Liver Cancer Prevention Randomized Control Trial

Inclusion Criteria:

1. Evidence of steatosis (CAP score ≥ 290 by vibration controlled transient elastography) OR Evidence of liver fibrosis (FIB-4 index ≥ 1.6 or fibrosis grade ≥ F2 by vibration controlled transient elastography [F2 score ≥ 8kPa]) AND meets one of the following criteria: i. overweight or obese (BMI≥23 in Asians or BMI≥25 in other racial groups), OR ii. presence of type II diabetes mellitus, OR iii. lean/normal weight with presence of at least two metabolic risk abnormalities, OR:

2. Waist circumference ≥90/80 cm in Asians or ≥102/88 cm in other racial groups)

3. Blood pressure ≥130/85 mmHg or specific drug treatment

4. Plasma triglycerides ≥150 mg/dl or specific drug treatment

5. Plasma HDL-cholesterol <40 mg/dl for men and <50 mg/dl for women, or specific drugtreatment

6. Prediabetes (fasting glucose levels 100-125 mg/dl , or HbA1c 5.7-6.4% ) iv. AUDIT-C ≥4 for men and ≥3 for women AND AUDIT-10 = 8-15

AND/OR 2. Evidence of liver fibrosis (FIB-4 index ≥ 1.6 or fibrosis grade ≥ F2 by vibration controlled transient elastography) and presence of one of the following:

1. chronic HBV (HBsAg+ or taking anti-HBV therapy), or

2. chronic HCV (1. detectable HCV RNA > 4 months or a 2. history of HCV infection andtaking anti-HCV therapy)

3. At least 18 years old 4. Speak and read English or Spanish 5. Access tosmartphone with data plan or Wi-Fi access 6. Willing to receive up to 12 textmessages per week

Exclusion Criteria:

1. Pregnant or planning to become pregnant in next 12 months (by self-report)

2. Medical contraindications to home-based exercise or low-fat,high-vegetable-and-fruit diet

3. Recent or planned surgery that would interfere with home-based exercise or alow-fat, high vegetable and fruit diet

4. Current or prior history of primary liver cancer or cancer that is metastaticto the liver

5. AUDIT-10 score >15

6. Family or household member already enrolled into study