Vilar-Gomez, EduardoAthinarayanan, Shaminie J.Adams, Rebecca N.Hallberg, Sarah J.Bhanpuri, Nasir H.McKenzie, Amy L.Campbell, Wayne W.McCarter, James P.Phinney, Stephen D.Volek, Jeff S.Chalasani, Naga2019-08-212019-08-212019-02-25Vilar-Gomez, E., Athinarayanan, S. J., Adams, R. N., Hallberg, S. J., Bhanpuri, N. H., McKenzie, A. L., … Chalasani, N. (2019). Post hoc analyses of surrogate markers of non-alcoholic fatty liver disease (NAFLD) and liver fibrosis in patients with type 2 diabetes in a digitally supported continuous care intervention: an open-label, non-randomised controlled study. BMJ open, 9(2), e023597. doi:10.1136/bmjopen-2018-023597https://hdl.handle.net/1805/20480OBJECTIVE: One year of comprehensive continuous care intervention (CCI) through nutritional ketosis improves glycosylated haemoglobin(HbA1c), body weight and liver enzymes among patients with type 2 diabetes (T2D). Here, we report the effect of the CCI on surrogate scores of non-alcoholic fatty liver disease (NAFLD) and liver fibrosis. METHODS: This was a non-randomised longitudinal study, including adults with T2D who were self-enrolled to the CCI (n=262) or to receive usual care (UC, n=87) during 1 year. An NAFLD liver fat score (N-LFS) >-0.640 defined the presence of fatty liver. An NAFLD fibrosis score (NFS) of >0.675 identified subjects with advanced fibrosis. Changes in N-LFS and NFS at 1 year were the main endpoints. RESULTS: At baseline, NAFLD was present in 95% of patients in the CCI and 90% of patients in the UC. At 1 year, weight loss of ≥5% was achieved in 79% of patients in the CCI versus 19% of patients in UC (p<0.001). N-LFS mean score was reduced in the CCI group (-1.95±0.22, p<0.001), whereas it was not changed in the UC (0.47±0.41, p=0.26) (CCI vs UC, p<0.001). NFS was reduced in the CCI group (-0.65±0.06, p<0.001) compared with UC (0.26±0.11, p=0.02) (p<0.001 between two groups). In the CCI group, the percentage of individuals with a low probability of advanced fibrosis increased from 18% at baseline to 33% at 1 year (p<0.001). CONCLUSIONS: One year of a digitally supported CCI significantly improved surrogates of NAFLD and advanced fibrosis in patients with T2D.en-USAttribution-NonCommercial 3.0 United StatesKetogenic dietLiver fibrosisNon-alcoholic fatty liver diseaseType 2 diabetesVery low carb dietWeight lossArticle