Reduced Onset of MASLD, MASH, and Advanced Liver Disease in patients who received Individualized Nutrition-Focused Remote Care for Adults with Type 2 Diabetes and Obesity

Background and Aims Metabolic dysfunction-associated steatotic liver disease (MASLD) and its progressive form, metabolic dysfunction-associated steatohepatitis (MASH), 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 = 5,031 per group). Using three complementary analytic approaches, incidence and time-to-event analyses were performed for new-onset liver disease. Across all strategies, VINT participants consistently showed lower incidence of: Any liver-related diagnosis (29.9 vs 44.9 per 1,000 person-years; HR = 0.64, p < 0.001), MASH and beyond (4.2 vs 10.7; HR = 0.38, p < 0.001), and Advanced liver disease (2.8 vs 9.0; HR = 0.30, p < 0.001). Among VINT participants, those who lost ≥15% body weight were at lower risk of new-onset liver disease (21.2 vs 31.8 per 1,000 person-years; HR = 0.66, p = 0.02) compared to those 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 scalable, lifestyle-first interventions to reduce the burden of liver disease in adults with T2D and obesity.