Adiposity and Cumulative Cardiometabolic Risk Factors as Determinants of Hepatic Steatosis Severity in Postmenopausal Women

Background/Objectives: Postmenopausal women are at increased risk of metabolic dysfunction-associated steatotic liver disease (MASLD). This study evaluated the associations of anthropometric and hormonal parameters and cardiometabolic risk-factor accumulation with steatosis and MASLD. Methods: In this cross-sectional study, 87 postmenopausal women at a university menopause clinic underwent anthropometric, biochemical, and liver imaging assessment. Hepatic steatosis was defined as CAP ≥ 248 dB/m on transient elastography, and MASLD as steatosis with ≥1 cardiometabolic risk factor (2023 consensus criteria). Anthropometry included body mass index (BMI), waist circumference, mid-upper arm circumference, and triceps skinfold thickness. Results: CAP-defined steatosis (46.0%) closely mirrored MASLD (44.8%; all but one steatotic woman met ≥ 1 criterion). Waist circumference independently correlated with steatosis (OR = 2.77, 95% CI 1.08–7.13, p = 0.035), adding value beyond BMI (Nagelkerke R2 0.202 vs. 0.140). Steatosis burden rose progressively with risk-factor number: each additional factor conferred a 30.59 dB/m CAP increase (95% CI 17.33–43.85, p < 0.001) and 3.38-fold higher odds of steatosis (95% CI 1.59–7.20, p = 0.002; ≥3 vs. 2 factors, Welch’s p = 0.004). Conclusions: MASLD and CAP-defined steatosis were largely coincident. Adiposity correlated with steatosis, but severity was determined chiefly by the accumulation of cardiometabolic risk factors, which is a key determinant of steatotic liver disease severity after menopause.