Doctors follow clinical guidelines designed to protect your liver health. These expert-backed steps guide your care to choose the right tests, suggest lifestyle changes, and prevent further progression and complications.
Why Clinical Guidelines for MASLD and MASH Matter to You
Your doctor uses guidelines to make decisions about your MASLD/MASH care. These guidelines help you and your doctor work together to:
- Catch liver problems early through proper screening and testing
- Prevent fatty liver disease (MASLD) from becoming more serious (MASH)
- Lower your risk of serious complications
- Reach specific goals, like reducing liver fat
Understanding these guidelines is the first step in taking an active role in your care. This begins with knowing your risk.
Why Are Hispanic People at Higher Risk?
Your genetics tell a part of the story. Many Hispanic people carry a gene variation called PNPLA3 that affects how the liver handles fat. This gene can cause your liver to store extra fat, injure your liver, and cause more scarring. This gene variation increases your risk of MASLD and MASH, but lifestyle factors are important too. Many people with this gene maintain good liver health through diet and exercise.
Several other factors can increase your risk:
- Extra weight, especially around your waist
- Type 2 diabetes
- High blood pressure
- High levels of blood fats
- Low levels of good cholesterol (HDL)
- Changes from traditional diets to processed foods
- Less physical activity
Are You at Risk for MASLD or MASH?
The guidelines give recommendations to doctors to help them make the right diagnosis as soon as possible. Why is this important? Many people don’t know they have these conditions until they become more serious. Finding out earlier helps prevent problems like liver scarring (fibrosis), severe damage (cirrhosis), and liver cancer.
Your doctor should check the health of your liver if you have:
- Type 2 diabetes
- Obesity plus heart and blood vessel problems (cardiometabolic risk factors)
- High liver blood test results (elevated liver enzymes) that don't go down
- Family members with liver disease
While having some fat in your liver may not cause problems right away, the amount of scarring matters most for your long-term health. This is something your doctor will run tests to figure out.
How Your Doctor Tests Your Liver
The specialist will typically review your medical history, do a physical exam, and may order specialized tests if they suspect you have MASLD or are at risk. They'll also discuss your diet and lifestyle and create a personalized treatment plan.
Even if your test results are in a normal range, your liver may still not be healthy. Many people with MASLD have normal liver tests, especially in the early stages. Because of this, doctors may recommend additional testing based on risk factors that increase the possibility of MASLD progressing to MASH.
Simple blood test (FIB-4 index). This test checks for liver scarring. Your score will tell your doctor what should happen next. If your risk is considered low, your doctor may recommend another check in one to three years. If it’s high, more detailed testing will be recommended.
Liver scan (VCTE). If your blood test showed a high result, your doctor will use a liver elastography test (VCTE), an ultrasound-based imaging study or a similar test to measure your liver scarring or stiffness more precisely. People at high risk, such as those with type 2 diabetes, obesity, family history of cirrhosis, or more than mild alcohol consumption, should be tested for advanced fibrosis as well.
Combined health score (FAST). Your doctor creates this score by combining:
- Your liver scan (VCTE) results, which show liver stiffness (a sign of scarring)
- A specific liver blood test called AST that shows liver inflammation
- A measurement called CAP (controlled attenuation parameter) that shows how much fat has built up in your liver cells. This measurement comes from the same scan that checks for scarring.
This FAST score helps your doctor identify at-risk people and helps them understand if your liver is inflamed and needs treatment.
Your doctor should also test you for other conditions that often come with MASLD and MASH:
- Blood sugar problems (type 2 diabetes)
- High cholesterol (dyslipidemia)
- High blood pressure (hypertension)
- Kidney disease
- Breathing problems during sleep (sleep apnea)
- Hormone changes in women (polycystic ovary syndrome)
Keeping an Eye on Your Liver Health
Your doctor will schedule regular checkups based on your test results.
If your initial FIB-4 score was low, the guidelines recommend another check every one to two years. This helps catch any changes early, even if your liver is healthy now.
If you have fat in your liver, your doctor will use the same or similar tests to track changes. These regular checks help show if your liver is getting better with treatment, if changes are needed to your treatment plan, and if liver scarring is getting any worse.
If you have liver inflammation (MASH) or scarring:
- You'll need more frequent checkups.
- Your doctor will closely track your liver blood tests.
- You may need regular liver scans to monitor scarring.
- Early treatment changes can help prevent serious liver damage (cirrhosis).
The key is catching changes early, when treatment works best. These checkups are like regular maintenance to help any diagnosed problems from getting worse.
Lifestyle Changes for Liver Health
Lifestyle changes will be the foundation of your treatment for MASLD and keeping your liver healthy. There are several aspects to pay special attention to:
Weight management. Specific weight loss goals can help your liver heal. Weight loss improves hepatic steatosis, MASH, and hepatic fibrosis.
- Losing 5% of your weight reduces fat in your liver.
- Losing 7%-10% of your weight decreases liver inflammation.
Healthy eating. Liver health guidelines recommend a calorie-controlled Mediterranean-style diet to help both your liver and heart. Follow these suggestions to make this diet part of your eating plan:
- Fill your plate with fruits, vegetables, whole grains, and healthy fats like olive oil and fish.
- Cut back on processed foods (which tend to be high in sugar and saturated fat).
- Skip sugary drinks.
Drinking coffee, with or without caffeine, may also be helpful. It may reduce the risk of MASLD and fibrosis.
Many traditional Hispanic foods are naturally healthy and can help protect your liver. Here are some ways to make traditional Hispanic foods work with liver health dietary guidelines:
Traditional healthy choices:
- Whole-grain corn tortillas for fiber
- Beans and legumes for protein
- Traditional vegetables like tomatoes, peppers, squash, and nopales
- Fresh herbs and spices like cilantro and cumin
Simple kitchen adjustments:
- Bake or grill instead of frying foods like empanadas.
- Choose brown rice or quinoa instead of white rice.
- Pick black beans or lentils instead of refried beans.
- Replace sugary drinks with water or unsweetened tea.
- Use lean meats like chicken and fish instead of higher-fat options.
- Cook with olive oil or avocado oil instead of lard.
Keys to success:
- Cook more meals at home where you can control ingredients.
- Start with small changes to your favorite recipes.
- Keep traditional flavors while making healthier choices.
Remember that your liver needs healthy fats to function correctly. Focus on healthy fats from sources like olive oil, avocados, and fish while limiting saturated and trans fats.
Alcohol use. Follow your doctor's advice about alcohol. If you have a fatty liver (steatotic liver), avoid alcohol. If you have serious scarring (advanced fibrosis) or severe liver damage (cirrhosis), completely stop drinking alcohol.
Staying active. Aim for at least 150 minutes of exercise each week, choosing activities you enjoy. Consider breaking it up into 30-minute sessions and mixing cardio and strength exercises. Regardless of weight loss, regular exercise has been shown to be beneficial to the health of your heart and liver.
Building Your Health Care Support System
Finding health care providers who understand your needs will make managing MASLD easier.
Look for providers who:
- Speak your preferred language
- Understand Hispanic dietary traditions and family dynamics
- Take time to listen to your concerns
- Respect cultural practices that affect your health choices
To find a provider that meets your needs, you can use a variety of sources. Ask your friends and family members if they have a doctor they trust and can recommend. Do some research with online search directories. Look for patient reviews and ratings for different doctors. And if you have insurance, see if your provider has a list of Spanish-speaking doctors in your network.
When looking for a liver specialist:
- Ask your primary care doctor for referrals.
- Find out if they have experience treating Hispanic patients.
- Confirm whether they accept your insurance.
- Consider their location and availability.
Community health workers ("promotores de salud") are health care workers who help you learn and practice healthy behaviors. You may be able to find one at a local hospital, clinic, or community organization. They can:
- Help explain medical terms and treatment options
- Guide you through the health care system
- Connect you with local resources
- Provide support in your preferred language
You may be able to schedule a doctor visit by video meeting online. Virtual health care benefits include:
- Fewer trips to the doctor's office
- Access to specialists who may be far from home
- Flexible scheduling that works around your job
- Options to include family members in your visits
Recap
- When you have MASLD or MASH, your liver stores too much fat, leading to inflammation and damage.
- Early diagnosis and proper management are key for Hispanic adults, who have a higher risk of developing these conditions.
- Regular checkups, including tests and scans, are important for monitoring liver health, especially since early changes can prevent serious liver damage.
- One of the best ways to manage MASLD is through lifestyle changes. These include gradual weight loss, exercise, and making healthy changes to traditional foods.
- You also need to control any chronic conditions you may have that place you at a higher risk, like diabetes, overweight or obesity.
- Your doctor can help monitor your progress and prevent serious complications while respecting your cultural practices.
Show Sources
Photo Credit: iStock/Getty Images
SOURCES:
Digestive Disease and Sciences: “Total body weight loss of ≥ 10 % is associated with improved hepatic fibrosis in patients with nonalcoholic steatohepatitis.”
University of Wisconsin Mora Pinzon Lab: “How to Find a Spanish-Speaking Primary Care Provider: A Helpful Guide.”
U.S. Bureau of Labor Statistics: “Community Health Workers.”
Frontiers in Medicine: “PNPLA3—A Potential Therapeutic Target for Personalized Treatment of Chronic Liver Disease.”
Annals of Gastroenterology: “Accuracy of controlled attenuation parameter for liver steatosis in patients at risk for metabolic dysfunction-associated steatotic liver disease using magnetic resonance imaging: a systematic review and meta-analysis.”
Journal of Hepatology: “EASL-EASD-EASO Clinical Practice Guidelines on the Management of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD).”
Harvard Public Health Review: “Acculturation, Familial Support, and Unhealthful Dietary Patterns.”
Journal of Clinical Medicine: “Metabolic Dysfunction-Associated Steatotic Liver Disease and Metabolic Dysfunction-Associated Steatohepatitis: The Patient and Physician Perspective.”
Nutrients: “Adherence to a Traditional Mexican Diet Is Associated with Lower Hepatic Steatosis in US-Born Hispanics of Mexican Descent with Overweight or Obesity.”
Pew Research Center: “Hispanic Americans’ Trust in and Engagement With Science.”
Office of Disease Prevention and Health Promotion: “Choosing a Doctor: Quick Tips.”
Johns Hopkins Medicine: “Benefits of Telemedicine.”
