%0 Journal Article
%@ 2561-326X
%I JMIR Publications
%V 9
%N 
%P e60051
%T A Very Low–Carbohydrate Program in Adults With Metabolic Dysfunction–Associated Steatotic Liver Disease and Phospholipase Domain–Containing Protein 3 Risk Genotype: Pre-Post Intervention Study
%A Saslow,Laura R
%A Krinock,Jamie
%A O'Brien,Alison
%A Raymond,Kaitlyn
%A Bayandorian,Hovig
%A Moskowitz,Judith T
%A Daubenmier,Jennifer
%A Oliveri,Antonino
%A Marriott,Deanna J
%A Griauzde,Dina H
%A Speliotes,Elizabeth K
%K metabolic dysfunction–associated steatotic liver disease
%K ketogenic diet
%K low carbohydrate
%K adult
%K genotype
%K insulin
%K insulin resistance
%K metabolic dysfunction
%K dietary pattern
%K type 2 diabetes
%K T2DM
%K single-arm pilot trial
%K liver function test
%K genome
%K non-alcoholic fatty liver disease
%D 2025
%7 10.1.2025
%9 
%J JMIR Form Res
%G English
%X Background: Insulin resistance and the G allele of rs738409 interact to create a greater risk of metabolic dysfunction–associated steatotic liver disease. Objective: This study aims to confirm that one promising way to reduce insulin resistance is by following a very low–carbohydrate (VLC) dietary pattern. Methods: Adults with rs738409-GG or -CG with liver steatosis and elevated liver function tests, were taught an ad libitum VLC diet, positive affect and mindful eating skills, goal setting, and self-monitoring and given feedback and coaching for 4 months. We measured liver steatosis, anthropometric, serum metabolic diet adherence, and quality of life measures. Results: In this small pilot trial, of the 11 participants enrolled, 9 (82%) participants completed outcomes. All 11 participants viewed at least 1 session of the intervention, and 8 (73%) participants viewed at least half of the sessions. Among the 9 participants who provided 4-month self-report information, intervention satisfaction was high (mean 6.22, 95% CI 5.58-6.85), with 5 (56%) participants rating the intervention the top score, and 4 (44%) participants reporting they did not plan to stop following the VLC diet. Across participants with a 4-month hepatic liver fat percent measurement, the percent change in liver fat was −33.17% (95% CI −86.48 to 20.14), and in only the participants who were adherent to the eating pattern, the percent change in liver fat was −53.12% (95% CI −71.25 to −34.99). Amongst participants with a 4-month hepatic liver fat percent measurement, 6 out of 8 (75%) participants were considered responders, with a relative decline in liver fat ≥30%, and of the 9 participants with a 4-month body weight, 9 (100%) participants lost ≥5% of their body weight. There were no serious adverse events. Conclusions: Results suggest the feasibility, acceptability, and preliminary efficacy of the VLC intervention in adults with higher genetic risk for metabolic dysfunction–associated steatotic liver disease, although there is a need for further studies given the small sample size and the high risk of substantial biases in this small pilot study. 
%R 10.2196/60051
%U https://formative.jmir.org/2025/1/e60051
%U https://doi.org/10.2196/60051