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

Inclusion Criteria:

1. Diagnosed with MASLD (defined per guideline based diagnostic criteria: evidence ofsteatosis with at least 1 metabolic syndrome feature)

2. Self-reported Mexican or Central American ethnicity

3. Age between 18 and 70 years

4. BMI≥25kg/m2

5. Able to read and write English and/or Spanish

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 bynon-hepatic causes. INR >1.4 unless due to therapeutic anticoagulants or laboratoryerror. Total bilirubin ≥2 mg/dL (unless explained by Gilbert Syndrome). Presence ofesophageal 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 chronicliver 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 diabetestreatment (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 tostudy entry with stable weight (defined as <5% weight loss in the 12 weeks prior tostudy 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 haveclearly been cured, stable and being monitored by primary doctor or oncologistwithout active treatment, or carries an excellent prognosis (e.g., Stage 1 cervicalcancer)

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 clinicno-shows in the past year)