A multidisciplinary nutritional-behavioral intervention improves weight loss and liver-related outcomes in patients with metabolic dysfunction-associated steatotic liver disease: A randomized controlled trial.
Marcello Dallio, Mario Romeo, Fiammetta Di Nardo et al.
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In 30 seconds
This randomized controlled trial evaluated a multidisciplinary hepatology, individualized nutrition, and cognitive behavioral support programme (Co-Co-Nut) in patients with metabolic dysfunction-associated steatotic liver disease (MASLD), compared with standard-care approaches. Across follow-up assessments through 18 months, the intervention increased the proportion achieving at least 10% weight loss and improved body composition, metabolic measures, liver stiffness, and steatosis measures; these improvements were not observed with standard care. The intervention group also had a lower risk of acute cardiovascular events (HR 0.36, 95% CI 0.18-0.71) and less loss of adherence.
Key findings
- Co-Co-Nut increased the proportion of patients achieving ≥10% weight loss and improved body composition, metabolic profile, LSM, and CAP (all p < 0.0001).
- Loss of adherence was lower with the multidisciplinary intervention than with standard care (p < 0.0001).
- The intervention group had a lower risk of acute cardiovascular events (HR 0.36, 95% CI 0.18-0.71).
- Large family size (OR 1.87), limited time for meals (OR 1.91), and full-time employment (OR 1.61) were associated with loss of adherence (all p < 0.0001).
Why it matters
MASLD management depends substantially on sustained lifestyle change, yet adherence can be difficult. This trial suggests that combining individualized nutrition with behavioral and hepatology support may improve adherence and liver-related and metabolic measures, while also being associated with fewer acute cardiovascular events. The identified social factors highlight that practical circumstances can influence participation in lifestyle programmes.
What to keep in mind
The abstract reports medium-term follow-up through 18 months; longer-term durability is not established. The standard-care cohort was subsequently divided into two subgroups, so comparisons involved three study groups.