When doctors diagnosed Terri Milton with fatty liver disease at age 35, she didn’t believe it was serious. Her doctor offered no guidance about treatment and dismissed the disease as very common, remembers Milton, who lives in Houston.
“My doctor said, ‘Don’t worry about it,’” says Milton, who is half Mexican American. “He said, ‘It’s no big deal. Everybody has a fatty liver.’”
With no treatment recommendations or advice, Milton made no major changes to her lifestyle.
About 10 years later, Milton was suffering from gallstones and chose to have her gallbladder removed. During the operation, surgeons discovered nodules in her liver, small bumps that can be benign or cancerous. Doctors told Milton she had cirrhosis of the liver due to metabolic dysfunction-associated steatohepatitis (MASH). MASH is a chronic liver disease caused by excess fat in the liver that causes inflammation, scarring, and ballooning of liver cells.
Milton was shocked. Like many, she believed liver disease only happened to people who drank alcohol heavily. Milton didn’t drink alcohol, and she was active, she said. She had an aunt who died from advanced liver disease, but she didn’t know at the time that the disease could be hereditary.
Over the next few years, Milton was in and out of the hospital with liver complications. She had bouts of hepatic encephalopathy, a neuropsychiatric syndrome that can happen as a result of severe liver disease. During the episodes, Milton would become extremely confused, not even remembering how to operate the television remote control, she says. Her body ached with pain, and she was exhausted most days.
“My body felt like it was hit by a Mack truck,” she recalls. “I was sleeping 18 hours a day. I would eat a little, water my flowers or pull a weed, and then go back to bed or fall asleep in my chair. That was my life.”
The disease ultimately led to cancerous tumors on Milton’s liver. Doctors told Milton her best chance at long-term survival was a liver transplant.
“When I was approved for the transplant list, [initially], I was pissed,” she says. “I had gotten used to the possibility that I would grow old with the liver I was born with. I was mad my native liver had failed me.”
A Rising Problem for Hispanics
Fatty liver disease is a growing health problem in the U.S., especially for Hispanics. A greater proportion of Hispanic adults have metabolic dysfunction-associated steatotic liver disease (MASLD) than other racial and ethnic groups, a recent study has found. MASLD is a type of fatty liver disease unrelated to drinking alcohol. MASH is a more aggressive form of MASLD. Both are caused by too much fat in the liver.
In the U.S., 42% of adults have fatty liver disease, according to the recent analysis led by a hepatologist at Virginia Commonwealth University. Of Hispanic adults, 47% have MASLD, compared with 40% of White adults, 35% of Black adults, and 39% of Asian adults, the study found.
Until recently, it wasn’t clear why Hispanic adults are having fatty liver disease at higher rates than other populations, says Blanca C. Lizaola-Mayo, MD, a transplant hepatologist at Mayo Clinic in Phoenix and a volunteer for the American Liver Foundation. Researchers now know that because of their genes, Hispanics are more likely to develop metabolic syndrome. This is a cluster of conditions that raise the risk of health problems such as heart disease, diabetes, and stroke.
Metabolic syndrome includes high blood pressure, high blood sugar, excess fat around the waist, and poor cholesterol levels. Fatty liver disease is a common effect of metabolic syndrome. Hispanics are also prone to genetic variations that make them more likely to have liver steatosis and fibrosis, studies show.
“The risk of fatty liver disease [among Hispanics] is increasing,” Lizaola-Mayo says. “What I frequently see is patients coming in the clinic with end-stage liver disease, telling me that 10 years, 15 years ago, they were told they have a fatty liver and the only guidance they received was, ‘You need to lose weight. I’ll see you later.’ That’s it.”
A lack of education and awareness about fatty liver disease are key drivers for the higher incidence of the condition, Lizaola-Mayo says. This goes for both the Hispanic community and medical providers, she says. Even today, some providers are unaware of the seriousness of fatty liver disease and which patients should be screened for it, she says.
To make things even trickier, fatty liver disease often has no symptoms, and many people have no idea they have it until the disease worsens. Monica Govea learned this firsthand when a vehicle crash sent her to the emergency department in May 2025. Doctors ran tests to examine her bruised kidney, and told her, “It looks like you have fatty liver disease,” recalls Govea, who lives in Round Lake Beach, Illinois.
Doctors weren’t sure how severe the disease was at the time, and Govea underwent two ultrasounds to learn more. The results showed she had stage II to III cirrhosis.
“I was freaking out,” she says. “I never had any symptoms. A lot of people say they have pain. I never experienced pain.”
Doctors recommended Govea lose weight, but they did not explain how or provide her with a plan, she says.
“[The doctor] really scared me,” she says. “She said, ‘Don’t worry, we’ll keep you comfortable.’ “I was like, ‘Am I dying?’ When my mother was sick and they told us they would ‘make her comfortable,’ she died.”
Frustrated with the lack of guidance, Govea decided to take matters into her own hands. She was determined to improve her condition, with or without medical help.
Obstacles in Care Can Delay Diagnosis, Derail Treatment
Hispanic patients face multiple barriers that can lead to missed diagnoses or delays in care for fatty liver disease, says Natalia Heredia, PhD, MPH, an assistant professor at the University of Texas Health Science Center at Houston. Heredia is currently developing a behavioral lifestyle intervention for the management of nonalcoholic fatty liver disease (NAFLD) in Hispanic/Latino adults.
Access to care is a top problem, she says. Many Hispanic patients are uninsured or underinsured, which limits their ability to seek timely diagnosis and treatment, she says. Language barriers and limited access to culturally appropriate health information can also hinder understanding and engagement with care plans, she adds.
On top of these challenges, there are also environmental and structural barriers.
“Many Hispanic communities face food insecurity and live in areas with limited access to healthy foods, known as food deserts,” Heredia says. “These conditions promote reliance on ultra-processed, high-sugar foods that contribute to insulin resistance and liver fat accumulation (buildup).”
Aurie Llamas, who was diagnosed with fatty liver disease in 2019, adds that many traditional foods in the Hispanic community are high in fat, carbs, and sugar, which lead to higher rates of obesity. When Llamas got her diagnosis, she was immediately determined to improve her liver condition. But like Govea, Llamas wasn’t given much medical guidance except for “clean up your diet,” she says. So she did just that.
But it wasn’t easy.
“It meant participating in family events and family functions differently,” says Llamas, 50, of Laguna Beach, California. “That was challenging, not so much for myself, but for my family, because food is such a love language. At Christmas, it was ‘Why aren’t you having six tamales?’ when I said, ‘I’ll have one and I‘ll skip the atole and have coffee instead.’ Things like that were frowned upon because you don’t do that.”
At her brother’s wedding, Llamas brought along a little cooler filled with arugula chicken salad and skipped the traditional wedding food. Instead of the wedding cake, she ate strawberries, dates, and almonds.
After eight months on the Mediterranean diet, Llamas lost 40 pounds. The next time she visited the hepatologist, her liver score was zero, meaning there was no fat detected on her liver, she says.
“I couldn't believe it because when I went in, I was thinking, ‘I don’t know what I’m going to see, but I know that every day I’ve been committed. So, maybe I'll show some progress.’ I was not expecting to be fully reversed.”
Making the Right Lifestyle Changes
As illustrated by Llamas, liver experts say making the right lifestyle and behavioral changes can improve fatty liver disease and prevent the condition from worsening, especially in its early stages.
The most important action to take is losing weight, Lizaola-Mayo says. By losing weight, you can change your metabolism and decrease other cardiometabolic risk factors that drive fatty liver disease, such as diabetes and obesity, she explains.
“I emphasize frequently to my patients, if they treat the problem early, they’re going to be able to regress the damage they have and prevent developing cirrhosis or even requiring a liver transplant,” she says.
Some key dietary changes to make include cutting down on ultra-processed foods and added sugars, such as sugar-sweetened beverages, while eating more fiber-rich, nutrient-dense foods, like vegetables, says Heredia. Regular movement and physical activity also help reduce liver fat and improve insulin sensitivity, she adds.
Tell your doctor if you have an immediate relative with fatty liver disease or cirrhosis of the liver, and ask to be screened for advanced fibrosis, adds Lizaola-Mayo. Advanced fibrosis is a severe stage of liver damage defined by scarring and damage to liver tissue. Similarly, if you have prediabetes, diabetes, hypertension, or obesity, or if you have high triglycerides or low HDL (“good”) cholesterol, request a screening for advanced fibrosis, she says.
“[Your provider] will do an ultrasound or a CT scan or an MRI of the abdomen, and in this image, we can see fat accumulation in the liver or hepatic steatosis,” she says. “That will be the first marker the patient has fatty liver or another disease that can potentially be causing fat accumulation in the liver. Number two is cardiometabolic risk factors [like] obesity, high blood pressure, hypertension, or hyperlipidemia. All of these factors are taken into account to make the diagnosis of fatty liver disease.”
If you have MASH, your doctor may prescribe medications that can help, such as:
- Resmetirom (Rezdiffra), a thyroid hormone receptor agonist that can reduce liver fat and inflammation.
- Semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist that improves liver fibrosis and reduces fat buildup. Wegovy is the form of semaglutide that is approved for MASH.
While no FDA-approved medications for MASLD exist yet, managing comorbid conditions like diabetes and hypertension is essential, says Heredia.
‘Stay on Track’
Since her diagnosis, Govea has made dramatic changes to her diet. She has cut out fatty foods and alcohol, and eats lots of raw vegetables, chicken, and salmon. She eats avocados and strawberries every day, she says. She has lost 54 pounds so far and hopes to see an improvement in her condition at her next medical visit in October 2025.
Govea encourages others facing similar struggles to stay disciplined when it comes to healthy food choices.
“Stay on track. Latinos, we like to go to parties and the next thing you know, you lose it,” she says. “You just eat everything. Tortillas are really bad. Corn is bad for the liver. Modify. I make Mexican rice out of cauliflower. Every time I want rice, if I want mashed potatoes, I make it with cauliflower.”
Milton, meanwhile, received a liver transplant in May 2022.
“Afterward, it was absolute relief,” says Milton, now 60. “One of the first things I noticed was my brain was clear.”
Milton emphasizes that she is not cured, however. A liver transplant is a treatment for cirrhosis, but she still has a genetic risk of getting fatty liver disease.
“I have to make sure that my lifestyle matches what I want my liver to do for the next 30, 35 years,” she says.
Today, Milton remains active by walking and hiking. After her transplant, she chose to have bariatric surgery and lost 175 pounds. Her cancer is in remission, but she goes for surveillance every six months. She has become a patient advocate for the Global Liver Institute and regularly speaks about liver disease and liver cancer at conferences and speaking events.
If you’re diagnosed with liver disease, Milton stresses the importance of not only taking care of your physical health, but also your mental health.
“During the years I was very ill, there were a couple of times I needed to reach out to my doctor and say, ‘Hey, I’m overwhelmed. I need help,’ and he would prescribe me some medication, and I would go to a therapist,” Milton says. “So it’s addressing your mental health as well as your physical health at the same time, because that’s so important to everything that you do.”
More education about fatty liver disease among the Hispanic community is vital for prevention, says Lizaola-Mayo. If you’ve been diagnosed, talk to your family members about getting screened, she says. Find tools and support groups that can help educate you and your family about the disease. Mayo Clinic in Houston, for example, hosts a fatty liver nutrition class to help patients understand the healthiest ways to eat.
“Learning how to eat and learning how to read the labels is very important,” she says. “Helping our Hispanic patients that have food insecurity, creating healthy sources of food for our patients is very important because weight loss starts with nutrition.”
