Modern Diets, Metabolic Inequity, and Race–Ethnic Disparities: Unraveling the Associations With MASLD and Cancer Risk

Metabolic dysfunction-associated steatotic liver disease (MASLD) is quickly emerging as a global public health concern, primarily fueled by the rising consumption of processed and ultraprocessed foods. This global health issue, showing a 50% increase in prevalence over two decades to 38% of the global population, is now the second most common cause of end-stage liver disease and liver transplants in Europe and the United States and an emerging driver of hepatocellular carcinoma, particularly in Hispanic and non-Hispanic White populations. Its prevalence, driven by increasing consumption of ultraprocessed foods, obesity, and sedentary lifestyles, disproportionately impacts racial and ethnic minorities, exacerbating health disparities. Genetic polymorphisms contribute to interindividual and interethnic variations in disease susceptibility. However, genetics alone cannot explain the disparities; social determinants, food insecurity, and limited access to healthcare also play pivotal roles. MASLD prevalence is rising fastest among older adults and Hispanic women, particularly in low-income and rural communities. Despite advances in pharmacologic therapies, access remains inequitable. Lifestyle interventions remain essential. Integrating genetic and epigenetic insights into risk stratification and treatment can support precision medicine approaches. A comprehensive MASLD management framework must include policy reforms to address food deserts, healthcare access, and socioeconomic inequities. Culturally tailored public health programs and personalized care models are crucial for enhancing outcomes in vulnerable populations. In this narrative review, we examine the multifaceted contributors to MASLD pathogenesis and disparities, with a focus on genetic risk, social determinants, dietary patterns, and cancer risk and policy-level interventions to inform more equitable liver health strategies.