Sex differences in the prevalence and cardiometabolic risk profiles of steatotic liver disease: A Canadian Longitudinal Study on Aging analysis

Objective: Steatotic liver disease (SLD) is absent from global public health agendas. Our study is the first to comprehensively examine SLD prevalence in Canada, focusing on sex differences. Methods: We used data from the Canadian Longitudinal Study on Aging between 2012 and 2018. Steatosis was identified using the validated NAFLD Ridge Score. Using the most recent diagnostic criteria, we defined metabolic (dysfunction)-associated steatotic liver disease (MASLD), metabolic dysfunction–associated alcohol-associated liver disease (MetALD), and alcohol-associated liver disease (ALD) and estimated prevalences by sociodemographic factors. Survey-weighted adjusted prevalence ratios (aPR) for MASLD (sex-stratified) and MetALD were estimated using Poisson regression with robust standard errors. Results: A total of 24,888 people (51.4% female; median age 58 years) were included. The most common subtype of SLD was MASLD, 35% (95%CI, 34–36), followed by MetALD 2.6% (2.3–2.9), and ALD 0.8% (0.6–1.0). Overall, the prevalences for MASLD and MetALD were significantly higher among males at 46% (45–48) and 3.7% (3.2–4.2) compared to females at 24% (23–26) and 1.6% (1.2‒2.1), respectively. Lower household incomes were associated with higher MASLD prevalence in females (aPR, 2.9, 2.4–3.5) and males (aPR, 1.1, 1.0–1.3). Multimorbidity was high among the MASLD group; 31 unique MASLD phenotypes based on cardiometabolic characteristics were identified. Females with MASLD were also more likely to have more cardiometabolic conditions compared to males with MASLD. Conclusion: In this large Canadian cohort, we found significant sex differences in SLD burden and cardiometabolic features. Epidemiological assessments are necessary to improve preparedness for the significant projected increase in advanced liver disease.