Objective,2,To investigate the clinical characteristics and traditional Chinese medicine （TCM） constitution distribution pattern of lean metabolic associated fatty liver disease （MAFLD） in the elderly in Shanghai communities， and to provide an objective basis for the prevention and treatment of lean MAFLD.,Methods,2,According to the prevalence of MAFLD， elderly people who participated in community-based physical examinations in Jiading District， Shanghai were selected and divided into lean MAFLD group，lean no-MAFLD group and non-lean MAFLD group to investigate their general information including gender， age， BMI， smoking and alcohol consumption， as well as fasting blood glucose （FBG）， triglyceride （TG）， total cholesterol （TC）， low-density lipoprotein cholesterol （LDL-C）， high-density lipoprotein cholesterol （HDL-C）， alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， total bilirubin （TBil）， Serum creatinine （Scr）， uric acid （UA）， white blood cells （WBC）， neutrophil percentage （NEU%）， lymphocyte percentage （LYMPH%）， hemoglobin （Hb） and platelet count （PLT）， and other laboratory indices. The distribution pattern of TCM body constitution types was explored and the risk factors of lean MAFLD were analyzed with the logistic regression model.,Results,2,①A total of 48，448 study subjects were finally included， including 2，270 patients with lean MAFLD， with a prevalence of 4.7% in the community-based elderly population and a male-to-female ratio of 1：3.27. ②The male-to-female ratio and the proportion of smoking and alcohol consumption in the lean MAFLD group were lower than those in the lean no-MAFLD group （,P,<,0.05）. The lean MAFLD group had lower levels of HDL-C， Scr， and NEU% （,P,<,0.05） and higher levels of BMI， TG， TC， LDL-C， FBG， ALT， UA， WBC， LYMPH%， Hb and PLT （,P,<,0.05） than the lean no-MAFLD group. The male-to-female ratio and the proportion of smoking and alcohol consumption were lower in the lean MAFLD group than those in the non-lean MAFLD group （,P,<,0.05）. The lean MAFLD group had lower levels of TG， FBG， ALT， AST， Scr， WBC， and Hb （,P,<,0.05） and higher levels of TC， LDL-C， HDL-C， UA， LYMPH% and PLT （,P,<,0.05） than the non-lean MAFLD group. ③The lean MAFLD group had a higher proportion in TCM constitutions including yin deficiency （20.8%）， qi deficiency （18.2%）， phlegm-damp （9.3%）， damp-heat （8.2%） and blood stasis （3.0%） （,P,<,0.05） than the lean no-MAFLD group. The lean MAFLD group had a higher proportion in TCM constitutions including qi deficiency （18.2%）， damp-heat （8.2%） and yang deficiency （5.3%） （,P,<,0.05） than the non-lean MAFLD group. ④ Elevated levels of BMI， TG， LDL-C and FBG may be risk factors for the development of lean MAFLD in the elderly ［,OR, （,95% CI,） 1.500 （1.432-1.572）， 2.125 （1.896-2.382）， 2.089 （1.682-2.595） and 1.163 （1.133-1.192）， respectively］. The TCM constitution types of blood stasis， damp-heat， phlegm-damp， and yin deficiency may be risk factors for the development of lean MAFLD in the elderly ［,OR, （95% ,CI,） 1.716 （1.256-2.346）， 1.702 （1.387-2.089）， 1.543 （1.272-1.873）， and 1.146 （1.003-1.310）， respectively］.,Conclusion,2,Prevention and treatment of lean MAFLD in the elderly over 60 years of age should focus on reducing BMI as well as lipid and uric acid levels， and controlling blood glucose. The identification of features of each TCM constitution type is recommended. Regular physical examinations and individualized treatment for the elderly with constitution types of phlegm-damp， damp-heat， blood-stasis and qi-deficiency and yin-deficiency （which are two main types in the elder） can help prevent and improve the symptoms of lean MAFLD.