Research examining the connection between traditional Chinese medicine constitution (TCMC) and metabolic dysfunction-associated fatty liver disease (MAFLD) in older adults remains limited. This study aimed to characterize the distribution of TCMC types and MAFLD prevalence among the elderly, providing insights for constitution-based prevention and management strategies. A cross-sectional survey was performed in Zhongshan, China, involving participants aged 65 years and older. Data were collected on demographics, health history, anthropometrics, and TCMC classification. Associations between TCMC types and MAFLD were assessed using chi-square tests, multivariate logistic regression, subgroup analyses, and propensity score-based inverse probability weighting. Of 7,085 participants, 1,408 (19.9%) were identified with MAFLD. The predominant TCMC types among those with MAFLD were phlegm-dampness, gentleness, and yin-deficiency. After adjusting for potential confounders including age, sex, smoking, alcohol use, BMI, waist-to-hip ratio, hypertension, diabetes, and dyslipidemia, PDC was significantly associated with MAFLD (adjusted OR = 1.776, 95% CI: 1.496–2.108, P < 0.001), whereas qi-depression constitution showed a negative association (adjusted OR = 0.643, 95% CI: 0.481–0.860, P = 0.003). The link between PDC and MAFLD was more pronounced in men compared with women (adjusted OR = 2.04 vs. 1.70, Pinteraction = 0.003) and in smokers versus non-smokers (2.11 vs. 1.75, Pinteraction = 0.006).In the elderly population of Zhongshan, PDC is positively correlated with MAFLD, with stronger effects observed in men and individuals who smoke. Targeted early detection and management of PDC may help prevent the development and progression of MAFLD.
