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Nutrition Intervention Combined With Resmetirom for MASH (NOURISH-MASH)

2 de julho de 2026 atualizado por: Jeffrey V. Lazarus, City University of New York

Assessing Nutrition-aligned Resmetirom Roll-out

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.

Visão geral do estudo

Status

Ainda não está recrutando

Condições

Intervenção / Tratamento

Descrição detalhada

On March 14, 2024, resmetirom, a selective thyroid hormone receptor-β agonist, became the first pharmacological therapy approved by the US Food and Drug Administration (FDA) for treating metabolic dysfunction-associated steatohepatitis (MASH). Although, lifestyle modification remains first-line MASH treatment the provision of resmetirom is rarely accompanied by structured non-pharmacological interventions, and evidence guiding the integration of nutrition-based strategies with pharmacotherapy is limited. This study aims to evaluate the effectiveness of a nutrition-based intervention, including medically tailored meal (MTM) and nutrition education provision combined with resmetirom therapy, compared with resmetirom therapy combined with standard-of-care lifestyle recommendations, in improving liver function.

This multi-site, prospective, randomised controlled trial will enroll 120 adults (18-75 years) with non-cirrhotic MASH and fibrosis stages F2-F3. Recruited participants will undergo baseline assessments including evaluation of medical history and lifestyle behaviors, completion of a food frequency questionnaire, blood pressure measurement, blood sampling, anthropometric measurements (weight, height, and waist and hip circumference), and assessment of liver steatosis and fibrosis using imaging methods. Upon completion of baseline evaluations, participants will be randomised 1:1 to receive either: (1) resmetirom plus standard-of-care lifestyle education (control); or (2) resmetirom plus a structured nutritional intervention consisting of MTM delivery and lifestyle education (intervention).

The primary endpoints are changes in liver steatosis and fibrosis at 12 months, assessed by imaging methods. Secondary endpoints include changes in blood-circulating lipids, alanine aminotransferase levels, metabolic parameters, anthropometrics, dietary quality, and lifestyle behaviours. Analyses will follow an intention-to-treat approach using regression models adjusted for relevant covariates.

Adherence assessments will be conducted at 3, 6, and 9 months, with outcome evaluations at 6 months and at the end of the study (12 months).

Tipo de estudo

Intervencional

Inscrição (Estimado)

120

Estágio

  • Fase 4

Contactos e Locais

Esta seção fornece os detalhes de contato para aqueles que conduzem o estudo e informações sobre onde este estudo está sendo realizado.

Contato de estudo

Locais de estudo

    • New York
      • New York, New York, Estados Unidos, 10027
        • CUNY Graduate School of Public Health and Health Policy
        • Contato:

Critérios de participação

Os pesquisadores procuram pessoas que se encaixem em uma determinada descrição, chamada de critérios de elegibilidade. Alguns exemplos desses critérios são a condição geral de saúde de uma pessoa ou tratamentos anteriores.

Critérios de elegibilidade

Idades elegíveis para estudo

  • Adulto
  • Adulto mais velho

Aceita Voluntários Saudáveis

Não

Descrição

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

Plano de estudo

Esta seção fornece detalhes do plano de estudo, incluindo como o estudo é projetado e o que o estudo está medindo.

Como o estudo é projetado?

Detalhes do projeto

  • Finalidade Principal: Tratamento
  • Alocação: Randomizado
  • Modelo Intervencional: Atribuição Paralela
  • Mascaramento: Nenhum (rótulo aberto)

Armas e Intervenções

Grupo de Participantes / Braço
Intervenção / Tratamento
Experimental: Resmetirom plus medically tailored meals and lifestyle education
Participants receive resmetirom once daily by weight-based dosing (80 mg if <100 kg; 100 mg if ≥100 kg) plus 10 medically tailored meals per week based on Mediterranean-diet principles, along with online nutrition and physical activity education at baseline and follow-up.

All participants involved in the study will receive treatment according to resemetirom protocol:

For patients weighing:

  • <100 kg, the recommended dosage is 80 mg orally, once daily
  • ≥100 kg, the recommended dosage is 100 mg orally, once daily

The nutritional intervention will consist of two components:

  1. Medically tailored meals (MTMs): Participants will receive 10 MTMs per week delivered by God's Love We Deliver in New York City. Meals will follow Mediterranean diet principles (40% carbohydrate, 35-45% fat, 15-25% protein), be delivered frozen with preparation and safety instructions, and meal preferences will be collected in advance. Participants will be encouraged to eat two meals per weekday and source any additional food independently.
  2. Nutritional and physical activity educational support: Online educational materials will be provided at baseline and follow-up visits, covering healthy eating, Mediterranean-diet principles, and exercise recommendations.
Comparador Ativo: Resmetirom plus standard-of-care lifestyle education
Participants receive the same resmetirom protocol once daily by weight-based dosing (80 mg if <100 kg; 100 mg if ≥100 kg), plus healthy diet and physical activity handouts and the option of a telehealth consultation with a dietitian.

All participants involved in the study will receive treatment according to resemetirom protocol:

For patients weighing:

  • <100 kg, the recommended dosage is 80 mg orally, once daily
  • ≥100 kg, the recommended dosage is 100 mg orally, once daily
Participants will receive standard-of-care lifestyle recommendations, including handouts on healthy diet and physical activity, and the option of a telehealth consultation with a dietitian.

O que o estudo está medindo?

Medidas de resultados primários

Medida de resultado
Descrição da medida
Prazo
MRI-PDFF change
Prazo: Baseline and 12 months
Magnetic resonance imaging derived proton-density-fat-fraction (MRI-PDFF) will be used to evaluate liver steatosis. Absolute change in MRI-PDFF (%) between the two groups at month 12, as an indicator for steatosis change
Baseline and 12 months
MRE change
Prazo: Baseline and 12 months
Magnetic resonance elastography (MRE) will be used to evaluate liver fibrosis. Absolute change in MRE (kPa) between the two groups at month 12
Baseline and 12 months

Medidas de resultados secundários

Medida de resultado
Descrição da medida
Prazo
Controlled attenuation parameter (CAP) change
Prazo: Baseline, 6 months and 12 months
The CAP will be used to assess liver steatotis. Absolute change in CAP (dB/m) between the two groups at month 12
Baseline, 6 months and 12 months
Vibration-controlled transient elastography (VCTE) responder
Prazo: Baseline, 6 months and 12 months
The VSTE will be used to assess liver fibrosis. The percentage of patients that achieve a ≥25% relative reduction at months 6 and 12, as compared with baseline VCTE (kPa)
Baseline, 6 months and 12 months
Plasma LDL-C responder
Prazo: Baseline, 6 months and 12 months
The percentage of patients with plasma LDL-C >100 mg/dL at baseline who are able to reduce it to <100 mg/dL at months 6 and 12
Baseline, 6 months and 12 months
Triglyceride responder
Prazo: Baseline, 6 and 12 months
The percentage of patients with triglycerides >150 mg/dL at baseline who are able to reduce it to <150 mg/dL at months 6 and 12
Baseline, 6 and 12 months
Apolipoprotein B change
Prazo: Baseline, 6 and 12 months
Change (%) from baseline in directly measured apolipoprotein B at months 6 and 12
Baseline, 6 and 12 months
Lp(α) change
Prazo: Baseline, 6 and 12 months
Change (%) from baseline in directly measured Lp(α) in patients with baseline Lp(α) >10 nmol/L at months 6 and 12
Baseline, 6 and 12 months
ALT responder
Prazo: Baseline, 6 and 12 months
The percentage of patients with ALT >30 IU/L at baseline with a >20% and/or 17 IU/L reduction at months 6 and 12
Baseline, 6 and 12 months

Outras medidas de resultado

Medida de resultado
Descrição da medida
Prazo
Weight reduction
Prazo: Baseline, 6 months and 12 months
The percentage of patients that achieve a ≥5% relative reduction in weight (Kg) at months 6 and 12, as compared with baseline weight (Kg)
Baseline, 6 months and 12 months
Waist to hip ratio
Prazo: Baseline, 6 months and 12 months
The waist-to-hip ratio will be calculated by dividing the waist circumference (cm) by the hip circumference (cm). Waist circumference will be measured at the narrowest part of the waist (or midway between the lowest rib and the top of the hip bone), and hip circumference will be measured at the widest part of the buttocks. A higher waist-to-hip ratio indicates a greater proportion of abdominal fat relative to hip circumference.
Baseline, 6 months and 12 months
BMI
Prazo: Baseline, 6 and 12 months
Body mass index (BMI) will be calculated by dividing a person's weight in kilograms by the square of their height in meters (weight [kg] ÷ height [m²]). BMI is commonly used as a screening measure to classify body weight relative to height and to identify categories such as underweight, normal weight, overweight, and obesity.
Baseline, 6 and 12 months
Medication adherence
Prazo: 3 months, 6 months, 9 months and 12 months
At each study visit, participants will bring any remaining resmetirom pills. Study staff will count the pills and compare this to the number dispensed. Adherence is defined as taking at least 80% of dispensed medication.
3 months, 6 months, 9 months and 12 months
Medication adherence blood biomarker
Prazo: 3 months, 6 months, 9 months and 12 months
Serum sex hormone-binding globulin (SHBG) concentrations will be measured using a standardized immunoassay and reported in nanomoles per liter (nmol/L). SHBG is a glycoprotein produced primarily by the liver and is regulated, in part, by thyroid hormone receptor beta (THR-β) signaling. As SHBG is a downstream target of THR-β agonism, increases in SHBG levels have been observed following treatment with the THR-β agonist resmetirom and may serve as a pharmacodynamic marker of hepatic drug exposure. Therefore, SHBG levels will be assessed as an indirect measure of treatment adherence and biological response to resmetirom therapy.
3 months, 6 months, 9 months and 12 months
Dietary intake
Prazo: Baseline, 6 months and 12 months
Will be measured using a Food Frequency Questionnaire (FFQ)
Baseline, 6 months and 12 months
Physical activity
Prazo: Baseline, 6 and 12 months
Will be evaluated using the International Physical Activity Questionnaire
Baseline, 6 and 12 months
Sleeping habits
Prazo: Baseline, 6 months and 12 months
Will be assessed using the single-item sleep quality scale questionnaire
Baseline, 6 months and 12 months
Smoking habits
Prazo: Baseline, 6 months and 12 months
Will be assessed by pack years calculation. Pack-years will be calculated by dividing the average number of cigarettes smoked per day by 20 (the number of cigarettes in a standard pack) and multiplying the result by the total number of years the person has smoked.
Baseline, 6 months and 12 months
Alcohol consumption
Prazo: Baseline, 6 months and 12 months
will be evaluated using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questionnaire
Baseline, 6 months and 12 months
Alcohol consumption blood biomarker
Prazo: Baseline, 6 months and 12 months
Will be assessed using the Phosphatidylethanol (PEth) test
Baseline, 6 months and 12 months
Binge eating disorder
Prazo: Baseline, 6 months and 12 months
Will be assessed using the validated Being Eating Disorder Screener-7 (BEDS-7) questionnaire
Baseline, 6 months and 12 months
Liver enzymes
Prazo: Baseline, 6 and 12 months
Liver enzymes will be measured using automated enzymatic assays and will include alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), and alkaline phosphatase (ALP). Results will be reported in units per liter (U/L).
Baseline, 6 and 12 months
Fasting plasma glucose
Prazo: Baseline, 6 and 12 months
Fasting plasma glucose will be measured using an enzymatic assay and reported in milligrams per deciliter (mg/dL)
Baseline, 6 and 12 months
Fasting insulin
Prazo: Baseline, 6 and 12 months
Fasting insulin concentrations will be measured using a standardized immunoassay and reported in micro-international units per milliliter (μIU/mL).
Baseline, 6 and 12 months
Insulin resistance
Prazo: Baseline, 6 and 12 months

Insulin resistance will be assessed using the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR). HOMA-IR will be calculated from fasting plasma glucose and fasting insulin concentrations using the following formula:

HOMA-IR = [fasting insulin (μIU/mL) × fasting glucose (mg/dL)] ÷ 405 Higher HOMA-IR values indicate greater insulin resistance. There is no universally accepted cutoff for insulin resistance, as values vary according to age, sex, ethnicity, and study population. In adults, HOMA-IR values above approximately 2.0-2.5 are often considered suggestive of insulin resistance, while values above 3.0 are generally considered indicative of significant insulin resistance.

HOMA-IR will also be analyzed as a continuous variable or categorized according to population-specific upper quartile

Baseline, 6 and 12 months
Hemoglobin A1c
Prazo: Baseline, 6 and 12 months
Hemoglobin A1c (HbA1c) will be measured using a standardized assay certified according to international guidelines and reported as a percentage (%)
Baseline, 6 and 12 months
Estimated glomerular filtration rate (eGFR)
Prazo: Baseline, 6 and 12 months

Estimated glomerular filtration rate (eGFR) is a widely used measure of the kidneys' ability to filter blood. The eGFR will be calculated from serum creatinine concentrations using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, which incorporates age and sex. Results will be reported in milliliters per minute per 1.73 square meters of body surface area (mL/min/1.73 m²).

Higher eGFR values indicate better kidney function, whereas lower values indicate impaired kidney function. An eGFR of 90 mL/min/1.73 m² or higher is generally considered normal, provided there is no other evidence of kidney damage. Values between 60 and 89 mL/min/1.73 m² may reflect mildly reduced kidney function, while an eGFR below 60 mL/min/1.73 m² persisting for at least three months is commonly used as a criterion for chronic kidney disease (CKD). An eGFR below 30 mL/min/1.73 m² indicates severe kidney impairment.

Baseline, 6 and 12 months
Complete blood count
Prazo: Baseline, 6 and 12 months

A complete blood count (CBC) will be performed using an automated hematology analyzer. Parameters will include:

Hemoglobin (g/dL) White blood cell count (×10⁹/L) Platelet count (×10⁹/L) Red blood cell count (×10¹²/L) Hematocrit (%) Mean corpuscular volume (MCV; fL) Mean corpuscular hemoglobin (MCH; pg) Mean corpuscular hemoglobin concentration (MCHC; g/dL) Red cell distribution width (RDW; %)

Baseline, 6 and 12 months
Blood pressure measurements
Prazo: Baseline, 6 and 12 months
Blood pressure will be measured using a validated automated sphygmomanometer according to standard clinical procedures. Participants will be seated comfortably with their back supported and feet flat on the floor for at least 5 minutes before the measurement. Blood pressure will be measured in the upper arm using an appropriately sized cuff. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) will be recorded in millimeters of mercury (mmHg). Blood pressure values will be analyzed as continuous variables, and participants may also be categorized according to established hypertension guidelines.
Baseline, 6 and 12 months
Serum free thyroxine (FT4) concentrations
Prazo: Baseline, 6 and 12 months
Serum free thyroxine (FT4) concentrations will be measured using a standardized immunoassay. FT4 is the biologically active fraction of thyroxine and is commonly used to assess thyroid function and monitor the safety of therapies that may affect the thyroid gland. Results will be reported in nanograms per deciliter (ng/dL). Changes in FT4 concentrations from baseline to follow-up will be evaluated, and the percentage change will be analyzed as a continuous variable to assess the safety of the intervention.
Baseline, 6 and 12 months

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Datas de registro do estudo

Essas datas acompanham o progresso do registro do estudo e os envios de resumo dos resultados para ClinicalTrials.gov. Os registros do estudo e os resultados relatados são revisados ​​pela National Library of Medicine (NLM) para garantir que atendam aos padrões específicos de controle de qualidade antes de serem publicados no site público.

Datas Principais do Estudo

Início do estudo (Estimado)

1 de outubro de 2026

Conclusão Primária (Estimado)

28 de fevereiro de 2028

Conclusão do estudo (Estimado)

30 de junho de 2028

Datas de inscrição no estudo

Enviado pela primeira vez

18 de junho de 2026

Enviado pela primeira vez que atendeu aos critérios de CQ

25 de junho de 2026

Primeira postagem (Real)

2 de julho de 2026

Atualizações de registro de estudo

Última Atualização Postada (Real)

6 de julho de 2026

Última atualização enviada que atendeu aos critérios de controle de qualidade

2 de julho de 2026

Última verificação

1 de julho de 2026

Mais Informações

Termos relacionados a este estudo

Outros números de identificação do estudo

  • GR-00013739

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