Intrabiliary rapamycin may slow progression of primary sclerosing cholangitis

We thank Prof. Filik for his interest in our recent article. 2 He points to the fact that the interpretation of our results could be affected by lack of data on physical activity and diet. In response to this issue, we are aware that both physical activity and diet are able to affect not only anthropometric and metabolic parameters of visceral adiposity index (VAI) but also the severity of liver disease. Unfortunately, data on both physical activity and diet in our patients with biopsy-proven non-alcoholic fatty liver disease (NAFLD) are not available, even if we are confident that their variations should not significantly affect our results. In fact, in our study, we evaluated histological liver damage and metabolic features of NAFLD patients who had not yet undergone lifestyle intervention. In any case, we found useful a further prospective evaluation of the impact of baseline diet and physical activity on both VAI and liver disease severity. These data, in fact, together with follow-up data, could help validate VAI as a surrogate marker of metabolic and liver disease improvement after therapeutic approaches in NAFLD patients.