A Behaviorally-Based Tailored Disease Management Intervention to Prevent Liver Cancer in Patients with Risk Factors for Liver Disease

Inclusion Criteria

• 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: * Overweight or obese (body mass index [BMI] >= 23 in Asians or BMI >= 25 in other racial groups) OR * Presence of type II diabetes mellitus, OR * Lean/normal weight with presence of at least two metabolic risk abnormalities, OR ** Waist circumference >= 90/80cm in Asians or >= 102/88 cm in other racial groups) ** Blood pressure >= 130/85 mmHG or specific drug treatment ** Plasma triglycerides >= 150 mg/dl or specific drug treatment ** Plasma high-density lipoprotein (HDL)-cholesterol < 40 mg/dl for men and < 50 mg/dl for women or specific drug treatment ** Prediabetes (fasting glucose levels 100-125 mg/dl or HbA1c 5.7%-6.4%) * Alcohol Use Disorders Identification Test-Concise (AUDIT-C) >= 4 for men and >= 3 for women AND AUDIT-10 = 8-15
• Evidence of liver fibrosis (liver fibrosis serum biomarker [FIB-4] index >= 1.6 or liver fibrosis grade >= F2 by vibration controlled transient elastography) and presence of one of the following: * Chronic hepatitis B virus (HBV) (hepatitis B antigen positive [HBsAg+] or taking anti-HBV therapy), or * Chronic hepatitis C virus (HCV) (detectable HCV ribonucleic acid [RNA] > 4 months or a history of HCV infection and taking anti-HCV therapy)
• At least 18 years old
• Speak and read English or Spanish
• Access to smartphone with data plan or Wi-Fi access
• Willing to receive up to 12 text messages per week

Exclusion Criteria

• Pregnant or planning to become pregnant in next 12 months (by self-report)
• Medical contraindications to home-based exercise or low-fat, high-vegetable-and-fruit diet
• Recent or planned surgery that would interfere with home-based exercise or a low-fat, high vegetable and fruit diet
• Current or prior history of primary liver cancer or cancer that is metastatic to the liver
• AUDIT-10 score > 15
• Family or household member already enrolled into study