The Ewha Medical Journal
Ewha Womans University School of Medicine

Sex differences in metabolic dysfunction-associated steatotic liver disease: a narrative review

Won Kim1,*
1Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul 07061, Korea.
*Corresponding Author: Won Kim, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul 07061, Korea, Republic of. E-mail:

© Copyright 2024 Ewha Womans University School of Medicine. This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received: Apr 20, 2024; Revised: Apr 22, 2024; Accepted: Apr 22, 2024

Published Online: Apr 30, 2024


Understanding the effects of sex and sex differences on liver health and disease is crucial to individualized healthcare and informed decision-making for patients with liver disease. The impact of sex on liver disease varies according to its etiology. Women have a lower prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) than men. However, women who are in the postmenopausal stage are at higher risk for advanced liver fibrosis because of hormonal influences. Sex differences affect the pathogenesis of MASLD, which comprises a complex process involving several factors such as hormones, obesity, and the gut microbiome. Furthermore, sex-related differences in the development of MASLD-related hepatocellular carcinoma (HCC) have been observed. Given that MASLD exhibits a sex-differentiated characteristics, an individualized management approach based on scientific evidence is necessary. However, research in this area has been lacking. This article reviews the current understanding of sex differences in MASLD.

Keywords: non-alcoholic fatty liver disease; estrogen; menopause; sex characteristics