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Summary: Background: Autoimmune hepatitis (AIH) may coexist with metabolic syndrome‐associated diseases (MSADs) given patients' inherent need for corticosteroid therapy, as well as general population trends. Aim: To examine the impact of MSAD risk factors on AIH or its treatment, and vice versa Methods: This was a multi‐centre retrospective cohort study of 552 patients with AIH diagnosed between January 2000 and December 2019. Data relating to demographic factors, laboratory values, AIH medications and MSADs were collected at diagnosis and at 1‐ and 3‐year follow‐up. Statistical relationships were analysed and reported. Results: We included 552 patients in the study cohort (median age 50 years, 76.1% female). All MSADs, including hypertension, dyslipidaemia, diabetes and a gain of BMI ≥3 kg/m2, increased within the AIH cohort over time. Initial treatment regimen impacted de novo diabetes but not other MSAD development. AIH biochemical remission was less frequent at 3 years post‐diagnosis among patients with ≥1 MSAD. The incidence of new MSADs could be predicted by baseline factors in certain cases. Conclusion: In the largest US‐based cohort of patients newly diagnosed with AIH, there was a considerable burden of pre‐existing and de novo MSADs that may affect AIH treatment outcomes. Identifying those at highest risk of co‐morbid MSADs allows for an individualised approach to management to reduce its long‐term sequelae in patients with AIH. [ABSTRACT FROM AUTHOR]