Hispanics have the highest rates of liver disease among U.S. adults, and Hispanic men are much more likely than other adults to get liver disease and to die of it, according to federal health officials and experts from the American Liver Foundation.

A snapshot of facts about liver disease in the U.S.:

• Hispanics in the U.S. are more than twice as likely to get liver cancer as non-Hispanic Whites in the U.S.
• Among Hispanics who are at the highest risk for getting liver disease, the most vulnerable are people who trace their roots to Mexico.
• Hispanics represent the largest ethnic minority in the U.S., making up about 20% of the population — or 68 million people.
• Among Hispanics in the U.S., about 60% are from Mexico.
• And Hispanics with Mexican roots get liver disease twice as often as other U.S. adults, according to experts at the U.S. Department of Health and Human Services’ Office of Minority Health.

What is driving higher rates of liver disease among Hispanics, and how can people reduce their risk?

To learn more about how and why liver diseases affect Hispanics at disproportionate rates, we consulted with Dr. James Burton, a transplant hepatologist who cares for patients with acute and chronic liver disease before and after liver transplantation at UCHealth University of Colorado Hospital.

‘‘The Hispanic population is at a particular risk for having more liver disease,’’ said Burton, who is also a professor of medicine and gastroenterology at the University of Colorado Anschutz School of Medicine.

The liver is the largest organ in the body, and liver health is essential for survival. The liver plays a key role in metabolism, digestion and eliminating toxins from the body, Burton said.

Why are Hispanics more susceptible to liver diseases?

A combination of genetic factors, lifestyle behaviors, and barriers to accessing preventive healthcare services contributes to the rising incidence of liver diseases among Hispanics, Burton said.

Our genes, inherited from our parents, determine everything, from our physical appearance to how our bodies respond to medical treatments. And yes, they also influence our predisposition to developing certain diseases.

‘‘There’s a gene called the PNPLA3 gene, which has a much higher prevalence in Hispanics than non-Hispanics, which puts Hispanics at risk for liver diseases,’’ Burton said.

This gene is also associated with obesity and diabetes, which are also more common among Hispanic people. The gene does not directly cause obesity, but obesity amplifies the harmful effects of the gene, which also increases insulin resistance and susceptibility to diabetes.

‘‘Metabolic dysfunction-associated steatotic liver disease is one of the leading causes of liver disease in the U.S.,’’ Burton said.

The incidence and mortality rates for cirrhosis and liver diseases are higher among men than women, according to experts at the National Institutes of Health.

How do obesity and diabetes increase the risk of liver diseases?

Obesity and diabetes are conditions that disproportionately affect Hispanic communities.

Experts estimate that 35% of Hispanics in the U.S. are dealing with obesity, and about 12% have diabetes.

“Obesity and diabetes lead to fat accumulation in the liver. In many people, that fat may simply sit there and do nothing, but in some, it triggers a cascade of inflammation that ultimately leads to fibrosis or scarring which in its end-stage is called cirrhosis,” Burton said.

Eating and drinking habits also contribute to liver damage.

“When someone has risk factors such as obesity, diabetes, and abnormal liver enzymes, that’s a risk factor for liver disease. They’ve got inflammation, and they should have further assessment for developing fibrosis or scarring in the liver,’’ Burton said.

What is cirrhosis, and how common is it in the U.S.?

Cirrhosis is the result of long‑term damage to the liver and can develop for several reasons, including:

• A chronic infection with the hepatitis B or hepatitis C virus.
• Genetic factors.
• Having metabolic dysfunction-associated steatotic liver disease.
• Drinking too much alcohol.

“We’re seeing more liver disease that leads to cirrhosis,” Burton said.

Cirrhosis causes 26,000 deaths each year in the U.S. and is the seventh leading cause of death among adults ages 25 to 64, according to data from experts at the American College of Gastroenterology.

Does alcohol increase the risk of liver disease, especially for those with a genetic risk?

Yes. Alcohol consumption contributes to the development of liver disease.

‘‘Many people don’t realize how much alcohol they consume,’’ Burton said.

The following examples illustrate how much alcohol is too much:

• One standard beer has about 12 ounces at 4% alcohol.
• A typical bottle of wine has five glasses, and one standard drink of wine equates to 5 ounces.
• One standard drink of liquor equates to 1.5 ounces of 40% (80‑proof) spirits.

‘‘If a couple splits a bottle of wine every night, each person is drinking 2.5 glasses,’’ Burton said.

‘‘For women, one drink per day is considered moderate drinking. For men, two to three drinks per day is considered moderate. That means a woman who regularly splits a bottle of wine with her spouse is drinking more than the recommended amount,” he said.

Being aware of behaviors and habits that affect liver health is crucial to caring for your liver.

How can Hispanics reduce their risk of liver disease?

A healthy lifestyle can reduce the genetic risk of developing liver disease.

‘‘Lose weight and control your diabetes,’’ Burton said. ‘’There are FDA-approved drugs that help people lose weight effectively, including GLP-1 agonists like semaglutide and tirzepatide.’’

The weight loss drugs work very well for many people, but they have been expensive and some lower-income people in the U.S. have had trouble accessing medications that could help them avoid becoming obese and reduce their risk of developing liver disease.

Burton said health experts need to do a much better job of finding people who are at risk of developing liver disease and getting them appropriate treatments — including weight loss medications — so they can avoid obesity and reduce their chances of getting liver disease.

What are the early signs and symptoms of liver disease?

Experts call liver disease a “silent pandemic.”

‘‘There are a lot of people who develop cirrhosis and have absolutely no symptoms,’’ Burton said.

Jaundice — a yellowing of the skin and eyes caused by high bilirubin levels — can be a warning sign.

‘‘When someone develops jaundice, they develop ascites or fluid in the abdomen. They start bleeding from the big veins in their esophagus and stomach related to cirrhosis. Those are overt signs of liver disease. But by the time someone develops overt problems, the treatment is liver transplantation,’’ Burton said.

If a patient is diagnosed with advanced liver disease, the patient is at risk of liver cancer.

In Colorado, there are an estimated 600 new cases and 420 deaths from liver cancer each year.

‘‘If a patient is diagnosed with cirrhosis, the recommendations are to do imaging of their liver with ultrasound at least every six months,’’ Burton said. ‘’That is a big intervention.’’

Proper and close follow-up is essential.

‘‘If one is at risk for cancer and you don’t look for it and you wait until it grows, it’s too late. If liver cancer is caught early, there are several available treatments including surgery, ablative therapies through blood vessels and even liver transplantation.’’

What are the recommended screening tests for liver disease?

It’s important to have regular blood tests that monitor liver function.

These tests include:

• The hepatic function panel helps assess elevated liver enzyme levels, an indication of liver disease. Elevation in the total bilirubin levels is a marker of severe liver disease.
• Blood clotting tests can be prolonged in patients with advanced liver disease as the liver makes clotting factors and when there is liver dysfunction the production of these clotting factors declines.
• Alpha-fetoprotein is a tumor marker made by 20% of liver cancers, an elevated level means a high likelihood of cancer. A normal level unfortunately is not helpful.
• A complete blood count a test that measures the levels of red blood cells, white blood cells and platelets in the blood. Low platelet counts are often seen in patients with cirrhosis. In cirrhosis, the spleen is often enlarged, and platelets get sequestered in the enlarged spleen.

‘‘If liver tests are abnormal or if the patient has fat in the liver, it is important to take the extra step,’’ Burton said. ‘‘A primary care doctor should look and screen for liver disease and then assess if it is advanced.’’

What should I do if I get an abnormal liver test result?

Burton recommends being proactive about your health.

‘‘If you have abnormal liver test results, don’t ignore it. Ask for further analysis, either imaging or the FIB4 index test to look for advanced liver disease.’’

The Fibrosis-4 (FIB-4) index takes the liver enzymes, the result of a platelet count, and your age.

‘‘It’s a simple calculation, and it gives you a number. If this number is normal, it means you have more than a 90% chance of not having severe scarring in the liver. But if it’s abnormal, you really need to have further assessment,’’ Burton said.

FIB-4 is a tool that can help identify patients at high risk of advanced liver fibrosis. Patients with high risk are referred to a specialist in liver disease.

Why is hepatitis testing important?

‘‘Yes. Basic screening for viral hepatitis is important,’’ Burton said. ‘‘If you’ve not been screened for viral hepatitis, I would ask your doctor to do that.’’

People aged 18 years and older should be tested for hepatitis B at least once in their lifetime, according to recommendations from the U.S. Centers for Disease Control and Prevention.

How effective is the hepatitis B vaccine?

‘‘Absolutely. Hepatitis B can be entirely prevented with vaccination,’’ Burton said.

Hepatitis B and hepatitis C viruses are among the main risk factors for developing cirrhosis and liver cancer.

‘‘There are no vaccines for hepatitis C,’’ Burton said.

Hepatitis B is the leading indication of liver cancer in the world.

The most common route of transmission of hepatitis B is mother-to-child during birth, according to experts at the World Health Organization.

‘‘If you get the hepatitis B virus as a child, and you don’t get rid of it, you develop a chronic infection. So, vaccinating children at birth for hepatitis B prevents them from getting hepatitis B in their lives. And there are no cures for hepatitis B,’’ Burton said.

‘‘There’s treatment for hepatitis B. Hepatitis B is a carcinogen. It causes cancer. It causes liver disease. So, vaccination could prevent cancer. And it’s entirely through preventing viral infections such as hepatitis B, that we can prevent liver cancer, by doing vaccinations in young people and children as well.’’

Burton said vaccines are vital to liver health. He encourages all of his patients who have liver disease to get the hepatitis B vaccine.

‘‘Vaccines play a major role in preventing hepatitis B in the U.S.  All babies should be vaccinated,’’ he said.

How is hepatitis B spread?

Hepatitis B is a viral infection that causes inflammation in the liver.  The virus can be spread through:

• Unprotected sexual contact
• Sharing needles
• From mother to baby during birth

Do ‘liver detox’ or ‘liver cleansing’ supplements really work?

The liver supplement industry generates billions of dollars each year in the U.S., but most supplements don’t work, especially for serious and dangerous liver diseases.

‘‘People want a quick fix,” Burton said. “They are doing something to try to support their liver health. Some are taking herbal supplements, others are doing a liver cleanse, which is perceived as somewhat healthy. And these products are not regulated. If anything, they can be harmful.’’

Focus on what can actually help you and is backed by evidence, Burton said.

‘‘The real evidence-based medicine of what is helpful in preventing chronic liver disease is losing at least 10% of your body weight if you have metabolic dysfunction-associated steatohepatitis,’’ he said.

Adopting health habits, like eating nutritious foods, avoiding alcohol and asking for help if you need to lose weight, are vital to reducing rates of liver disease and liver cancer, Burton said.

‘’Take control of your healthcare.’’