Language Gaps Delay Fatty Liver Diagnosis in Hispanic Communities

Medically Reviewed by Zilpah Sheikh, MD on October 05, 2025
8 min read

You’re a Hispanic adult living in the U.S. Your doctor asks if you’ve ever been told you have fatty liver disease. You say yes, many years ago. Your doctor back then didn’t speak Spanish. They never told you what it meant or what to do about it. Or if they did, you didn’t understand.

Life went on. You kept eating rice and tortillas, drank beer and wine, and avoided exercise. Over time, you feel more nauseated, lose your appetite, and see your skin turn yellow.

Your doctor today speaks Spanish. He tells you that you have metabolic dysfunction-associated steatohepatitis (MASH), a serious liver disease that could have been avoided if you had understood your first diagnosis.

That’s a true story. It represents the fatty liver disease (FLD) journey for many Hispanics living in the U.S.

More than 43 million people in the U.S. speak Spanish at home. It is the most common language after English. Many people speak it as their first and only language.

Language barriers can cause serious gaps in health care, and it’s common for Spanish speakers to misunderstand their diagnosis and treatment plan, especially with MASH.

“You need to understand if your liver enzymes are high or you have fat in your liver ultrasound, you should look for further care,” says Juan Pablo Arab, MD, a transplant hepatologist and Director of Alcohol Sciences at the Stravitz-Sanyal Institute for Liver Disease and Metabolic Health at Virginia Commonwealth University.

 

In the U.S., over 40% of adults have fatty liver. Among Hispanics, it’s 47% — the highest of any group. Arab says diet, genetics, income, and nutritious habits all play a role.

A typical Hispanic diet, for example, is rich in carbohydrates, such as beans, rice, and tortillas. These foods, often higher in added sugar and saturated fat, raise the risk of FLD.

Research shows that a significant number of people of Mexican and Mexican American descent have a change in a gene called PNPLA3. This gene makes the liver more prone to fat buildup, inflammation, fibrosis, and scarring and increases the risk for liver cancer.

Other risk factors include obesity, diabetes, high blood pressure, and high cholesterol. Studies show that Hispanics have high rates of these as well.

Over 25 million people in the U.S. have limited English proficiency (LEP). They’re unable to speak, read, write, and understand English. Of that number, 62% are Hispanic.

Some of the ways language barriers affect medical care include:

  • Diagnosis, treatment, and medication errors
  • Physical harm
  • Greater risk of serious medical events in pediatric care
  • Surgical delays
  • Higher readmission rates
  • Misunderstandings about procedure preparation
  • Misunderstandings about managing conditions

Viviana Figueroa Diaz, MD, a transplant hepatologist at NYU Langone, says language barriers deepen the lack of trust in Hispanic communities. “They may not want to take part in studies or clinical trials because they feel like the system is experimenting on them.”

Maria Hernández, director of Strategic Latino Community Outreach for Liver Education Advocates, organizes workshops and events to educate Hispanics about MASH and metabolic dysfunction-associated steatotic liver disease (MASLD).

“I’ve had people come up to me and tell me, ‘I was told once I have fatty liver disease, but I don’t know much about it’ or ‘I was told a while ago, but I didn’t think any more about it,’” Hernández says. Without a treatment plan and follow-up care, the liver progressively gets worse.

Many Spanish speakers in the U.S. struggle to get the health care they need because there just aren’t enough bilingual providers. Even though 1 in 5 people in the U.S. speak Spanish, only about 6% of doctors are Hispanic, and only 2% of non-Hispanic doctors speak Spanish.

There’s also a shortage of in-person medical interpreters, bilingual patient materials and health apps. Even when forms are available in Spanish, non-English speakers may not understand them. Studies show that some Spanish speakers do not read and others have low literacy levels.

To tackle this problem, some health systems have created Hispanic health centers, including programs focused on liver care. Across the country, initiatives such as NYU Langone’s Latino Liver Program, UChicago Medicine’s Latino Transplant Program, and the Hispanic Transplant Evaluation Clinic at Beth Israel Deaconess Medical Center in Boston focus on improving liver health in Hispanic communities.

Liseth Ordoñes, 32, is a mom from Ecuador who lives near Pittsburgh, Pennsylvania, and only speaks Spanish. During a postpartum visit, her doctor told her she had fatty liver disease. He used a translator. After a series of blood tests and an ultrasound, she received a phone message. It confirmed the diagnosis and told her to avoid alcohol. There were no other explanations or next steps.

Ordoñes doesn’t drink. “I thought they were going to schedule an appointment to explain what fatty liver is, but they didn’t,” she says. With an 8-month-old at home and no transportation, Ordoñes is trying to figure out her next steps. 

“I’m planning to switch to another clinic to see if they can set me up with a doctor who speaks Spanish,” she says. “Even with a translator, it’s not the same as having a doctor who actually speaks Spanish and can talk more in depth.”

The kind of interpreter you have can make a big difference in the care you get.

Teresa Rodriguez, 71, saw this firsthand during the COVID-19 pandemic. She takes care of her sister, Leonor, who has mental and physical disabilities. During a virtual appointment with a gastroenterologist who didn’t speak Spanish, the interpreter misunderstood and mistranslated many key details. Because of those errors, her sister didn’t get the right treatment or follow-up for her MASLD diagnosis.

Recently, Teresa found a gastroenterologist who speaks Spanish. He confirmed that her sister now has MASH. “She follows many treatments, especially for her mental disability, but her fatty liver disease didn’t get the attention it needed when it mattered most,” Teresa says.

Her sister had high cholesterol for years, likely because of genetics. Without the right care, it eventually led to MASH.

 “Not speaking the language changes everything,” Teresa says. “I don’t speak English. I’m older. I have a hard time with technology, and I don’t have family who speaks English who can go with us to medical appointments.”

Older Hispanic adults in the U.S. are among the groups most affected by language barriers. More than half of Latinos over 65 don’t speak English well. Mexican Americans have the lowest level of English proficiency among major Latino subgroups, which makes them even more vulnerable to language gaps in health care.

Some doctors, clinics, and hospitals are taking steps to close language gaps. They set up interpreter service programs or train their bilingual staff to become certified medical interpreters. Others work with outside interpreter agencies. Some make it a priority to hire staff who speak their patients’ languages.

New translation tools also help Spanish speakers when a bilingual doctor or interpreter isn’t available:

AI-powered translation tools such as Google Translate and DeepL give quick translations for basic conversations.

Mobile apps such as MediBabble or Canopy Speak offer medical phrases and voice translation made for use in clinics and doctor’s offices.

Online dictionaries help explain key medical terms in Spanish during appointments.

These tools can support communication, though they don’t replace professional interpreters or bilingual doctors.

Navigating the health care system can be hard for English speakers. When you add language and cultural differences into the mix, it can make things harder. If you’re Hispanic, learning to speak up or advocate for yourself is key to achieving better health care. 

“You already know that you have a history, that you have risk factors because you’re Latino. Ask your doctor to get your liver enzymes checked. Have your questions written down so you already know what you’re going to ask,” Hernández says.

Other ways to advocate for yourself include:

  • Ask the clinic for a certified medical interpreter in person, by phone, or via video.
  • Request written materials, lab results, and follow-up instructions in Spanish.
  • Bring a trusted bilingual friend or family member as support (not as the leading interpreter).
  • Prepare your questions in advance, and translate them before your visit.
  • Speak up if you don’t understand something. You have the right to clear information in your language.

Health systems can do more, too. They can offer Spanish-language materials on patient portals, lab results, and discharge instructions. They can train staff on cultural competence so language and cultural differences don’t get in the way of care. Building partnerships with Hispanic community organizations can also help build trust and improve communication.

Despite the language challenges, the future of health care for Hispanics looks promising. More medical schools are offering Spanish-language training. Diaz, who considers herself a millennial, sees a growing number of bilingual doctors from her generation and younger. “That’s important in medicine. It’s very hard to provide care if you don’t speak the language.”

With better communication and more Spanish resources, FLD patients are in a stronger position to take control of their health. The next step is to focus on what you can do to manage fatty liver disease for yourself and your family.

“I’m optimistic that more access to care and resources will be available in Spanish to meet the needs of fatty liver disease patients in Hispanic communities,” Diaz says. “Hopefully, that access through primary care education about fatty liver disease will lead to better outcomes and disease management for Latinos.”