Estimated reading time: 6 minutes
Medically reviewed and verified by Kate Burke, MD, MHA
There are some conditions that are found more often in certain racial and ethnic groups. Sickle cell disease is more common in people of African, African-American, or Mediterranean descent. Tay-Sachs disease is more common in people of Ashkenazi Jewish or French-Canadian descent. In the United States, racial and ethnic minorities are between 1.5 and 2 times more likely to get a major chronic disease! Asthma, obesity, hypertension, mental illnesses: they all happen in higher rates in minority populations. This is also true for the condition metabolic dysfunction-associated steatohepatitis (MASH). MASH is a form of metabolic dysfunction-associated steatotic liver disease (MASLD). MASH can damage the liver to the point it needs to be replaced. Fortunately, it can be treated through lifestyle changes, but understanding why this disease is found more often in certain groups is an important step in catching it early!
Why Is MASH More Common for Some People?
This is the question we need to answer. Why is it that certain diseases pop up more often in different ethnic or racial groups? Is it a cultural difference? Genetic? It turns out, it is a complicated interplay between a lot of different factors. The reason MASH is more common in certain groups comes from a combination of genetic, lifestyle, and environmental factors.
Genetics
There are small genetic differences among certain ethnic groups. One of the most well-studied genetic risk factors for MASLD and MASH is the PNPLA3 gene variant. This gene tells our body how to make a specific protein called adiponutrin. While we do not completely understand the role this protein plays in the body, researchers believe it helps with the production and breakdown of fats in our fat cells and in liver cells. The variant associated with higher rates of MASLD and MASH is most commonly found in Hispanic populations, particularly in people of Mexican ancestry. People carrying this gene variant are more likely to build up liver fat and develop severe liver disease. The PNPLA3 variant is least commonly found in non-Hispanic Black populations, which may explain why that group has lower rates of MASLD.
Lifestyle Factors
Diet and physical activity play the biggest role in how MASLD and MASH develop. The first problem is high-fat, high-carbohydrate diets. Any diet rich in processed foods, saturated fats, and sugary beverages leads to more fat in the liver and more inflammation. Drinking sugar-sweetened beverages is linked to higher rates of MASLD and MASH severity.
Being physically inactive is also a major factor! People who are sedentary (inactive) are more likely to develop MASLD. Studies show that getting at least 150 minutes of physical activity per week reduces the risk of MASLD by 40%. Being overweight or obese also significantly increases the risk of MASLD and MASH.
Environmental and Social Factors
Social determinants of health (SDOH) are factors that impact someone's health. In the United States, these play a big role in how and why certain conditions are more common in minority groups. Food insecurity is a primary driver. Limited access to fresh, healthy foods means people rely on processed, high-calorie diets that contribute to obesity and MASLD. Certain areas of the country also have limited healthcare access. People who are not able to easily see a doctor are less likely to get early screening and intervention for metabolic conditions like MASLD. Finally, lower income and education levels are associated with higher MASLD risk.
MASH in Different Ethnic Groups
Hispanic Populations
Studies show that Hispanic people, particularly those of Mexican descent, have the highest rates of both MASLD and MASH. Moreover, Hispanic people are more likely to develop severe MASLD. This means they are at a higher risk of liver fibrosis, cirrhosis, and liver failure.
Non-Hispanic White and Asian Populations
Non-Hispanic White people have lower rates of MASLD compared to Hispanics but are more affected than non-Hispanic Black populations. Asian Americans also have lower rates than White people, but there is not enough research done on ancestry-specific risks within Asian populations.
Non-Hispanic Black Populations
Non-Hispanic Black people have a significantly lower rate of MASLD despite having similar rates of type 2 diabetes as other groups. However, when MASLD is diagnosed, Black people experience MASH at similar rates to White people. This means that other protective factors may play a role. A protective factor is something that reduces the risk of disease progression. In the case of MASLD, lower liver fat accumulation in non-Hispanic Black individuals may be partly due to genetic and metabolic differences, though social and lifestyle factors could also play a role.
How Can We Reduce the Disparity?
So now that we have established there is a higher risk for certain groups, what can we do? What steps are there to reduce the burden minorities carry with MASLD and MASH? Targeted interventions and education. The first is to improve access to healthcare. Expanding screening programs and providing education on preventing MASLD can help at-risk populations receive earlier diagnosis and treatment. Encouraging Mediterranean, high-protein, and low-carbohydrate diets can help reduce liver fat accumulation. Reducing MASLD disparities requires a multi-level approach, including increased healthcare access, culturally tailored nutrition education, and policy changes to address food deserts and economic barriers to healthy living. Additional public health initiatives can also focus on reducing sedentary behavior and promoting increased opportunities for exercise in the community across all age groups.
MASH shows up in different rates among different racial and ethnic groups. We can address these disparities through dietary interventions, increased physical activity, and improved healthcare access. Knowledge and education are the first line of defense!
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