Uric Acid–to–HDL cholesterol ratio and probable MASLD across adiposity strata in postmenopausal women

Purpose: To examine the association between serum uric acid-to-HDL cholesterol ratio (UHR) and probable metabolic dysfunction-associated steatotic liver disease (MASLD) in postmenopausal women, and to assess whether this association varies across body mass index (BMI) strata. Methods: This cross-sectional study evaluated 2647 postmenopausal women. Among first-visit participants with complete covariate data (n = 375), 67.7% met criteria for probable MASLD. Among participants with elastography data, 37/77 (48.1%) met CAP-defined MASLD criteria. Steatotic liver disease was defined according to contemporary MASLD consensus criteria. Alcohol intake was uniformly low, with no participants meeting criteria for moderate or high consumption. UHR was ln-transformed and analysed using multivariable, sensitivity, and BMI-stratified logistic regression models with standardised effect estimates. Results: . Conclusion: UHR was associated with probable MASLD and may reflect broader metabolic vulnerability alongside anthropometric measures in postmenopausal women. Findings are associative and hypothesis-generating; prospective external validation is required before clinical translation.