Nutrition Intervention Combined With Resmetirom for MASH

This randomized control trial aims to evaluate the effectiveness of combining resmetirom therapy (first approved pharmacological therapy for treating metabolic dysfunction-associated steatohepatitis (MASH)) with a nutritional intervention compared to resmetirom therapy alone over one year in improving liver health among 120 patients living with non-cirrhotic MASH. We hypothesize that patients receiving resmetirom and nutritional intervention will experience more significant improvements in liver function than those receiving only resmetirom therapy.

Inclusion Criteria: * Provide informed consent * Be 18-75 years old * Have non-cirrhotic MASH with fibrosis stage F2-F3 (VCTE 8-20 kPa and CAP =280 dB/m) * Be initiating resmetirom per standard of care * Be able to comply with study procedures, including fasting visits * Reside in one of the five New York City boroughs Exclusion Criteria: * Have cirrhosis or decompensated liver disease * Have other chronic liver diseases * Are pregnant or breastfeeding * Consume alcohol above defined thresholds or have PEth =20 ng/mL * Have recent major surgery or hospitalization * Are on glucagon-like peptide-1 agonist therapy (e.g., exenatide, liraglutide, lixisenatide, albiglutide, dulaglutide, semaglutide and albiglutide), unless the dose is stable for 12 weeks prior to the baseline evaluation and they have not experienced a \>5% weight loss in the 6 months preceding resmetirom initiation. * Are undergoing bariatric surgery * Are living with any other end-stage organ disease (e.g., heart, lung or kidney failure requiring dialysis) or have any active malignancy in the last 5 years. * Have conditions preventing consumption of provided meals