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We read with interest the article by Stepanova et al in a recent issue of Gut. These authors used death certificate data from the third National Health and Nutrition Examination survey (NHANES-III 1988–1994) in order to assess the impact of metabolic syndrome components on all-cause and cause-specific mortality in patients with chronic liver disease (CLD).1 They concluded that components of the metabolic syndrome are independently associated with overall and liver-related mortality in patients with CLD (principally among those with viral hepatitis C, alcohol-related liver disease (ALD) or non-alcoholic fatty liver disease (NAFLD)).1
Overall, the article is well written and the authors have discussed their results cautiously and in a balanced way, given the well-recognised limitations of using the NHANES-III dataset …
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