Feasibility of the Paso Program for Patients With Metabolic Dysfunction Associated Steatotic Liver Disease

Exclusion Criteria

• •1. ≥5% weight loss over the prior 3 months
• •2. HbA1c ≥9.0% within 30 days of weight loss program initiation\*
• •3. History of bariatric surgery
• •4. Advanced liver disease, defined as:
• •platelet count \< 150,000, serum albumin \<3.5 g/dL, except as explained by non-hepatic causes. INR \>1.4 unless due to therapeutic anticoagulants or laboratory error. Total bilirubin ≥2 mg/dL (unless explained by Gilbert Syndrome). Presence of esophageal varices,
• •5. Any history of liver disease decompensations\*\* or hepatocellular carcinoma,
• •6. History of any organ transplant (including liver transplant)
• •7. Active HCV infection (defined as HCV Ab positive with detectable viral load)\*, Hepatitis B infection (defined as positive HBsAg) and/or other etiologies of chronic liver disease (AIH, PBC, Wilson disease, PSC) or acute hepatic injury.
• •8. Ongoing heavy alcohol use defined as 320-420grams/week
• •9. SGLT2 inhibitor or Glucagon-like peptide 1 (GLP-1) agonist therapy for diabetes treatment (e.g., exenatide, liraglutide, lixisenatide, albiglutide, dulaglutide, semaglutide, and albiglutide) or for weight loss (e.g., semaglutide at doses up to 2.4 mg subcutaneous weekly) must be at a stable dose for at least 6 months prior to study entry with stable weight (defined as \<5% weight loss in the 12 weeks prior to study entry)\*
• •10. Pioglitazone is allowed if on a stable dose for 3 months prior to study entry
• •11. current pregnancy/nursing or planned pregnancy
• •12. conditions limiting dietary calorie reduction or physical activity
• •13. Active cancer, except for example non-melanoma skin cancers or cancers that have clearly been cured, stable and being monitored by primary doctor or oncologist without active treatment, or carries an excellent prognosis (e.g., Stage 1 cervical cancer)
• •14. unstable cardiac disease
• •15. intestinal resection or malabsorption disorders
• •16. life expectancy\<2 years
• •17. competing serious medical or psychiatric comorbidity
• •18. HIV infection
• •19. History of noncompliance (\>3 primary care, endocrine, and/or hepatology clinic no-shows in the past year)