised (conclusion: Increasing the consumption of B1, B2, and B6 may significantly lower values of indices of obesity and cardiac function regardless of sex differences. Thus reducing the occurrence of obesity and related coronary heart diseases

4. in the introduction, please also include women with PCOS, in the course of which insulin resistance, metabolic syndrome and obesity develop
ref [1]
Response: it has been added

5. the age of the examined patients is missing in table 1
Response: the table was prepared regarding the age group, as shown in raw 1)

6. the following issues should be discussed in the discussion:
- increased demand for B vitamins in people with obesity and diabetes re [2].
- peripheral neuropathy ref [3]
- effects of supplementation and over-supplementation of B vitamins
ref [4]

Response: it has been provided (references 35, 36). But reference no 4 is not within the scope of discussion.

7. It is recommended to use the provided literature to improve and improve the article.
Response: many thanks for your suggestions, it has been provided

Is the work clearly and accurately presented and does it cite the current literature?

Yes

Is the study design appropriate and is the work technically sound?

Yes

Are sufficient details of methods and analysis provided to allow replication by others?

Yes

If applicable, is the statistical analysis and its interpretation appropriate?

Yes

Are all the source data underlying the results available to ensure full reproducibility?

Yes

Are the conclusions drawn adequately supported by the results?

Yes
The article is clearly written and easy to read. Although it seems that at the same time it does not exhaust the topic in some respects

Response: Thank you

2. A major advantage of the study is the number of patients examined and the well-described statistics of the results
Response: thank you

3. the summary lacks a specific summary and conclusion
Response: it has been revised (conclusion: Increasing the consumption of B1, B2, and B6 may significantly lower values of indices of obesity and cardiac function regardless of sex differences. Thus reducing the occurrence of obesity and related coronary heart diseases

4. in the introduction, please also include women with PCOS, in the course of which insulin resistance, metabolic syndrome and obesity develop
ref [1]
Response: it has been added

5. the age of the examined patients is missing in table 1
Response: the table was prepared regarding the age group, as shown in raw 1)

6. the following issues should be discussed in the discussion:
- increased demand for B vitamins in people with obesity and diabetes re [2].
- peripheral neuropathy ref [3]
- effects of supplementation and over-supplementation of B vitamins
ref [4]

Response: it has been provided (references 35, 36). But reference no 4 is not within the scope of discussion.

7. It is recommended to use the provided literature to improve and improve the article.
Response: many thanks for your suggestions, it has been provided

Is the work clearly and accurately presented and does it cite the current literature?

Yes

Is the study design appropriate and is the work technically sound?

Yes

Are sufficient details of methods and analysis provided to allow replication by others?

Yes

If applicable, is the statistical analysis and its interpretation appropriate?

Yes

Are all the source data underlying the results available to ensure full reproducibility?

Yes

Are the conclusions drawn adequately supported by the results?

Yes
Competing Interests: no competing interest Close
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VERSION 3 PUBLISHED 20 Oct 2023

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Version 2 (revision) 23 Feb 24	read	read
Version 1 20 Oct 23	read

Małgorzata Szczuko, Pomeranian Medical University, Szczecin, Poland
Mehran Rahimlou, Zanjan University of Medical Sciences, Zanjan, Iran

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12 Aug 2024 | for Version 3

Mehran Rahimlou, Nutrition, Zanjan University of Medical Sciences, Zanjan, Iran

6 Views Cite this report Responses(0)

Approved

The authors have been able to make the necessary changes in the manuscript and the manuscript meets the necessary conditions for acceptance.

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Nutrition and diet

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Reviewer Report

10 Views

01 Aug 2024 | for Version 2

Mehran Rahimlou, Nutrition, Zanjan University of Medical Sciences, Zanjan, Iran

10 Views Cite this report Responses(1)

Approved With Reservations

This study entitled: The impact of energy releasing B-vitamin intake on indices of obesity and cardiac function: a cross-sectional study is interesting. However, I have some comments.

In the introduction section, it would have been better for the researchers to point out why obese people with metabolic syndrome are at risk of deficiency of group B vitamins.
B-vitamin deficiency may impact energy metabolism, and cause insulin resistance, chronic inflammation, obesity, and elevated oxidative stress, which may contribute to the pathophysiology of metabolic syndrome (add more references such as these articles to this sentence: Ghanavati M, et al., 2020 [Ref-1])
"Study design, participants, and ethical approval" It is better to explain information about the type of sampling in this section.
On the other hand, one of the drawbacks of this study is that all people were selected from a university group, and this significantly reduces the ability to generalize the results to the society, because in sampling based on an institution or organization, the factors There are many confounders that have low generalizability compared to population studies.
Researchers should also explain how to calculate the sample size.
"Data collection" what is your approach about subjects who consumed nutritional supplements like multi vitamins or subjects who adherent from restrictive diets such as weight loss diets.
"The first 24 hours of dietary intake were recorded during these interviews" It would have been better if three days dietary recall (including two working days and one off day) were collected.

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Partly
Are sufficient details of methods and analysis provided to allow replication by others?

Partly
If applicable, is the statistical analysis and its interpretation appropriate?

Partly
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

References

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Nutrition and diet

Respond to this report

Responses (1)

Author Response

06 Aug 2024

Buthaina Alkhatib, Department of Clinical Nutrition and Dietetics, Faculty of Applied Medical Sciences, The Hashemite University, Zarqa, Jordan

This study entitled: The impact of energy-releasing B-vitamin intake on indices of obesity and cardiac function: a cross-sectional study is interesting. However, I have some comments.
1. In the introduction section, it would have been better for the researchers to point out why obese people with metabolic syndrome are at risk of deficiency of group B vitamins.
Response: The core of the study hypothesis was to study the effect of a lower dietary intake of B vitamins, which leads to obesity and metabolic syndrome, rather than approving that obese and metabolic syndrome people are at risk of B vitamin deficiency.

2. B-vitamin deficiency may impact energy metabolism, and cause insulin resistance, chronic inflammation, obesity, and elevated oxidative stress, which may contribute to the pathophysiology of metabolic syndrome (add more references such as these articles to this sentence: Ghanavati M, et al., 2020 [Ref-1])
Response: Done, Thank you.

3. "Study design, participants, and ethical approval" It is better to explain information about the type of sampling in this section.
Response: A random sample.

4. On the other hand, one of the drawbacks of this study is that all people were selected from a university group, and this significantly reduces the ability to generalise the results to the society, because in sampling based on an institution or organisation, the factors There are many confounders that have low generalisability compared to population studies.
Response: It has been added to the study limitations.

5. Researchers should also explain how to calculate the sample size.
Response: Done (The Raosoft calculator (online) was used to calculate the sample size based on the Department of Statistics in 2020. Adults represented 52.2% (5,621,970) of Jordan's population (10,806,000). With a 5% error margin, 95% CI, and 50% response distribution, the minimum sample size was 385 participants.)

6. "Data collection:" What is your approach to subjects who consumed nutritional supplements like multivitamins or subjects who adhered to restrictive diets such as weight loss diets?
Response: Yes, we asked about medications, dietary supplements intake, food allergies, and adhesion to a weight reduction diet, and they were excluded (We added sentence about this)

7. "The first 24 hours of dietary intake were recorded during these interviews." It would have been better if three days of dietary recall (including two working days and one off day) were collected.
Response: Thank you, there many references whom used 2 days 24 hour recalls for the big samples, rather than using 3 days (sure it is better)

View more View less

Competing Interests

No competing interests were disclosed.

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Reviewer Report

6 Views

26 Feb 2024 | for Version 2

Małgorzata Szczuko, Department of Biochemistry and Human Nutrition, Pomeranian Medical University, Szczecin, Poland

6 Views Cite this report Responses(0)

Approved

Position 24 and 25 in the references are identical.
I have no further comments.

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

nutrition, metabolic syndrom, vitamin B

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Reviewer Report

16 Views

12 Feb 2024 | for Version 1

Małgorzata Szczuko, Department of Biochemistry and Human Nutrition, Pomeranian Medical University, Szczecin, Poland

16 Views Cite this report Responses(1)

Approved With Reservations

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

Yes
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

References

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

nutrition, metabolic syndrom, vitamin B

Respond to this report

Responses (1)

Author Response

13 Apr 2024

Buthaina Alkhatib, Department of Clinical Nutrition and Dietetics, Faculty of Applied Medical Sciences, The Hashemite University, Zarqa, Jordan

The article is clearly written and easy to read. Although it seems that at the same time it does not exhaust the topic in some respects
Response: Thank you

2. A major advantage of the study is the number of patients examined and the well-described statistics of the results
Response: thank you

3. the summary lacks a specific summary and conclusion
Response: it has been revised (conclusion: Increasing the consumption of B1, B2, and B6 may significantly lower values of indices of obesity and cardiac function regardless of sex differences. Thus reducing the occurrence of obesity and related coronary heart diseases

4. in the introduction, please also include women with PCOS, in the course of which insulin resistance, metabolic syndrome and obesity develop
ref [1]
Response: it has been added

5. the age of the examined patients is missing in table 1
Response: the table was prepared regarding the age group, as shown in raw 1)

6. the following issues should be discussed in the discussion:
- increased demand for B vitamins in people with obesity and diabetes re [2].
- peripheral neuropathy ref [3]
- effects of supplementation and over-supplementation of B vitamins
ref [4]

Response: it has been provided (references 35, 36). But reference no 4 is not within the scope of discussion.

7. It is recommended to use the provided literature to improve and improve the article.
Response: many thanks for your suggestions, it has been provided
Is the work clearly and accurately presented and does it cite the current literature?
Yes
Is the study design appropriate and is the work technically sound?
Yes
Are sufficient details of methods and analysis provided to allow replication by others?
Yes
If applicable, is the statistical analysis and its interpretation appropriate?
Yes
Are all the source data underlying the results available to ensure full reproducibility?
Yes
Are the conclusions drawn adequately supported by the results?
Yes

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Competing Interests

no competing interest

Alongside their report, reviewers assign a status to the article:

Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested

Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.

Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions

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The impact of energy releasing B-vitamin intake on indices of obesity and cardiac function: a cross-sectional study

Abstract

Background

Objectives

Methods

Results

Conclusions

Keywords

Revised Amendments from Version 2

Introduction

Methods

Study design, participants, and ethical approval

Data collection

Qualitative variables

Quantitative variables

Dietary assessment

Bias

Study size

Statistical analysis

Results

Descriptive data

Table 1. The general characteristics of the study population (n=491).

Main results

Table 2. The mean scores of indices of obesity and cardiac function among the adjusted B-vitamins tertiles.

Table 3. The correlation between adjusted for energy vitamin B1, B2, B3, and B6 intake with obesity and cardiac function indices.

Table 4. Changes in obesity and cardiac function indices based on B vitamin intake using the linear regression model.

Discussion

Figure 1. Mechanism of interaction between reduction level of serum B-complex and obesity.

Figure 2. Relationship between B-vitamins intake and cardiovascular disease.

Conclusions

Data availability

Underlying data

Extended data

Acknowledgments

References

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