Submited on: 19 Aug 2014 02:50:47 AM GMT
Published on: 20 Aug 2014 04:55:41 AM GMT
 

  • What are the main claims of the paper and how important are they?

    The main claim of the paper includechanging the quantity of edible fat in the diet to change the consistency of stool, to alleviate constipation.Probably it is an important concept, but how much? it is physiologically not well understood. We still do not understand the amount of allowable oil for different gender, ages, lifestyle, activity level, pregnancy, illness and so on so forth. Since the authors claim constipation is such a huge problem and diet and medicines are unable to solve the problem they should have not have difficulties recruiting more patients in the trial. A justification needs to be provided for such small numbers enrolled for a chronic disease like constipation. This trial does not even stand true for a proof of concept trial.


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    Not novel, it is a cultural remedy used since ages in many countries, so certainly would not give a claim of novel recipe. However, this certainly has not been tested in any clinical trials or has been employed in the medical management of constipation in western world. 

     

    The MAJOR drawbacks of this study are: 1) the soup consisted of vegetables, legumes, fruits and adequate water, and are confounding variables that weakens this study.  Hard to interpret if constipation in patients improved because of regular daily intake of fiber (which draws water and keep stools soft) with this soup recipe. 2) The softness of stools is determined by water intake, amount of physical activity, both have not been accounted for in this trial. 3) The N=2 in an uncontrolled settings makes it hard to interpret the data, and its applicability to larger population, across different cultural traditions, gender, physical activity, and age is questionable. 4) The durability of the response is questionable because of restrictive nature of the diet, although soup may be a complete source of nutrition. The effects may be lost as soon as the person is not soup diet. It is the same fallacy as with the use of medications. 

     

    The author keeps on talking of medicine and veterinary management, albeit animal trials cannot be mixed with human trials. In addition, the authors have not conducted trials in animals to make that claim. 

     

    Finally the discussion section did not really focus on amount of oil, rather spoke of method of oil use, which was not the context of this trial. The exact recipe boiling time, quantity of fat increased or decreased are very vague and unclear.


  • Are the claims properly placed in the context of the previous literature?

    Some are placed in appropriate context, some are not. Although this reviewer did not read all the literature that was cited by the author. 


  • Do the results support the claims? If not, what other evidence is required?

    There is lot of noise in the data to draw the conclusion. In this reviewer’s opinion, it is not clear if regular consistent fiber intake and water intake was the reason for improvement rather than reduction in fat. At best, the claim can be made excess fat may interfere with regular bowel movements and cause constipation. However, the physiological basis remains unclear. 


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    This is not a RCT. Very vague protocol; use of some laxatives for couple of days does not communicate meaningful statement. There are no well-defined inclusion and exclusion criteria, what medications are allowed and what not are not well delineated. When was the symptom diary was filled by subjects, how many occasions was it reviewed and taken in consideration. Some blood or lot of blood do not mean much clinically. There are over exaggerated statements, which are misleading such as constipation would produce colitis and colonic cancer. Use of terms such as “Chinese restaurants” creates a bias in reader’s minds and must be eliminated. To this reviewer’s knowledge, physiologically role of reducing fat in dietis still not well elucidated. Since 95-97% fat is absorbed in small intestines and remaining fat in colon becomes fuel for the colonic bacteria, it is hard for the reviewer to understand how lipid distribution can be of utmost importance in constipation. Current known hypothesis is fat reduces intestinal motility thereby, slowing the transit time of stool into rectum, thereby water gets absorbed and stools drier as they approach the rectal vault. 


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    I am not sure, this needs to be tested in many people before this can be validated, it may be reproducible. However, the most important intervention that will make this study validated would be to keep all the components (vegetables, fruits and water) in same ratio and change the fat content to notice changes in bowel movement. However, an ethics consult should be placed before embarking on such trial.


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    Please see above


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    No, although it is a good attempt to emphasize the importance of fat in diet.


  • Other Comments:

    Grammatically errors, it needs corrections, words like “blooding” or “too many waters in the stools and colons” etc.

     

    Biases such as mention of Chinese restaurants, over exaggerated statements “leads to colonic cancer”.

     

    Need to clarify how was the healing time of fissure assessed, was it visually inspected, if yes, how frequent and by whom. How was the epithelialization and dermal healing determined? Clarify if a biopsy collected to see epithelialization changes. 

  • Competing interests:
    None
  • Invited by the author to review this article? :
    Yes
  • Have you previously published on this or a similar topic?:
    No
  • References:

    None

  • Experience and credentials in the specific area of science:

    Medical Officer

  • How to cite:  Mehta R .Review on Biochemical and Biophysical Models of Constipation and Diarrhea Caused by Incorrect Dose or Uneven Intake of Edible Oils (Fats)[Review of the article 'Biochemical and Biophysical Models of Constipation and Diarrhea Caused by Incorrect Dose or Uneven Intake of Edible Oils (Fats) ' by Zou C].WebmedCentral 2014;5(9):WMCRW003101
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  • What are the main claims of the paper and how important are they?

    Constipation and diarrhea could be cured by adjusting the dose or evening the intake of the oils (fats) in diet. The authors proposed food models to manage the constipation and diarrhea successfully. However, the preliminary clinical trial data were based on the experience of two individuals with chronic constipation.


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    The claims is not particularly novel because the modification of fat intake has been proposed to be a remedy for constipation.

    However, a clinical trial on this subject is rare. The model proposed by the authors are interesting.


  • Are the claims properly placed in the context of the previous literature?

    Yes. There are not many previous literatures on clinical trial that modify dietary fat intake in treating constipation or diarrhea.


  • Do the results support the claims? If not, what other evidence is required?

    The claim is interesting, but is not supported by the preliminary trail that was based on the experience of two individuals. There were no adequate control groups. A cross-over study design may help understand the cause of improved symptoms, such as high fruit intake, low animal fat intake, or higher plant-oil intake.


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    No.


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    Not valid. The study design based on two subjects is hardly ideal. The detailed cooking instruction is provided, but it is not easy to follow and variations can be introduced in many steps. The compliance is unknown. It seems one individual did not follow the cooking instruction for a period of time.  


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    A clinical trial with adequate control groups is needed. A larger sample size and clinically well-annotated study population are needed. The foods should be prepared in one central kitchen. It may not be easy to conduct a well-controlled study.


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    No, although the idea is intriguing. More scientific eveidence is needed. The proposed models are of interest.


  • Other Comments:

    No

  • Competing interests:
    None
  • Invited by the author to review this article? :
    Yes
  • Have you previously published on this or a similar topic?:
    No
  • References:

    None

  • Experience and credentials in the specific area of science:

    I am a nutritional epidemiologist with clinical knowledge.

  • How to cite:  Jiao L .Biochemical and Biophysical Models of Constipation and Diarrhea Caused by Incorrect Dose or Uneven Intake of Edible Oils (Fats) [Review of the article 'Biochemical and Biophysical Models of Constipation and Diarrhea Caused by Incorrect Dose or Uneven Intake of Edible Oils (Fats) ' by Zou C].WebmedCentral 2014;5(9):WMCRW003100
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Interesting study but inadequate data
Posted by Dr. Jianyuan Chai on 20 Aug 2014 09:18:32 PM GMT Reviewed by WMC Editors

  • What are the main claims of the paper and how important are they?

    The study is about the cause of constipation and approaches to correct it. It is a great topic and could be very meaningful if it was done properly.


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    The idea is good. However, only two subjects were studied. The sample size is too small to draw any meaningful conclusions. 


  • Are the claims properly placed in the context of the previous literature?

    Yes.


  • Do the results support the claims? If not, what other evidence is required?

    The study needs to be expended before writing a paper.


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    N/A


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    Yes.


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    The experimental groups need to be enlarged so that the results can be statistically analyzed.


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    No.


  • Other Comments:

    No.

  • Competing interests:
    None
  • Invited by the author to review this article? :
    Yes
  • Have you previously published on this or a similar topic?:
    No
  • References:

    None

  • Experience and credentials in the specific area of science:

    I have been in research, particularly in gastrointestinal field, for more than a decade.

  • How to cite:  Chai J .Interesting study but inadequate data[Review of the article 'Biochemical and Biophysical Models of Constipation and Diarrhea Caused by Incorrect Dose or Uneven Intake of Edible Oils (Fats) ' by Zou C].WebmedCentral 2014;5(8):WMCRW003096
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Biochemical and biophysical models of constipation and diarrhea etc
Posted by Dr. Esam Z Dajani on 20 Aug 2014 08:57:06 PM GMT Reviewed by WMC Editors

  • What are the main claims of the paper and how important are they?

    Described a model for diarrhea and constipation based on dietary intake of fats.


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    The claims are highly speculative based on the findings in two subjects.


  • Are the claims properly placed in the context of the previous literature?

    Highly speculative manuscript.


  • Do the results support the claims? If not, what other evidence is required?

    No, the results are very preliminary and not conclusive.


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    A proper prtocol is needed to support the assertions made by the authors. 


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    The methodology is O.K. although not ideal.


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    A properly designed experiments are needed to support or refute the speculation by the authors.


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    Poor manuscript


  • Other Comments:

    Highly speculative paper not based on adequate experimental evidence.

  • Competing interests:
    None
  • Invited by the author to review this article? :
    Yes
  • Have you previously published on this or a similar topic?:
    Yes
  • References:

    Many papers.

  • Experience and credentials in the specific area of science:

    Published many papers on constipation, diarrhea and intestinal secretion.

  • How to cite:  Dajani E Z.Biochemical and biophysical models of constipation and diarrhea etc[Review of the article 'Biochemical and Biophysical Models of Constipation and Diarrhea Caused by Incorrect Dose or Uneven Intake of Edible Oils (Fats) ' by Zou C].WebmedCentral 2014;5(8):WMCRW003095
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