Keywords
MASH
Health disparities
Resmetirom
Semaglutide
PNPLA3
Genetic ancestry
Social determinants of health
Data Availability Statement
No original data were generated for this narrative review. All data discussed are available in the cited published literature. The complete final search strategy for each database is provided in the Supplementary Material (Appendix S1).
How to Cite
Abstract
Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) affects 25.6% of U.S. adults and is the fastest-growing indication for liver transplantation. The 2023 MASLD nomenclature change, 2024 FDA approval of resmetirom, and 2025 accelerated approval of semaglutide for metabolic dysfunction-associated steatohepatitis (MASH) reshaped the therapeutic landscape. Yet, racial and ethnic disparities persist across the U.S. care continuum.
Methods: This narrative review searched PubMed, MEDLINE, Embase, and Cochrane CENTRAL from inception through 30 April 2026 for English-language studies on racial and ethnic disparities in MASLD epidemiology, screening, fibrosis progression, outcomes, trial representation, and pharmacotherapy access. Guidelines, systematic reviews, observational studies, and randomized trials were prioritized; no PRISMA methodology was used.
Results: Hispanic/Latino adults bear the highest MASLD prevalence (pooled 41%; relative risk vs. non-Hispanic adults 1.50, 95% CI 1.32–1.69), with disproportionate biopsy-cohort MASH (61%), advanced fibrosis (27%), and lower transplant probability (sHR 0.793, 95% CI 0.747–0.842). Non-Hispanic Black adults exhibit lower MASLD prevalence on adjusted NHANES but higher mortality and lower transplant rates in cirrhosis. Noninvasive tools show reduced accuracy in Hispanics (false-negative rates 14%–21%). MAESTRO-NASH enrolled only 2% of Black participants. Resmetirom costs $47,000–$57,670 annually; GLP-1 prescribing disparities in obesity persist across all periods.
Conclusions: Disparities accumulate across the continuum and reflect the interplay among genetic ancestry, social determinants of health, and structural barriers, rather than race or ethnicity as biological variables. An equity framework distinguishing clinical actions, implementation priorities, and research gaps is proposed. No intervention has been demonstrated in MASLD-specific studies to reduce inequities.
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