Targeting MASLD and MASH in the US Hispanic/Latino Population: A Review

The prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) in the US is highest among Hispanic/Latino individuals. Their risk of developing metabolic dysfunction-associated steatohepatitis (MASH) with fibrosis, cirrhosis with progression to hepatocellular carcinoma and need for liver transplant, and death is similarly elevated.

The Hispanic/Latino population is the fastest-growing ethnic group in the US, and their annual increase in MASLD prevalence outpaces other ethnic groups. Cardiometabolic and genetic risk factors are highly prevalent among Hispanic/Latino persons and are closely linked to the development of MASLD. Food insecurity, limited access to health care, language barriers, and low health literacy also contribute to the risk of MASLD or progressing to MASH and cirrhosis. Culturally tailored interventions may improve individual outcomes. Screening for chronic and advanced liver disease due to MASLD can be done in high-risk patients using the Fibrosis-4 Index (FIB-4), although several studies suggest current thresholds may be insufficiently sensitive for Hispanic/Latino patients. US Food and Drug Administration-approved liver-directed pharmacologic therapy for MASH should be considered alongside management of cardiometabolic risk factors, as outlined in a proposed pathway incorporating new FIB-4 and secondary assessment thresholds for Hispanic/Latino patients.

The prevalence of MASLD and MASH among Hispanic/Latino persons in the US is a significant public health challenge. Addressing this issue requires multifaceted, culturally mindful strategies that target disparities in nutrition, physical activity, genetics, research, and social determinants of health. Clinicians should incorporate routine FIB-4 risk stratification for MASLD in Hispanic/Latino patients with cardiometabolic risk factors to enable early detection and intervention.