Abstract / Summary
Metabolic dysfunction-associated steatotic liver disease (MASLD) is a common chronic liver disease for which lifestyle modification remains a central component of management. However, real-world evidence regarding structured nurse-coordinated lifestyle management in outpatient MASLD care remains limited. This single-centre retrospective cohort study evaluated adults with MASLD whose care pathway was defined at baseline and who had an outcome assessment within the prespecified 9–15-month follow-up window. Baseline enrolment or referral defined the nurse-coordinated exposure, whereas attendance at at least two nurse-led follow-up encounters was used only to confirm participation fidelity; 1:1 propensity score matching yielded 152 matched pairs ( n = 304). The primary outcomes were 1-year changes in ALT and AST; secondary outcomes were change in FIB-4 and follow-up high-risk FIB-4 status, while anthropometric and metabolic outcomes were exploratory. Continuous outcomes were analysed using baseline-adjusted ANCOVA with robust standard errors clustered by matched pair. The matched cohort included 304 patients, with 152 in each care pathway. Nurse-coordinated care was associated with greater reductions in ALT (− 18.0 vs. − 7.0 U/L; adjusted difference − 11.0 U/L, 95% CI − 17.0 to − 5.0; P < 0.001) and AST (− 10.0 vs. − 3.0 U/L; adjusted difference − 7.0 U/L, 95% CI − 12.0 to − 1.0; P = 0.02). FIB-4 decreased by − 0.22 versus − 0.05 (adjusted difference − 0.17, 95% CI − 0.31 to − 0.03; P = 0.02), whereas high-risk FIB-4 at follow-up was 11.8% versus 17.1% (adjusted risk difference − 5.1%, 95% CI − 11.9% to 1.7%; P = 0.14). Exploratory analyses also showed greater reductions in weight (− 3.0 vs. − 1.3 kg; P = 0.003) and triglycerides (− 0.28 vs. − 0.10 mmol/L; P = 0.04). Baseline enrolment in a nurse-coordinated lifestyle management pathway was associated with greater 1-year reductions in liver enzymes and modest changes in FIB-4 and selected metabolic measures compared with usual care. These observational findings do not establish causality, and the reduction in FIB-4 should be interpreted as a change in fibrosis-risk score rather than evidence of fibrosis regression. Not applicable.