Association between menopausal status and the probability of steatotic liver disease in middle-aged Korean women: a cross-sectional study using the Korea National Health and Nutrition Examination Survey 2007–2023

Background: Metabolic dysfunction-associated steatotic liver disease (SLD) emphasizes that metabolic dysfunction is a key driver of hepatic steatosis. Although menopause is characterized by substantial hormonal and metabolic shifts, population-based evidence on its association with the probability of SLD under the updated diagnostic framework remains limited. Therefore, this study investigated the association between menopausal status and probability of SLD in middle-aged Korean women. Methods: We analyzed data of 15,106 women aged 40 to 59 years who participated in the Korea National Health and Nutrition Examination Survey (2007-2023). The probability of SLD was assessed using the hepatic steatosis index (≥36) in the presence of at least one metabolic abnormality. Menopausal status was self-reported. Weighted multivariate logistic regression was performed after adjusting for age, body mass index, waist circumference, and major metabolic risk factors. Effect modification was evaluated through subgroup analysis. Results: Among the 15,106 women, 31.5% were postmenopausal and 22.1% met the criteria for SLD probability. Post-menopausal women exhibited higher metabolic risk profiles and a higher probability of SLD than premenopausal women. Menopausal status remained independently associated with SLD probability after multivariable adjustment (adjusted odds ratios, 1.22; P=0.035). The association varied by age; it was strongest among women aged 40 to 49 years and progressively attenuated in older age groups (P for interaction=0.001). Conclusion: Menopausal status is independently associated with a higher probability of SLD among middle-aged Korean women, an association most pronounced in the early midlife. These findings highlight the importance of proactive metabolic screening and timely intervention during this critical period.