Real-World Outcomes of Virtual Medical Nutrition Therapy in Dyslipidemia, Hypertension, or Diabetes
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Importance
Dyslipidemia, hypertension, and diabetes are highly prevalent conditions for which medical nutrition therapy (MNT) is guideline-recommended, yet access remains limited, and real-world evidence on technology-enabled MNT models at scale is sparse.
Objective
To characterize lipid, blood pressure, and glycemic outcomes among adults receiving virtual MNT (vMNT) across three cardiometabolic conditions.
Design
Retrospective cohort study of adults with a first Nourish appointment before November 2025, followed for 6 months.
Setting
National vMNT platform.
Participants
Adults meeting enrollment criteria for dyslipidemia, hypertension, or diabetes and remaining engaged in care with ≥1 follow-up measurement at 3 or 6 months. Final cohorts: dyslipidemia (n=6,501), hypertension (n=13,704), diabetes (n=2,444); 18,965 unique patients overall.
Exposure
vMNT delivered by a registered dietitian via telehealth visits, with technology-enabled support between visits.
Main Outcomes and Measures
Outcomes were LDL cholesterol, total cholesterol, HDL cholesterol, and triglycerides (dyslipidemia); systolic and diastolic blood pressure (SBP, DBP) (hypertension); and HbA1c (diabetes), assessed at enrollment, 3, and 6 months. Weight was a secondary outcome. The proportion achieving guideline-recommended targets (HbA1c <7.0%, SBP <130 mmHg) was also assessed.
Results
Among 18,965 patients (mean [SD] age, 42.9 [11.6] years; 15,770 [83.2%] female), significant changes from baseline to 6 months included: LDL cholesterol (−14.0 mg/dL [SE, 0.56]); total cholesterol (−19.4 mg/dL [SE, 0.61]); HDL cholesterol (−0.5 mg/dL [SE, 0.15]); triglycerides (−28.6 mg/dL [SE, 1.06]); SBP (−5.5 mmHg [SE, 0.16]); DBP (−4.5 mmHg [SE, 0.11]); and HbA1c (−1.37 percentage points [SE, 0.04]) (all P<.001). Among those with elevated SBP, 57.3% achieved <130 mmHg by 6 months; among those with elevated HbA1c, 54.7% achieved <7.0%. Outcomes among patients with stable medication regimens were similar to the full cohort.
Conclusions and Relevance
In this study of 18,965 patients, vMNT delivered through a technology-enabled care model was associated with clinically meaningful improvement across three prevalent cardiometabolic conditions. These findings support technology-enabled virtual care as a scalable approach to delivering effective MNT.
