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Adipose Tissue_Appetite_and Obesity

SUN-707 - Optimizing Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) Risk Stratification in Hispanic Populations: A Safety-Net Hospital Experience

Sunday, June 14, 2026
9:00 AM - 4:00 PM CT
Location: ENDOExpo; Poster Floor



Background:
Metabolic dysfunction associated steatotic liver disease (MASLD) is the leading cause of chronic liver disease in the United States, with a disproportionate burden in Hispanic populations. Identifying patients at risk for Metabolic dysfunction-associated steatohepatitis (MASH) with advanced fibrosis is essential for timely intervention, yet remains challenging in safety-net hospitals that serve ethnically diverse and socioeconomically vulnerable populations. Fibrosis-4 index (FIB-4), a noninvasive index is used to predict significant fibrosis in MASLD, however race/ethnicity is notably absent from its algorithm. Given the high prevalence of MASLD, and impact of social determinants of health on Hispanic populations¹, we evaluated the performance of FIB-4 in fibrosis risk stratification in Hispanic patients at an urban safety-net hospital.

Methods:
We conducted a retrospective chart review of 200 adult patients diagnosed with MASLD between 2024-2025 at a large urban safety-net hospital. FIB-4 was calculated using available electronic health record data. Patients were stratified by ethnicity (Asian, Black, Hispanic, White). Transient elastography (Fibroscan) was used to assess liver fibrosis. Advanced fibrosis was defined as liver stiffness measurement ≥8.0 kPa ( ≥F2). Subgroup analyses focused on Hispanic patients with advanced fibrosis were performed.

Results:
Among 200 patients, the majority were Hispanic (69%), followed by Black (11%), Asian (10%) and White (9%). In the overall cohort, a FIB-4 cut off of 1.3 differentiated patients with no or mild fibrosis (F0-1;mean of 1.02) from those with advanced fibrosis (≥F2;mean 1.64). Among the Hispanic population, 39 patients (28%) patients had advanced fibrosis. Notably 16 of these patients (41%) had FIB-4 score < 1.3 indicating under-detection by the standard threshold (P < 0.001). Hispanic patients with advanced fibrosis but low FIB-4 were younger (mean age 51 vs 56 years; p< 0.01) and had higher BMI ( 35.5 vs 31.6kg/m²; p< 0.01) compared with those with FIB-4 ≥1.3.

Conclusions:
In this population, reliance on standard FIB-4 cutoffs may lead to under-screening of advanced fibrosis in high-risk Hispanic patients with MASLD. These findings underscore the need for more sensitive screening strategies, including ethnicity-informed thresholds or adjunctive non-invasive testing, to improve early detection of MASH and fibrosis in vulnerable populations. Optimizing fibrosis risk stratification in safety-net settings is essential to reducing disparities in liver-related outcomes.

References:
1.‌Ochoa-Allemant, Pedro1; Marrero, Jorge A.1; Serper, Marina1,2,3. Racial and ethnic differences and the role of unfavorable social determinants of health across steatotic liver disease subtypes in the United States. Hepatology Communications 7(12):e0324, December 2023. | DOI: 10.1097/HC9.0000000000000324