TLDR: Keto avoids liver disease

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<0.001), MASH-and-beyond (4.2 vs. 10.7; HR=0.38, p<0.001), advanced liver disease (2.8 vs. 8.7; HR=0.33, p<0.001), and any liver complications (2.0 vs. 7.7; HR=0.25, 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 1000 person-years; HR=0.66, 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.

Full Paper - https://doi.org/10.1097/HEP.0000000000001713