Sex Differences in Patients with MASLD and Their Association with Cardiometabolic Risk Factors: Insights from the Polish Gallstone Surgery Registry

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is defined by the presence of hepatic steatosis and at least one cardiometabolic risk factor. Differences in the incidence of MASLD between men and women are primarily due to distinct metabolic and cardiovascular profiles. The aim of this observational study was to investigate the prevalence and characteristics of MASLD in men and women. Methods: The study included patients from the Polish Gallstone Surgery Registry diagnosed with MASLD according to current criteria. Results: Among 3419 patients, MASLD was diagnosed in 24.2%. Its prevalence was significantly higher in men (29.8%) than in women (21.9%) (p < 0.0001), with the highest incidence observed in men aged 70–79 (32.1%) and women aged 70–79 (33.3%). MASLD was associated with overweight in individuals aged < 50 years (OR 1.87; 95% CI: 1.11–3.14; p < 0.0186) and in those aged ≥ 50 years (OR 1.99; 95% CI: 1.48–2.68; p < 0.001), as well as with obesity in patients aged < 50 years (OR 6.53; 95% CI: 4.08–10.47; p < 0.001) and in those aged ≥ 50 years (OR 3.9; 95% CI: 2.92–5.22; p < 0.0001). Conclusions: In this study, MASLD was diagnosed more frequently in men than in women, and its incidence showed a positive association with increasing BMI. These findings indicate that excess body weight and sex are key predictors of MASLD, highlighting the need for individualized treatment strategies.