Prevalence of Elevated Liver-Associated Enzymes in Women Aged 40-65 Years in the United States Overall, and With and Without Metabolic Dysfunction-Associated Steatotic Liver Disease.

BACKGROUND

We estimated the prevalence of elevated liver-associated enzymes (LAEs) in a nationally representative sample of women aged 40-65 years in the United States, overall and by menopausal status or by metabolic dysfunction-associated steatotic liver disease (MASLD).

METHODS

This descriptive study used cross-sectional data from the National Health and Nutrition Examination Survey collected from 1999/2000 to 2017/March 2020. The primary study endpoint was the weighted prevalence of elevated LAEs, measured by alanine aminotransferase (ALT) or aspartate aminotransferase (AST) >3× the upper limit of normal (ULN). Prespecified secondary endpoints included the prevalence of elevated LAEs by different definitions and by menopause and MASLD status.

RESULTS

The study included 11,443 women aged 40-65 years (mean age 51.7 years) from surveys representing the general population: 53.3% postmenopausal, 33.8% premenopausal, and 12.9% with unknown menopausal status. The prevalence of MASLD was estimated at 29.5% (95% confidence interval [CI]: 27.7-31.4); this was higher in postmenopausal women (34.4%, 95% CI: 32.0-36.9) than premenopausal women (22.7%, 95% CI: 20.2-25.4). The estimated prevalence of ALT or AST >3× ULN was 0.87% (95% CI: 0.68-1.11); this was similar for premenopausal (0.84%, 95% CI: 0.48-1.36) and postmenopausal (0.91%, 95% CI: 0.67-1.21) women, but higher for women with MASLD (1.50%, 95% CI: 0.87-2.40) than those without MASLD (0.25%, 95% CI: 0.09-0.56).

CONCLUSIONS

This study provides prevalence estimates of elevated LAEs in middle-aged women in the US general population. MASLD was common, and ALT or AST >3× ULN was more prevalent in women with than without MASLD.