Life-cycle assessment of yeast-based single-cell protein production with oat processing side-stream.

Production of fish meal and plant-based feed proteins continues to increase to meet the growing demand for seafood, leading to impacts on marine and terrestrial ecosystems. Microbial proteins such as single-cell proteins (SCPs) have been introduced as feed alternatives since they can replace current fish feed ingredients, e.g., soybean, which are associated with negative environmental impacts. Microbial protein production also enables utilization of grain processing side-streams as feedstock sources. This study assesses the environmental impacts of yeast-based SCP using oat side-stream as feedstock (OS-SCP). Life-cycle assessment with a cradle-to-gate approach was used to quantify global warming, freshwater eutrophication, marine eutrophication, terrestrial acidification, land use, and water consumption of OS-SCP production in Finland. Dried and wet side-streams of oat were compared with each other to identify differences in energy consumption and transportation effects. Sensitivity analysis was performed to examine the difference in impacts at various locations and fermentation times. Benchmarking was used to evaluate the environmental impacts of OS-SCP and other feed products, including both conventional and novel protein products. Results highlight the importance of energy sources in quantifying the environmental performance of OS-SCP production. OS-SCP produced with dried side-streams resulted in higher global warming (16.3 %) and water consumption (7.5 %) than OS-SCP produced from wet side-streams, reflecting the energy and water requirements for the drying process. Compared with conventional products, such as soy protein concentrates, OS-SCP resulted in 61 % less land use, while exacerbating the environmental impacts in all the other categories. OS-SCP had more impact on global warming (205-754 %), water consumption (166-1401 %), freshwater eutrophication (118-333 %), and terrestrial acidification (85-340 %) than other novel products, including yeast protein concentrate, methanotrophic bacterial SCP, and insect meal, while lowering global warming (11 %) and freshwater eutrophication (20 %) compared with dry microalgae biomass.

Multidrug-Resistant Tuberculosis Outbreak among Immigrants in Tokyo, Japan, 2019-2021.

In mid-September 2019, a teenage Chinese male student and part-time waiter in Tokyo was diagnosed with multidrug-resistant (MDR) sputum smear-positive pulmonary tuberculosis (TB). This study describes the outbreak investigation of his friends and colleagues at the restaurant. We investigated 6 friends and 15 colleagues; 5 friends and 13 colleagues underwent interferon-γ release assay (IGRA). Of these, 3 friends (60.0%) and 4 colleagues (30.8%) were IGRA-positive. Each of the friends and colleagues was found to have MDR-TB (20% and 7.7%, respectively). Challenges during the investigation were the unavailability of regimens for latent TB infection (LTBI) for contacts with MDR-TB, budgetary constraints concerning implementing computed tomography (CT) scans for the contacts, frequent address changes of foreign-born patients and contacts, investigation during the coronavirus disease pandemic, and variations of alphabetical expression of the names of the patients and contacts, particularly for those from China. It is recommended that the national government officially adopt prophylaxis regimens for LTBI with MDR-TB, address the budgetary constraints regarding CT scans, and deploy liaison officers for coordinating investigations involving many foreign-born patients and contacts scattered in multiple municipalities. The names of foreign-born persons could more accurately be identified using both the alphabet and Chinese characters.

Origin and expansion of the world's most widespread pinniped: Range-wide population genomics of the harbour seal (Phoca vitulina).

The harbour seal (Phoca vitulina) is the most widely distributed pinniped, occupying a wide variety of habitats and climatic zones across the Northern Hemisphere. Intriguingly, the harbour seal is also one of the most philopatric seals, raising questions as to how it colonized its current range. To shed light on the origin, remarkable range expansion, population structure and genetic diversity of this species, we used genotyping-by-sequencing to analyse ~13,500 biallelic single nucleotide polymorphisms from 286 individuals sampled from 22 localities across the species' range. Our results point to a Northeast Pacific origin of the harbour seal, colonization of the North Atlantic via the Canadian Arctic, and subsequent stepping-stone range expansions across the North Atlantic from North America to Europe, accompanied by a successive loss of genetic diversity. Our analyses further revealed a deep divergence between modern North Pacific and North Atlantic harbour seals, with finer-scale genetic structure at regional and local scales consistent with strong philopatry. The study provides new insights into the harbour seal's remarkable ability to colonize and adapt to a wide range of habitats. Furthermore, it has implications for current harbour seal subspecies delineations and highlights the need for international and national red lists and management plans to ensure the protection of genetically and demographically isolated populations.

Life cycle assessment of plant cell cultures.

A novel food such as plant cell culture (PCC) is an important complementary asset for traditional agriculture to tackle global food insecurity. To evaluate environmental impacts of PCC, a life cycle assessment was applied to tobacco bright yellow-2 and cloudberry PCCs. Global warming potential (GWP), freshwater eutrophication potential (FEUP), marine eutrophication potential, terrestrial acidification potential (TAP), stratospheric ozone depletion, water consumption and land use were assessed. The results showed particularly high contributions (82-93%) of electricity consumption to GWP, FEUP and TAP. Sensitivity analysis indicated that using wind energy instead of the average Finnish electricity mix reduced the environmental impacts by 34-81%. Enhancement in the energy efficiency of bioreactor mixing processes and reduction in cultivation time also effectively improved the environmental performance (4-47% reduction of impacts). In comparison with other novel foods, the environmental impacts of the PCC products studied were mostly comparable to those of microalgae products but higher than those of microbial protein products produced by autotrophic hydrogen-oxidizing bacteria. Assayed fresh PCC products were similar or close to GWP of conventionally grown food products and, with technological advancements, can be highly competitive.

An attributional life cycle assessment of microbial protein production: A case study on using hydrogen-oxidizing bacteria.

Novel food production technologies are being developed to address the challenges of securing sustainable and healthy nutrition for the growing global population. This study assessed the environmental impacts of microbial protein (MP) produced by autotrophic hydrogen-oxidizing bacteria (HOB). Data was collected from a company currently producing MP using HOB (hereafter simply referred to as MP) on a small-scale. Earlier studies have performed an environmental assessment of MP on a theoretical basis but no study yet has used empirical data. An attributional life cycle assessment (LCA) with a cradle-to-gate approach was used to quantify global warming potential (GWP), land use, freshwater and marine eutrophication potential, water scarcity, human (non-)carcinogenic toxicity, and the cumulative energy demand (CED) of MP production in Finland. A Monte Carlo analysis was performed to assess uncertainties while a sensitivity analysis was used to explore the impacts of alternative production options and locations. The results were compared with animal- and plant-based protein sources for human consumption as well as protein sources for feed. Electricity consumption had the highest contribution to environmental impacts. Therefore, the source of energy had a substantial impact on the results. MP production using hydropower as an energy source yielded 87.5% lower GWP compared to using the average Finnish electricity mix. In comparison with animal-based protein sources for food production, MP had 53-100% lower environmental impacts depending on the reference product and the source of energy assumed for MP production. When compared with plant-based protein sources for food production, MP had lower land and water use requirements, and eutrophication potential but GWP was reduced only if low-emission energy sources were used. Compared to protein sources for feed production, MP production often resulted in lower environmental impact for GWP (FHE), land use, and eutrophication and acidification potential, but generally caused high water scarcity and required more energy.

Ovalbumin production using Trichoderma reesei culture and low-carbon energy could mitigate the environmental impacts of chicken-egg-derived ovalbumin.

Ovalbumin (OVA) produced using the fungus Trichoderma reesei (Tr-OVA) could become a sustainable replacement for chicken egg white protein powder-a widely used ingredient in the food industry. Although the approach can generate OVA at pilot scale, the environmental impacts of industrial-scale production have not been explored. Here, we conducted an anticipatory life cycle assessment using data from a pilot study to compare the impacts of Tr-OVA production with an equivalent functional unit of dried chicken egg white protein produced in Finland, Germany and Poland. Tr-OVA production reduced most agriculture-associated impacts, such as global warming and land use. Increased impacts were mostly related to industrial inputs, such as electricity production, but were also associated with glucose consumption. Switching to low-carbon energy sources could further reduce environmental impact, demonstrating the potential benefits of cellular agriculture over livestock agriculture for OVA production.

Mortality risks due to long-term ambient sulphur dioxide exposure: large variability of relative risk in the literature.

Several studies have been published about the potential health effects due to long-term exposure to sulphur dioxide (SO2) and the relative risks (RRs) for different causes of mortality. Broad differences in the RR values are found, however. In this study, we performed an analysis of these studies aiming finding potential explanations for the high variability of the RR reported. The RRs for stratified subgroups were also analysed to identify more susceptible subgroups. A total of 14 studies were identified. Some of them related strong associations between mortality and long-term ambient SO2 exposure, while others found insignificant or no associations to the same mortality indexes. The mean RR values ranged from 0.95 to 1.14 for mortality due to all causes, 0.99 to 3.05 for lung cancer, 0.87 to 1.3 for respiratory diseases, 0.96 to 1.14 cardiovascular diseases and 0.97 to 1.05 for cardiopulmonary diseases mortality. Among the factors that may affect the RR estimations, only the size of studied population and the spatial scales used in exposure assessment showed notable influences. The female population was found to be more susceptible to long-term SO2 exposure. For other stratified subgroups including age, smoking status and income levels, no obvious relationship with RR was observed.

Life cycle assessment of decentralized greywater treatment systems with reuse at different scales in cold regions.

Decentralized source-separated wastewater treatment systems offer an attractive alternative to conventional centralized wastewater treatment systems in various regions, yet few system analyses specifically address decentralized greywater treatment over different scales. Here we present a comparative life cycle assessment (LCA) and focus on global warming potential (GWP), eutrophication potential (EUP) and human health - carcinogenic potential (HHCP) of decentralized greywater management systems at different scales for a hypothetical community in a cold (winter) region. To provide a comparison between nature-based and engineered greywater treatment solutions, constructed wetlands (CW) and membrane bioreactors (MBR), respectively, were investigated at three different scales; community (3500 person equivalent [PE]), neighborhood (350 PE) and household (a single household [up to 5 PE]). Conventional centralized wastewater treatment was also included as a business-as-usual (BAU) scenario. In the MBR scenarios, greywater reuse was also considered for multiple non-potable applications due to its high-quality effluent and subsurface garden irrigation was considered for reuse in the CW scenarios. For scenarios with the same treatment technology, larger scales reduced GWP, EUP and HHCP up to 57 kg CO2-eq.PE-1.y-1, 0.2 kg N-eq.PE-1.y-1 and 5.3E-6 CTUh.PE-1.y-1, respectively, despite the need for more extensive wastewater networks. The CW scenarios at community and neighborhood scales outperformed the MBR and BAU scenarios for greywater treatment, while the community-scale MBR scenario may be environmentally preferable when large amount of greywater can be reused. The scale of decentralized systems, quantity of water reused and mix of electricity technologies all played important roles in determining GWP, EUP and HHCP values.

Discovery of broflanilide, a novel insecticide.

Broflanilide (1), discovered by Mitsui Chemicals Agro, Inc., has a unique chemical structure characterized as a meta-diamide and exhibits high activity against various pests, including Lepidopteran, Coleopteran, and Thysanopteran pests. Because broflanilide has a novel mode of action, the Insecticide Resistance Action Committee (IRAC) categorized it as a member of a new group: Group 30. The meta-diamide structure was generated via drastic structural modification of a lead compound, flubendiamide (2), and the subsequent structural optimization of meta-diamides on each of its three benzene rings led to the discovery of broflanilide. In the present study, the details of the generation of meta-diamides from the lead compound and the structural optimization of meta-diamides are described.

Solvation Structure of Poly(benzyl methacrylate) in a Solvate Ionic Liquid: Preferential Solvation of Li-Glyme Complex Cation.

We report the solvation structure of a lower critical solution temperature (LCST)-type thermoresponsive polymer in a solvate ionic liquid (SIL, i.e., an ionic liquid comprising solvate ions) to elucidate the predominant interaction for the dissolution of the thermoresponsive polymer in SIL at low temperatures. The solvation structure of poly(benzyl methacrylate) (PBnMA) and a model compound of its monomer in a typical glyme-based SIL, [Li(G4)][TFSA] (G4: tetraglyme; TFSA: bis(trifluoromethanesulfonyl)amide), have been investigated using high-energy X-ray total scattering and all-atom molecular dynamics simulations. In the model compound/SIL system, the intermolecular components extracted from the total G( r)s revealed that the ester moiety of BnMA is preferentially solvated by Li cations through a cation-dipole interaction, which induces slight desolvation of the G4 molecules, and the aromatic ring of BnMA is secondarily solvated by the [Li(G4)] cation complex through a cation-π interaction with maintaining the complex structure. In contrast, TFSA anions are attracted only by the [Li(G4)] cation. These interactions result in the formation of a solvation layer of SILs around the aromatic ring, which plays a key role in the negative entropy and enthalpy of mixing. Meanwhile, in the polymer solution, the coordination number of the Li cation around the ester moiety significantly decreased. This could be ascribed to the steric effect of the bulky side chains, preventing the approach of the [Li(G4)] cation complex to the ester moiety located near the main chain. These solvation structures lead to small absolute values of negative entropy and enthalpy of mixing, which together are key factors to understand the LCST-type phase behavior in the IL system.

Thermosensitive Phase Separation Behavior of Poly(benzyl methacrylate)/Solvate Ionic Liquid Solutions.

We report a lower critical solution temperature (LCST) behavior of binary systems consisting of poly(benzyl methacrylate) (PBnMA) and solvate ionic liquids: equimolar mixtures of triglyme (G3) or tetraglyme (G4) and lithium bis(trifluoromethanesulfonyl)amide. We evaluated the critical temperatures (Tcs) using transmittance measurements. The stability of the glyme-Li+ complex ([Li(G3 or G4)]+) in the presence of PBnMA was confirmed using Raman spectroscopy, pulsed-field gradient spin-echo NMR (PGSE-NMR), and thermogravimetric analysis to demonstrate that the complex was not disrupted. The interaction between glyme-Li+ complex and PBnMA was investigated via 7Li NMR chemical shifts. Upfield shifts originating from the ring-current effect of the aromatic ring within PBnMA were observed with the addition of PBnMA, indicating localization of the glyme-Li+ complex above and below the benzyl group of PBnMA, which may be a reason for negative mixing entropy, a key requirement of the LCST.

Extralobar pulmonary sequestration in two pinniped species.

Two cases of extralobar pulmonary sequestrations from a walrus (Odobenus rosmarus) and a Steller sea lion (Eumetopias jubatus) are described in the present study. Grossly, an independent, soft unilocular cystic mass was found within the abdominal cavities of both animals, adherent to the diaphragm in O. rosmarus and attached to the cardia of the stomach in E. jubatus. Histopathologically, the cysts were lined by pseudostratified ciliated columnar epithelium with abundant goblet cells, while the wall comprised of glands, hyaline cartilage, bronchiole- and alveolus-like structures, smooth muscles, and large, well-developed elastic and muscular arteries. The pinniped cases presented are exceptionally rare and to the best of the authors' knowledge, marks the first descriptions of this congenital anomaly in wildlife.

From Macromolecular to Small-Molecular Triggers: Facile Method toward Photoinduced LCST Phase Behavior of Thermoresponsive Polymers in Mixed Ionic Liquids Containing an Azobenzene Moiety.

Instead of the reported photoinduced lower critical solution temperature (LCST) phase transition behavior in ionic liquids (ILs) achieved by photofunctional polymers, this study reports the facile photoinduced LCST phase behavior of nonfunctionalized polymers (poly(benzyl methacrylate) (PBnMA) and poly(2-phenylethyl methacrylate) (PPhEtMA)) in mixed ILs (1,3-dimethylimidazolium bis(trifluoromethanesulfonyl)amide; [C1 mim][NTf2 ] and a newly designed functionalized IL containing an azobenzene moiety (1-butyl-3-(4-phenylazobenzyl)imidazolium bis(trifluoromethanesulfonyl)amide; [Azo][NTf2 ])) as a small-molecular photo trigger. Interestingly, the length of the alkyl spacer between the ester and aryl groups, which is the only structural difference between the two polymers, leads to two different photoresponsive LCST phase transition behaviors. On the basis of spectroscopic studies, the different phase transition behaviors of PBnMA and PPhEtMA may attribute to the different cooperative interactions between the polymers and [C1 mim][NTf2 ].

Self-Assembly of Polyether Diblock Copolymers in Water and Ionic Liquids.

Here the thermoresponsive self-assembly of diblock copolymers comprising poly(ethyl glycidyl ether) (PEGE) and poly(ethylene oxide) (PEO) in water and ionic liquids (ILs) is investigated. PEGE undergoes lower critical solution temperature (LCST) phase separation in both water and 1-ethyl-3-methylimidazolium bis(trifluoromethanesulfonyl)amide ([C2 mim][NTf2 ]), while PEO is a compatible segment for these solvents. The diblock copolymers, PEGE-b-PEO, undergo thermosensitive unimer-micelle transitions at temperatures close to the LCST point (TLCST ) of the PEGE homopolymer in water but not in [C2 mim][NTf2 ], even at temperatures much higher than TLCST . The difference in the thermoresponsivity of these solutions is explored using differential scanning calorimetry results from rather small magnitudes of the thermodynamic parameters for the phase transition of the PEGE segment in [C2 mim][NTf2 ], compared with those in water. Due to such small magnitudes, TLCST of the PEGE segment for the block copolymers in the IL is greatly affected by the elongation of soluble PEO segments.

Assessing burden of disease as disability adjusted life years in life cycle assessment.

Disability adjusted life years (DALYs) have been used to quantify endpoint indicators of the human burden of disease in life cycle assessment (LCA). The purpose of this paper was to examine the current use of DALYs in LCA, and also to consider whether DALYs as used in LCA have the potential to be compatible with DALYs as used in quantitative risk assessment (QRA) to facilitate direct comparison of the results of the two approaches. A literature review of current usage of DALYs in LCA was undertaken. Two prominent methods were identified: ReCiPe 2008 and LIME2. The methods and assumptions used in their calculations were then critically reviewed. The assumptions used for the derivation of characterization factors in DALYs were found to be considerably different between LCA methods. In many cases, transparency of these calculations and assumptions is lacking. Furthermore, global average DALY values are often used in these calculations, but may not be applicable for impact categories where the local factors play a significant role. The concept of DALYs seems beneficial since it enables direct comparison and aggregation of different health impacts. However, given the different assumptions used in each LCA method, it is important that LCA practitioners are aware of the differences and select the appropriate method for the focus of their study. When applying DALYs as a common metric between LCA and QRA, understanding the background information on how DALYs were derived is crucial to ensure the consistency of DALYs used in LCA and QRA for resulting DALYs to be comparable and to minimize any double counting of effects.

Adsorption of Polyether Block Copolymers at Silica-Water and Silica-Ethylammonium Nitrate Interfaces.

Atomic force microscope (AFM) force curves and images are used to characterize the adsorbed layer structure formed by a series of diblock copolymers with solvophilic poly(ethylene oxide) (PEO) and solvophobic poly(ethyl glycidyl ether) (PEGE) blocks at silica-water and silica-ethylammoniun nitrate (EAN, a room temperature ionic liquid (IL)) interfaces. The diblock polyethers examined are EGE109EO54, EGE113EO115, and EGE104EO178. These experiments reveal how adsorbed layer structure varies as the length of the EO block varies while the EGE block length is kept approximately constant; water is a better solvent for PEO than EAN, so higher curvature structures are found at the interface of silica with water than with EAN. At silica-water interfaces, EGE109EO54 forms a bilayer and EGE113EO115 forms elongated aggregates, while a well-ordered array of spheres is present for EGE104EO178. EGE109EO54 does not adsorb at the silica-EAN interface because the EO chain is too short to compete with the ethylammonium cation for surface adsorption sites. However, EGE113EO115 and EGE104EO178 do adsorb and form a bilayer and elongated aggregates, respectively.

Global and local health burden trade-off through the hybridisation of quantitative microbial risk assessment and life cycle assessment to aid water management.

Life cycle assessment (LCA) and quantitative risk assessment (QRA) are commonly used to evaluate potential human health impacts associated with proposed or existing infrastructure and products. Each approach has a distinct objective and, consequently, their conclusions may be inconsistent or contradictory. It is proposed that the integration of elements of QRA and LCA may provide a more holistic approach to health impact assessment. Here we examine the possibility of merging LCA assessed human health impacts with quantitative microbial risk assessment (QMRA) for waterborne pathogen impacts, expressed with the common health metric, disability adjusted life years (DALYs). The example of a recent large-scale water recycling project in Sydney, Australia was used to identify and demonstrate the potential advantages and current limitations of this approach. A comparative analysis of two scenarios - with and without the development of this project - was undertaken for this purpose. LCA and QMRA were carried out independently for the two scenarios to compare human health impacts, as measured by DALYs lost per year. LCA results suggested that construction of the project would lead to an increased number of DALYs lost per year, while estimated disease burden resulting from microbial exposures indicated that it would result in the loss of fewer DALYs per year than the alternative scenario. By merging the results of the LCA and QMRA, we demonstrate the advantages in providing a more comprehensive assessment of human disease burden for the two scenarios, in particular, the importance of considering the results of both LCA and QRA in a comparative assessment of decision alternatives to avoid problem shifting. The application of DALYs as a common measure between the two approaches was found to be useful for this purpose.

Aggression in Teachers is Related to Role Conflict and Role Ambiguity as Occupational Stress.

BACKGROUND: Aggression in the workplace is increasingly recognized as a serious problem, but there are few studies about worker aggression toward outsiders in the workplace. We investigated the association between aggression and occupational stress among teachers. METHODS: This was a cross-sectional study of 1583 teachers, principals, and vice-principals. Aggression was measured using the Japanese version of the Buss-Perry Aggression Questionnaire (BAQ). The survey respondents were classified into tertiles according to the BAQ score. The high BAQ group was defined as the upper tertile for the BAQ total score (BAQ total score 625). Occupational stress was measured using the Japanese version of the Generic Job Stress Questionnaire. Comparisons among the groups were performed using multiple logistic regression analysis. RESULTS: Of the 1583 respondents, 488 were included in the high BAQ group. After adjusting for demographic and occupational variables, high role conflict and role ambiguity were significantly associated with belonging to the high BAQ group. In subscales of the BAQ, high role conflict and role ambiguity related to high levels of hostility, and physical aggression. CONCLUSIONS: Occupational stress such as role conflict and role ambiguity was associated with aggression among teachers. It is necessary to reduce problems which relates to role conflict and role ambiguity for preventing teachers' aggression.

Relationships between occupational stress and depressive symptoms among prison officers in Japan.

BACKGROUND: The relationships between occupational stress and depressive symptoms in prison officers have rarely been studied in Japan. Thus, we analyzed the associations between occupational stress factors and depressive symptoms among Japanese prison officers. METHODS: This was a cross-sectional study involving 426 male prison officers (20-60-year-old). Depressive symptoms were assessed using the Zung Self-Rating Depression Scale. Using this scale and a cut-off point of 50, the subjects were divided into the "depressive group" and "non-depressive group". Occupational stress was evaluated using the Generic Job Stress Questionnaire. Comparisons among the groups were performed with multiple logistic regression analysis. RESULTS: Of the 426 subjects, 107 were included in the depressive group. After adjusting for demographic and occupational variables, higher scores for the physical environment, role ambiguity, and quantitative workload and a lower score for social support from co-workers were found to be associated with an increased odds ratio of depressive symptoms. CONCLUSIONS: The physical environment, role ambiguity, quantitative workload, and social support from coworkers are associated with depressive symptoms in Japanese prison officers. We hope that educating prison officers about the results of this study and organizational/individual-based improvement strategies will reduce their risk of depression.

Metabolic factors are associated with serum alanine aminotransferase levels in patients with chronic hepatitis C.

BACKGROUND: Although serum alanine aminotransferase (ALT) activity is an important marker for the management of chronic hepatitis C (CHC), the factors associated with serum ALT levels remain to be fully understood. This study aimed to clarify the association between serum ALT levels and clinical, histological, and virological factors in patients with CHC. METHODS: We retrospectively analyzed 256 patients with CHC who underwent liver biopsy, and classified them into three groups according to serum ALT levels: normal to minimal (<40 IU/L), mild (40-80 IU/L), and moderate to severe elevation (≥80 IU/L). All demographic and laboratory data were collected at the time of liver biopsy. All biopsies were evaluated for fibrosis, inflammation, and steatosis. Glucose metabolism was assessed by various indices derived from oral glucose tolerance tests, including the homeostasis model assessment for insulin resistance (HOMA-IR). In 180 patients, visceral fat area was measured at the umbilical level by abdominal computed tomography. RESULTS: Ordered logistic regression analysis showed that higher serum ALT levels were significantly associated with male sex, lower high-density lipoprotein cholesterol (HDL-C), higher HOMA-IR, and higher grades of histological inflammation and steatosis. HOMA-IR, HDL-C, and hepatic steatosis were associated with visceral fat accumulation. CONCLUSIONS: Metabolic factors, as well as sex and hepatic inflammation, are independent risk factors for serum ALT elevation in hepatitis C virus (HCV)-infected patients. Metabolic factors may offer targets to decrease serum ALT levels.