Khalili M, et al. - The prevalence of metabolic syndrome (MS) as well as its impact on alanine aminotransferase (ALT) levels and fibrosis were inspected by the experts, measured via the aspartate aminotransferase–to–platelet ratio index (APRI), in a large, multiethnic North American cohort with chronic hepatitis B (HBV) infection. Data revealed that MS patients were found to be older, more often male and born in the U.S./Canada or had immigrated >20 years ago compared to individuals without MS. MS displayed an independent link with higher ALT levels longitudinally. Hence, the significance of screening for MS and the potential for MS to affect ALT along with its interpretation in the context of HBV therapeutic decisions were underscored during this study.