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Background: Cardiovascular disease (CVD) is a major cause of morbidity and mortality after liver transplantation, mostly in patients transplanted for nonalcoholic steatohepatitis, obesity and diabetes. Few data exist on cardiovascular diseases among patients transplanted for viral hepatitis., Objective: Our aim is to clarify the cardiovascular risk and subclinical vascular damage among liver transplant recipients for chronic viral hepatitis (i.e. hepatits C virus, hepatis B virus and hepatitis D virus infection)., Methods: Adult patients (age ≥ 18 years) with orthotopic liver transplants (OLT) due to viral hepatitis who signed informed consent, and were admitted for a routine follow-up between June 2019 and September 2020 at the Infectious Disease outpatient clinic of the University of Campania Luigi Vanvitelli, Naples, Italy, were prospectively enrolled. An estimation of cardiovascular risk was assessed using three main risk charts, echocolor-Doppler of epiaortic vessels was performed to assess subclinical Intima-Media changes., Results: A total of 161 patients were evaluated; of these 15 were excluded because not affected by viral hepatitis. 146 patients were considered. 83 patients (56.8%) were considered at high cardiovascular risk according to Framingham, 54 patients (36.9%) to American Heart Association Arteriosclerotic Cardiovascular Disease (ASCVD) score and 19 (13.0%) to Heart Score. Only 8 patients (5.4%) showed a normal carotid ultrasound, while 52 patients (35.6%) had a carotid artery Intima-Media Thickness (IMT) and 86 (58.9%) an atherosclerotic plaque., Conclusions: Liver transplant recipients for virus-related associated liver disease are, in light of the high percentage of carotid lesions, at high risk of CVD. Risk charts compared to subclinical carotid lesions which represent damage already established and a real localization of the disease, seem to underestimate the cardiovascular risk. A chronic inflammatory status, could play a key role. It's important to raise the awareness of cardiovascular risk in liver transplant patients to prevent cardiovascular diseases and improve the timing of early diagnosis of premature vascular lesions., Competing Interests: NO authors have competing interests.

Although increasing the levels of phytochemicals in foods via traditional breeding or genetic engineering would appear to pose less of a risk, there is still the possibility of over consumption given the ease with which phytochemical content can be increased. According to the recent position paper by the American Dietetic Association on phytochemicals, "the dietetics professional ... is the specialist who should make recommendations concerning appropriate dietary intake to optimize the potential benefits of phytochemical-rich or functional foods in overall health." For dietitians to make these recommendations, it will be necessary for the nutrition community to make a concerted effort to incorporate information on phytochemicals into nutrition manuals and professional resources. As it is, most of the research and discussion of phytochemicals is conducted by professionals not related or only peripherally related to the field of nutrition. This is truly an exciting time to be involved in the nutrition field. We have moved a head from thinking that only a relatively small number of dietary factors possess biological activity to recognizing that there are hundreds and perhaps thousands of such factors. It will be many years before our understanding of phytochemicals approaches our knowledge of vitamins and minerals- and it is worth nothing that our knowledge of vitamins and minerals is still incomplete. But it does appear that the phytochemicals help explain why plant-based diets, in general, are associated with a reduced risk of many chronic diseases. And in fact, his may be the most important outcome from use of phytochemicals. The nutrition community now has more reasons for encouraging consumers to eat plant-based diets.