You may have been diagnosed with fatty liver disease years ago. But you may not have fully understood your condition because of your limited English. But today, you realize that you have what’s called metabolic dysfunction-associated steatohepatitis (MASH), a serious liver disease.
That’s a scenario for many of the 43 million people in the U.S. who speak Spanish at home. Nearly half of Hispanics in the U.S. have fatty liver, the highest share of any racial or ethnic.
"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',” says Maria Hernández, director of Strategic Latino Community Outreach for Liver Education Advocates in Pittsburgh, Pennsylvania.
Language barriers can cause serious gaps in health care. Many Spanish speakers misunderstand their diagnosis and treatment plan, especially with MASH.
“You need to understand if your liver enzymes are high or your ultrasound shows fat in your liver,” 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.
The Rise of Fatty Liver Disease in the Hispanic Population
Research shows that many Hispanic people of Mexican and Mexican American descent have a change in a gene called PNPLA3. This gene makes the liver more likely to store fat, cause inflammation and scarring, and raise the risk of liver cancer.
Arab says diet, genetics and eating habits all play a role. Together, they help explain why Hispanic communities have some of the highest rates of fatty liver disease.
Obesity, diabetes, high blood pressure, and high cholesterol also raise the risk. Studies show these conditions are especially common in this community.
The Real Impact of Language Gap
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.”
Where Does the Problem Lie?
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 Spanish-language health apps. Studies show that some Spanish speakers can't read, and others have limited reading skills.
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.
What Patients Tell Us: The Human Cost of Language Gaps
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 an interpreter. 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 an interpreter, 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 metabolic dysfunction-associated steatotic liver disease (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.
“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.
How Can We Bridge This Gap?
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.
How Can Patients Advocate for Themselves?
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.
The Way Forward
Despite the language challenges, the future of health care for Hispanics looks promising. More medical schools are offering Spanish-language training. Figueroa 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, MASLD and MASH patients are in a stronger position to take control of their health.
“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,” Figueroa Diaz says. “Hopefully, that access through primary care education about fatty liver disease will lead to better outcomes and disease management for Latinos.”
