We read with great interest the recent article by Wong et al highlighting the increased risk of liver cirrhosis in chronic hepatitis B with metabolic syndrome.1 In this large series cross-sectional study the authors have demonstrated many factors significantly associated with increased risk of cirrhosis in univariate analysis, including metabolic syndrome and serum levels of hepatitis B virus (HBV) DNA. However, in multivariate logistic regression analysis serum levels of HBV DNA (cut-off value of 10² copies/ml) did not have a consistent effect on the risk of cirrhosis while metabolic syndrome remained a significant risk factor. These data seemed to …