Two studies showed that components of the metabolic syndrome measured at baseline, including triglyceride, blood pressure and waist circumference (WC), were inversely associated with IC.12 13 Moreover, subjects with metabolic syndrome had lower IC compared with those without metabolic syndrome.13 Further, IC was inversely associated with alanine aminotransferase (ALT), a biomarker of fatty liver, as shown in cross-sectional8 14 15 and prospective cohort2 studies, while physical activity has been associated with increased IC.16 Here, GPT is linked to metabolic syndrome.