The Role of Race and Ethnicity in the Response to Metabolic Dysfunction-Associated Steatotic Liver Disease Treatment: A Review.

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, 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 (eg, resmetirom), glucagon-like peptide-1 receptor agonists (eg, semaglutide), dual glucagon-like peptide-1/glucose-dependent insulinotropic polypeptide receptor agonists (eg, tirzepatide), and sodium-glucose cotransporter-2 inhibitors (eg, 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.