Abstract
INTRODUCTION: The term steatotic liver disease (SLD) has replaced fatty liver disease following the Delphi consensus process. Recent trends indicate an increasing prevalence of SLD among women, particularly postmenopausal women. This study evaluates the prevalence of SLD in pre- and postmenopausal women and identifies risk factors contributing to its development. MATERIAL AND METHODS: We conducted a cross-sectional analysis using data from the National Health and Nutrition Examination Survey (NHANES) 2017-2020. Adults aged ≥18 years with available controlled attenuation parameter (CAP) and liver stiffness measures (LSM) from vibration-controlled transient elastography were included. SLD and its subtypes - metabolic dysfunction-associated steatotic liver disease (MASLD), metabolic-alcohol-related liver disease (MetALD), and alcohol-related liver disease (ALD) - were classified according to the consensus definitions. Menopausal status was determined via self-reported reproductive health data. Multivariate logistic regression identified risk factors for SLD and liver fibrosis, adjusting for demographic and metabolic variables. RESULTS: Steatotic liver disease prevalence was significantly higher in postmenopausal women (34.57% vs. 23.49%, p < 0.001), driven by MASLD (32.79% vs. 21.70%, p < 0.001). MetALD was more common in postmenopausal women (17.04% vs. 13.52%), while ALD was more frequent in premenopausal women (0.44% vs. 0.07%, p = 0.045). Advanced fibrosis (LSM ≥ 11.7 kPa) was also more prevalent in postmenopausal women (3.4% vs. 2.63%). Key predictors of SLD included higher BMI (OR = 1.94, 95% CI: 1.68-2.23, p < 0.001) and diabetes (OR = 1.52, 95% CI: 1.28-1.81, p < 0.001). CONCLUSIONS: Postmenopausal women face an increased burden of SLD, likely due to metabolic risk factors and estrogen loss. Preventive interventions are needed to reduce SLD-related morbidity in this population.