Sex-Specific Metabolic Dysfunction-Associated Steatotic Liver Disease Prevalence across the Age-Defined Menopausal Transition

Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) exhibits marked sex differences.However, age-specific prevalence patterns around the menopausal transition remain incompletely characterized.We investigated age-and sex-specific MASLD prevalence patterns and the concurrent role of dyslipidemia (DL).Methods: We analyzed 17,091 adults (8,199 females and 8,892 males) who underwent abdominal ultrasonography in a health screening cohort.MASLD was defined according to the 2023 multi-society Delphi consensus criteria, requiring hepatic steatosis and at least one cardiometabolic risk factor.DL was defined as triglycerides ≥150 mg/dL or use of lipid-lowering medication, and low high-density lipoproteincholesterol (<50 mg/dL in females and <40 mg/dL in males) was treated as a separate cardiometabolic risk factor.Age ≥50 years was used as a surrogate for postmenopausal status.Logistic regression models were used to evaluate the association between age ≥50 years and MASLD in females after adjustment for metabolic factors.Findings: Overall MASLD prevalence was lower in females than in males (19.6% vs. 38.9%,p<0.001).In males, prevalence was highest in the 40s (44.3%) and subsequently lower in older age groups.In females, prevalence was substantially higher in the 50s (24.7%) and 60s (28.6%) than in the 40s (14.0%).The male-to-female odds ratio (OR) narrowed progressively from 6.41 in the 30s to 1.28 in the 70s.During the age-defined menopausal transition (ages 45-54 years), DL was 8.3 percentage points (pp) higher in females but 3.4 pp lower in males, whereas diabetes mellitus and hypertension showed similar changes in both sexes (p<0.001 for interaction).In females, age ≥50 years remained independently associated with MASLD after adjustment for metabolic factors (OR 2.103, 95% confidence interval 1.791-2.469,p<0.001).Conclusions: Females showed a distinct age-specific MASLD prevalence pattern around the age-defined menopausal transition, accompanied by a sex-specific difference in DL that persisted after metabolic adjustment.