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.