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No consensus exists on how serum uric acid (sUA) affects metabolism-associated fatty liver disease (MAFLD) in postmenopausal women.This prospective observational study examined this link using National Health and Nutrition Examination Survey (NHANES) 2017 to 2020 data. We divided women\u2019s sUA levels into four quartiles and used logistic regression, subgroup analyses, and restricted triple spline methods to compare the prevalence of MAFLD in postmenopausal and non-menopausal women. We also used histograms to analyze the effect of BMI-based indices. This population-based study involved 4477 women, including 1139 postmenopausal women aged 55\u201373 years. Multivariate logistic regression showed that, in the fully adjusted model, we found that participants in the highest quartile of sUA had a statistically significant 254% increased risk of MAFLD compared with participants in the lowest quartile (OR: 3.54; 95% CI 3.54 1.47\u20138.55; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001). Subgroup analyses showed no significant interaction between sUA levels and specific subgroups <jats:italic>P<\/jats:italic>(\u2009&gt;\u20090.05 for all interactions). Additionally, RCS and threshold analysis showed a linear correlation (<jats:italic>P<\/jats:italic>\u2009=\u20090.186) and an ideal inflection point of 4.6 (<jats:italic>P<\/jats:italic>\u2009=\u20090.818) to the left. Right of the inflection point, the effect size was 1.524 (95% CI 1.291\u20131.814; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.01). Histograms demonstrated that postmenopausal BMI increased sUA\u2019s influence on MAFLD and higher sUA levels and BMI may enhance the prevalence of MAFLA in US postmenopausal women. The results of this study suggest that monitoring sUA levels in the postmenopausal period is critical in determining the occurrence of and interventions for MAFLD.<\/jats:p>","DOI":"10.1038\/s41598-025-93738-3","type":"journal-article","created":{"date-parts":[[2025,3,15]],"date-time":"2025-03-15T06:40:04Z","timestamp":1742020804000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Relationship between serum uric acid levels and metabolism associated fatty liver disease in postmenopausal women based on NHANES 2017\u20132020"],"prefix":"10.1038","volume":"15","author":[{"given":"Xiaoding","family":"Zhou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zongxiang","family":"Yue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuming","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fengjuan","family":"Yuan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingrui","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaqi","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rong","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ya","family":"Luo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiong","family":"Yi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,3,15]]},"reference":[{"key":"93738_CR1","doi-asserted-by":"publisher","first-page":"1335","DOI":"10.1097\/HEP.0000000000000004","volume":"77","author":"ZM Younossi","year":"2023","unstructured":"Younossi, Z. 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