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). VINT participants 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 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 scalable, lifestyle-first interventions to reduce liver disease burden in adults with T2D and obesity.

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Plain Language Summary

People with type 2 diabetes and obesity are more likely to develop liver conditions such as metabolic dysfunction–associated steatotic liver disease (MASLD) and metabolic dysfunction– associated steatohepatitis (MASH), which can progress to liver failure or liver cancer. This study examined whether a nutrition-focused remote care program could help prevent these liver diseases. The Virta Individualized Nutrition Therapy (VINT) program uses telemedicine and personalized, carbohydrate-reduced nutrition to support long-term weight loss and metabolic health. Using health claims data, researchers compared more than 5,000 participants in the VINT program with matched individuals receiving usual care. Those in the VINT group had significantly fewer new cases of MASLD, MASH, and advanced liver disease. Participants who lost 15% or more of their body weight were especially protected. These findings suggest that individualized, nutrition-based remote care can help prevent liver disease in people with type 2 diabetes and obesity.