Letter to the editor Reply to: “Metabolic syndrome after liver transplantation: Is there a role for infections?” To the Editor: We would like to thank Dr. Eshraghian for the interest in and comments on our article.They represent a broad view ofthe multiple perspectives ofstudies,which would definitely con- tribute to a better understanding of metabolic syndrome among liver transplant patients. However,the aim of our study was not to cover the mentioned aspects, independently of its real impor- tance.Although there is a logical association between infection and metabolic syndrome as well as with its components (due to the inflammatory response, acute phase protein production, and resistance to insulin action) [1], the contribution of prior or current infection to metabolic syndrome has not been assessed yet in the population undergoing liver transplantation [2–5]. Furthermore, in our study [2],contrary to others [5,6], we were not able to show the impact of hepatitis C virus infection on the prevalence of metabolic syndrome. Also, hepatitis B infection was not associ- ated with the prevalence of metabolic syndrome among our patients [2], in agreement with other researchers [7]. Finally,we were, at the time, interested in studying aspects of metabolic syndrome specifically linked to liver transplantation. In this chal- lenging setting, the disease can be, at the same time, a cause of transplantation (as NASH evolution to cirrhosis) and a consequence of its treatment. We agree with Dr. Eshraghian that much must be studied on this intricate syndrome. Thus,future studies should address the relationship with chronic infectious factors and the onset of metabolic syndrome, among other potential risk factors. References [1] Black PH. The inflammatory response is an integral part of the stress response: Implications for atherosclerosis,insulin resistance, type II diabetes and metabolic syndrome X. Brain Behav Immun 2003;17: 350–64. [2] Anastacio LR,Ferreira LG,Ribeiro Hde S,Liboredo JC,Lima AS,Correia MI. Metabolic syndrome after liver transplantation: prevalence and predictive factors.Nutrition 2011;27:931–7. [3] Bianchi G, Marchesini G, Marzocchi R, Pinna AD, Zoli M. Metabolic syndrome in liver transplantation: relation to etiology and immunosuppression. Liver Transpl 2008;14:1648–54. [4] Laish I,Braun M,Mor E, Sulkes J,Harif Y,Ben Ari Z.Metabolic syndrome in liver transplantrecipients:prevalence,risk factors, and association with cardiovascular events. Liver Transpl 2011;17:15–22. [5] Laryea M, Watt KD, Molinari M, Walsh MJ, McAlister VC, Marotta PJ, et al. Metabolic syndrome in liver transplant recipients: prevalence and association with major vascular events. Liver Transpl 2007;13: 1109–14. [6] Bugianesi E, Salamone F,Negro F. The interaction of metabolic factors with HCV infection: Does it matter? J Hepatol 2012;56(suppl 1): S56–65. [7] Wong VW, Wong GL, Chu WC, Chim AM, Ong A, Yeung DK, et al. Hepa- titis B virus infection and fatty liver in the general population. J Hep- atol 2012;56:533–40. Lucilene Rezende Anast acio,R.D.,M.Sc. Adult Health Postgraduate Program, Medical School Universidade Federal de Minas Gerais Minas Gerais, Brazil Eduardo Garcia Vilela, M.D.,Ph.D. Adult Health Postgraduate Program, Medical School Universidade Federal de Minas Gerais Minas Gerais, Brazil Alfa Institute of Gastroenterology Hospital of Clinics, Medical School Universidade Federal de Minas Gerais Minas Gerais, Brazil Agnaldo Soares Lima, M.D.,Ph.D. Maria Isabel Toulson Davisson Correia, M.D.,Ph.D. Alfa Institute of Gastroenterology Hospital of Clinics, Medical School Universidade Federal de Minas Gerais Minas Gerais, Brazil Contents lists available at ScienceDirect Nutrition j o u r n a l homepage: w w w . n u t r i t i o n j r n l . c o m 0899-9007/$ - see front matter Ó 2012 Elsevier Inc. All rights reserved. Nutrition 28 (2012) 827