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

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.


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.Any reports and responses or comments on the article can be found at the end of the article.

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. 14][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. 4,6vitamins play a crucial role in the balance and metabolism of energy. 7Energy 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. 80][11] B-vitamin deficiency has been approved in individuals with obesity and metabolic syndrome. 2,12Moreover, thiamin (B1) and riboflavin (B2) intake are inversely associated with body mass index (BMI). 2,7As 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. 13,14Additionally, B vitamins play a vital role (methyl group donor and act as a coenzyme) in DNA methylation, which is important for body adiposity regulation 15 and is associated with BMI. 16 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. 12,17etary 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. 18These risk factors have been linked to the atherosclerotic process 19 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. 21,22rthermore, 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 highdensity 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. 24Based 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.

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. 25Exclusion 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

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.
Any further responses from the reviewers can be found at the end of the article 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. 26The 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.

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 (meansAE 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. 32This 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.

Descriptive data
From the total sample, 198 participants were aged between 20-34 years old, 169 were aged 35  1). 33A 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).

Main results
The average total intake of the macronutrients and selected B vitamins were 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 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.
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).

Discussion
Obesity is considered to be one of the malnutrition forms, which develops individually and as a result of unbalanced nutrition. 2Based 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. 34Vitamins 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. 12Some 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 watersoluble vitamins. 12,35Also, it has been found that the requirements of B vitamins has been increased for people with obesity, diabetes, and peripheral neuropathy. 36,37e 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. 38In line with the present findings, B1 deficiency was found in children with obesity, and most of those cases were subclinical. 39Kardas 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. 2Studies show that vitamin B2 deficiency causes functional alterations in adipocytes, and thus has proinflammatory and proinsulin effects, resulting from increased adipocytes. 40Moreover, in the subjects with obesity, an inverse correlation was found between vitamin B6 and body weight. 2 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. 6Also, 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. 14Additionally, decreased B1, B3, and B6 concentrations correlate significantly with an increased risk of insulin resistance, metabolic dysfunction, and obesity. 41Moreover, 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. 42lso, B2 plays a vital role in energy-expenditure adipocyte gene regulation at the epigenetic level. 43The 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. 7,24udies 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  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. 12Additionally, 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. 6It 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. 43They suggested that a higher intake of vitamin B1, B2, niacin, B6, and dietary folate equivalent was associated with a reduced risk of metabolic syndrome. 6Not 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.
B3 intake is suggested to decrease serum levels of LDL, VLDL, and TG, as well as, increase levels of HDL. 21,24Also, vitamins B2 and B6 have a vital role in homocysteine demethylation into methionine, which leads to decreased risk of atherosclerosis. 15,21Additionally, B6 is associated with a reduced risk of metabolic syndrome. 6Lastly, 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. 12,44is 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.(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 proliferatoractivated 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. 478) Increased body weight leads to the reduction of vitamin B6 levels by inducing systemic oxidative stress, which leads to stimulating cytokines dysregulation. 7,42he 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.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. 15,213) Decreased levels of folate intake lead to decreased DNA-methylation, which has been detected in atherosclerotic lesions. 48Also, 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. 12,44he 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. 26is 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. 25is 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).
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 "Study design, participants, and ethical approval" It is better to explain information about the type of sampling in this section.

3.
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.

4.
Researchers should also explain how to calculate the sample size. 5.
"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.

6.
"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.

Buthaina Alkhatib
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 1. 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

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.The benefits of publishing with F1000Research: Your article is published within days, with no editorial bias • You can publish traditional articles, null/negative results, case reports, data notes and more • The peer review process is transparent and collaborative • Your article is indexed in PubMed after passing peer review • Dedicated customer support at every stage • For pre-submission enquiries, contact research@f1000.com Odum et al. (2012) found that the mean plasma

Figure 1 .
Figure1.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 proliferatoractivated 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

7 . 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 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 Competing Interests: No competing interests were disclosed.Reviewer Expertise: Nutrition and diet 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.Reviewer Report 26 February 2024 https://doi.org/10.5256/f1000research.162623.r249706© 2024 Szczuko M. This is an open access peer review report 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.Małgorzata Szczuko Department of Biochemistry and Human Nutrition, Pomeranian Medical University, Szczecin, Poland Position 24 and 25 in the references are identical.I have no further comments.Is the work clearly and accurately presented and does it cite the current literature?YesIs the study design appropriate and is the work technically sound?YesAre sufficient details of methods and analysis provided to allow replication by others?YesIf applicable, is the statistical analysis and its interpretation appropriate?YesAre all the source data underlying the results available to ensure full reproducibility?YesAre the conclusions drawn adequately supported by the results?YesCompeting Interests: No competing interests were disclosed.Reviewer Expertise: nutrition, metabolic syndrom, vitamin B 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 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 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, however I have significant reservations, as outlined above.Author Response 12 Feb 2024

2 .
A major advantage of the study is the number of patients examined and the welldescribed 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 2.

7 .
It is recommended to use the provided literature to improve and improve the article.Response: many thanks for your suggestions, it has been providedIs the work clearly and accurately presented and does it cite the current literature?

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

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.
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).