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EPIDEMIOLOGY OF MASLD BY RACIAL AND ETHNIC GROUP
Higher prevalence of MASLD in Hispanic individuals in the United States
In the United States, Hispanic individuals have the highest prevalence of MASLD, followed by non-
Hispanic White individuals and then non-Hispanic Black individuals [2,11,12] [Table 1]. Browning et al. used
magnetic resonance spectroscopy to analyze a diverse longitudinal cohort and found that Hispanic
individuals had a higher prevalence of MASLD compared to non-Hispanic White individuals and non-
Hispanic Black individuals (45% vs. 33% vs. 24%); this study also found Hispanic individuals to have a
[13]
higher prevalence of obesity and insulin resistance . Studies from 2018 and onwards have continued to
support this finding. A systematic review and meta-analysis published in 2018 analyzed 34 studies with a
total of 368,569 unique patients in the United States and found that MASLD prevalence was highest in
Hispanic individuals, intermediate in non-Hispanic White individuals, and lowest in non-Hispanic Black
[14]
individuals (22.9% vs. 14.4% vs. 13.0%) . This study also found that among individuals with MASLD, the
risk of MASH was highest in Hispanic individuals and lowest in non-Hispanic Black individuals. A
systematic review published in 2021 that analyzed 20 articles (mostly from the United States) found that the
prevalence of MASLD is higher among Hispanic individuals, followed by non-Hispanic White individuals
and Asian individuals, and lastly, non-Hispanic Black individuals . This study also found that Hispanic
[15]
ethnicity is a risk factor for developing MASLD and that non-Hispanic Black individuals have lower odds of
developing MASLD. Similarly, data from the Nonalcoholic Steatohepatitis Clinical Research Network
(NASH CRN) found that of patients with biopsy-proven MASLD, the frequency of MASH varied by race
and ethnicity: 63% in Hispanic individuals, 62% in non-Hispanic White individuals, 52% in non-Hispanic
[16]
Black individuals, and 52% in Asians . A review paper that summarized published evidence for disease
disparities in the United States found that within 19 disease entities, including metabolic disorders, cancers,
inflammatory diseases, dermatologic disorders, and infectious diseases, the prevalence of the disease is
found in modest excess within Hispanic populations compared to non-Hispanic White populations, with
most notable differences found in MASLD, diabetes, and obesity . In a study of ICD codes for MASLD in
[17]
the National Inpatient Sample, Adejumo et al. found that the largest rate of increase of admissions with
MASLD was found among Hispanic individuals at 107/100,000 hospitalizations/year compared to White
individuals at 80/100,000 hospitalizations per year and Black individuals at 75/100,000
hospitalizations/year .
[18]

Higher prevalence of MASLD among Mexican-American populations
“Hispanic” is a blanket term for patients with ancestry from countries that speak Spanish, and overlooks
significant heterogeneity in race, ethnicity, and numerous other factors that may contribute to health
outcomes. Studies have found that within Hispanic populations in the United States, the prevalence of
[12]
MASLD is higher in those of Mexican origin . A study published in 2020 analyzed 4,538 adult participants
from the National Health and Nutrition Examination Survey (NHANES) from 2011-2016 in the United
States found that MASLD prevalence was highest among Mexican Americans (48.4%), and lowest among
non-Hispanic Black individuals (8.0%) and Asians (18.1%) . Another study utilizing NHANES data from
[19]
2017-2018 investigated 3,190 adults (categorized as normoglycemic, prediabetic, or diabetic) and found that
Mexican American men had the highest prevalence of severe MASLD (defined as controlled attenuation
parameter [CAP] score > 290 dB/m) in the normoglycemic and diabetic populations compared to non-
Hispanic White, non-Hispanic Black, and other Hispanic groups . Similarly, among females, Mexican-
[20]
Americans had the highest prevalence of severe MASLD among normoglycemic individuals. The review
from 2021 analyzing 20 articles mentioned above found that in the United States population, Mexican-
Americans had the highest prevalence of MASLD, followed by non-Hispanic White individuals and non-
[15]
Hispanic Black individuals (21.2% vs. 12.5% vs. 11.6%) .