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Gulati et al. Metab Target Organ Damage 2024;4:9 Metabolism and
DOI: 10.20517/mtod.2023.45
Target Organ Damage

Review Open Access

Racial and ethnic disparities in metabolic
dysfunction-associated steatotic liver disease

Reeti Gulati 1 , Cynthia A. Moylan 2,3 , Julius Wilder 2 , Kara Wegermann 2
1
Internal Medicine, Duke University Hospital, Durham, NC 27710, USA.
2
Department of Medicine, Division of Gastroenterology and Hepatology, Duke University, Durham, NC 27710, USA.
3
Department of Medicine, Durham Veterans Affairs Medical Center, Durham, NC 27710, USA.
Correspondence to: Dr. Reeti Gulati, Internal Medicine, Duke University Hospital, 2301 Erwin Rd, Durham, NC 27710, USA. E-
mail: reeti.gulati@duke.edu

How to cite this article: Gulati R, Moylan CA, Wilder J, Wegermann K. Racial and ethnic disparities in metabolic dysfunction-
associated steatotic liver disease. Metab Target Organ Damage 2024;4:9. https://dx.doi.org/10.20517/mtod.2023.45

Received: 22 Nov 2023 First Decision: 22 Dec 2023 Revised: 6 Feb 2024 Accepted: 19 Feb 2024 Published: 26 Feb 2024
Academic Editor: Amedeo Lonardo Copy Editor: Yanbing Bai Production Editor: Yanbing Bai

Abstract
Metabolic dysfunction-associated steatotic liver disease (MASLD) has an increasing prevalence, morbidity, and
mortality both within the United States and globally. Here, we review newer evidence demonstrating racial and
ethnic disparities that exist in the incidence of MASLD in the United States Many studies demonstrate that
Hispanic populations have the highest prevalence of MASLD within the United States, followed by non-Hispanic
White populations and then non-Hispanic Black populations. In addition, we present the latest research
investigating specific factors that contribute to these disparities, including genetics, environmental exposures, diet,
physical activity, and socioeconomic disparities. Finally, we discuss future directions and interventions needed to
increase knowledge of racial and ethnic disparities in MASLD and reduce future disparities. The necessary
strategies include increasing diversity and documentation of race and ethnicity in MASLD clinical studies, and
increased screening and preventative health education for MASLD in vulnerable populations.

Keywords: Metabolic, fatty liver disease, non-alcoholic, racial, ethnic, disparities

INTRODUCTION
This narrative review covers disparities by race and ethnicity in metabolic dysfunction-associated steatotic
liver disease (MASLD). We first present recent epidemiologic studies and then discuss potential

© The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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