Burden of steatotic liver disease in postmenopausal women: NHANES 2017–2020 insights

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.