Reduced risk of liver-related events among patients receiving individualized nutrition-focused remote care in the United States

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Abstract
Background and Aims: Metabolic dysfunction–associated steatotic liver disease (MASLD) and its progressive form, metabolic dysfunction–associated steatohepatitis (MASH), can lead to significant morbidity and mortality in adults with type 2 diabetes (T2D) and obesity. This study evaluated whether participation in an individualized, nutrition-focused telemedicine care model emphasizing carbohydrate reduction (Virta Individualized Nutrition Therapy, VINT) was associated with reduced onset of MASLD, MASH, and advanced liver disease. Approach and Results: Adults with T2D, prediabetes, overweight,or obesity who enrolled in VINT (2015–2024) were identified in the Komodo Healthcare Map and matched 1:1 to usual care (UC) controls (n=5031 per group). Using 3 complementary analytic approaches, incidence and time-to-event analyses were performed for new-onset liver disease. Across all strategies, VINT participants consistently showed a lower incidence of any liver-related diagnosis (27.3 vs. 42.8 per 1000 person-years; HR=0.61, p p p p p =0.02) compared with VINT participants who lost less weight. Conclusions: Participation in individualized nutrition-focused telemedicine care was associated with significantly lower incidence and risk of new-onset MASLD, MASH, and advanced liver disease. These findings support lifestyle-first interventions that are potentially scalable to reduce liver disease burden in adults with T2D and obesity.

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