Why Hispanics are at higher risk for liver disease, and how to stay healthy

Hispanic adults, particularly men, face the highest rates of liver disease in the U.S., according to federal health officials and the American Liver Foundation. Those with roots in Mexico are twice as likely to develop the condition, driven by a combination of the PNPLA3 gene, obesity, and diabetes, according to the U.S. Department of Health and Human Services’ Office of Minority Health.

Hispanics make up about 20% of the U.S. population, or 68 million people. Among this group, those who trace their roots to Mexico are the most vulnerable. Federal data shows Hispanics are more than twice as likely to develop liver cancer compared to non-Hispanic Whites.

Why are Hispanics more susceptible to liver disease?

A mix of genetic predisposition, lifestyle behaviors, and healthcare access barriers drives these rates, according to Dr. James Burton, a transplant hepatologist at UCHealth University of Colorado Hospital. He identifies the PNPLA3 gene as a significant factor, noting it has a much higher prevalence in Hispanics than non-Hispanics.

This gene doesn’t cause obesity directly, but Burton says obesity amplifies its harmful effects. This interaction increases insulin resistance and susceptibility to diabetes. Metabolic dysfunction-associated steatotic liver disease is now one of the leading causes of liver disease across the U.S.

Did You Know? About 60% of Hispanics in the U.S. trace their roots to Mexico, a group that experts at the Office of Minority Health say develops liver disease twice as often as other U.S. adults.

How do obesity and diabetes impact liver health?

Experts estimate 35% of Hispanics in the U.S. deal with obesity and 12% have diabetes. These conditions lead to fat accumulation in the liver. For some, this triggers inflammation that leads to fibrosis, or scarring.

When this scarring reaches its end-stage, it is called cirrhosis. According to the American College of Gastroenterology, cirrhosis causes 26,000 deaths annually in the U.S. It ranks as the seventh leading cause of death for adults aged 25 to 64.

What are the signs of cirrhosis and liver cancer?

Dr. Burton describes liver disease as a “silent pandemic” because many people with cirrhosis show no symptoms. Overt signs typically appear late and include jaundice, which is the yellowing of the skin and eyes. Other late-stage signs include ascites, or fluid in the abdomen, and bleeding from veins in the stomach and esophagus.

Once overt problems emerge, the primary treatment is often liver transplantation. For those already diagnosed with cirrhosis, Burton recommends ultrasound imaging every six months to screen for liver cancer. In Colorado, liver cancer results in an estimated 420 deaths and 600 new cases each year.

Expert Insight: Samantha Carter notes that the “silent” nature of this disease creates a dangerous gap between onset and diagnosis. Because symptoms often only appear when the liver is severely damaged, the stakes for early screening and genetic awareness are significantly higher for high-risk populations.

How can individuals reduce their risk of liver disease?

Weight loss and diabetes control can mitigate genetic risks. Burton suggests losing at least 10% of body weight for those with metabolic dysfunction-associated steatohepatitis. He notes that FDA-approved GLP-1 agonists, such as semaglutide and tirzepatide, can help, though cost remains a barrier for lower-income patients.

The Liver Lowdown with Dr. James Burton

Alcohol consumption also increases risk. For men, moderate drinking is two to three drinks per day; for women, it is one. Burton warns that many people underestimate their intake, such as couples who split a bottle of wine nightly.

Vaccination is another critical tool. The World Health Organization identifies mother-to-child transmission during birth as the most common route for hepatitis B. Because hepatitis B is a carcinogen, vaccinating children at birth may prevent future liver cancer.

What screening tests are recommended?

Regular blood tests monitor liver function. A hepatic function panel assesses liver enzymes and bilirubin levels, while blood clotting tests can indicate advanced dysfunction. A complete blood count may reveal low platelet counts, often seen in cirrhosis when the spleen is enlarged.

For those with abnormal results, Burton recommends the Fibrosis-4 (FIB-4) index. This calculation uses age, platelet count, and liver enzymes to determine the likelihood of severe scarring. A normal FIB-4 score indicates a more than 90% chance that severe scarring is not present.

Regarding supplements, Burton warns that “liver detox” or “cleansing” products are unregulated and potentially harmful. He urges patients to rely on evidence-based medicine rather than quick-fix supplements.

What may happen next?

Health experts may need to improve the identification of at-risk individuals to increase access to treatments. Expanded access to weight-loss medications could potentially reduce obesity rates and subsequent liver disease in lower-income communities. Increased adherence to CDC recommendations for one-time hepatitis B screening for all adults aged 18 and older may also lead to earlier interventions.

Frequently Asked Questions

What is the PNPLA3 gene?
It is a gene with a higher prevalence in Hispanics than non-Hispanics that puts individuals at a higher risk for liver diseases and is associated with obesity and diabetes.

Can liver supplements cure liver disease?
No. According to Dr. Burton, these products are unregulated and may be harmful; evidence-based prevention focuses on weight loss and avoiding alcohol.

How is hepatitis B spread?
It is spread through unprotected sexual contact, sharing needles, and from mother to baby during birth.

Do you know if your primary care provider includes liver function tests in your annual wellness exam?