What question did this study set out to answer?

Investigate racial and ethnic disparities in treatment response for MASLD.

February 20, 2026

The role of Race and Ethnicity in the response to MASLD treatment: A Review

Key Points

Investigate racial and ethnic disparities in treatment response for MASLD.
Narrative review of literature from multiple databases including PubMed and Cochrane Library.
Analysis of MASLD prevalence and outcomes across various racial and ethnic groups.
Evaluation of emerging therapeutic agents and their effects on MASLD.
Hispanic populations have the highest MASLD prevalence compared to others.
Therapeutics reviewed include agents like GLP-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors.
Reported benefits include reductions in hepatic steatosis and improvements in liver stiffness and fibrosis.

Abstract

• Teaching points. • High incidence of MASLD. • Wide differences in MASLD outcomes. • Role and effect of ethnicity in MASLD outcomes. • Novel treatment modalities and their effect in MASLD in different settings. Teaching points. High incidence of MASLD. Wide differences in MASLD outcomes. Role and effect of ethnicity in MASLD outcomes. Novel treatment modalities and their effect in MASLD in different settings. Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly prevalent worldwide, contributing to rising morbidity and mortality. In the United States, MASLD is among the most common chronic liver diseases, affecting an estimated 75–100 million individuals. Estimated prevalence and outcomes differ significantly across racial and ethnic groups. Understanding the factors underlying these disparities and their impact on treatment response is essential for improving patient outcomes. A comprehensive literature search was performed using PubMed, Embase, Scopus, Web of Science, Scientific Electronic Library Online (SciELO), and the Cochrane Library. This narrative review summarizes evidence on racial and ethnic differences in MASLD prevalence and treatment response, emphasizing pharmacologic agents with emerging therapeutic potential. Hispanic populations demonstrate the highest MASLD prevalence, followed by non-Hispanic White and non-Hispanic African American populations. Therapeutic classes reviewed include thyroid hormone receptor-β agonists (e.g., resmetirom), glucagon-like peptide-1 receptor agonists (GLP-1 RAs; e.g., semaglutide), dual GLP-1/glucose-dependent insulinotropic polypeptide (GIP) receptor agonists (e.g., tirzepatide), and sodium-glucose cotransporter-2 inhibitors (e.g., empagliflozin). Reported benefits span reductions in hepatic steatosis, improvements in liver stiffness and fibrosis—assessed by histology, transient elastography, and other noninvasive indices—and favorable lipid parameter changes. Overall, this review highlights the persistent underrepresentation of diverse racial and ethnic populations in MASLD clinical trials and underscores the influence of genetics, environmental exposures, diet, and physical activity on disease expression and therapeutic outcomes.

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