Real-World Outcomes of Virtual Medical Nutrition Therapy in Dyslipidemia, Hypertension, or Diabetes

Importance: Dyslipidemia, hypertension, and diabetes are highly prevalent conditions for which medical nutrition therapy (MNT) is guideline-recommended, yet access remains limited, and real-world evidence on technology-enabled MNT models at scale is sparse. Objective: To characterize lipid, blood pressure, and glycemic outcomes among adults receiving virtual MNT (vMNT) across three cardiometabolic conditions. Design: Retrospective cohort study of adults with a first Nourish appointment before November 2025, followed for 6 months. Setting: National vMNT platform. Participants: Adults meeting enrollment criteria for dyslipidemia, hypertension, or diabetes and remaining engaged in care with [&ge;]1 follow-up measurement at 3 or 6 months. Final cohorts: dyslipidemia (n=6,501), hypertension (n=13,704), diabetes (n=2,444); 18,965 unique patients overall. Exposure: vMNT delivered by a registered dietitian via telehealth visits, with technology-enabled support between visits. Main Outcomes and Measures: Outcomes were LDL cholesterol, total cholesterol, HDL cholesterol, and triglycerides (dyslipidemia); systolic and diastolic blood pressure (SBP, DBP) (hypertension); and HbA1c (diabetes), assessed at enrollment, 3, and 6 months. Weight was a secondary outcome. The proportion achieving guideline-recommended targets (HbA1c <7.0%, SBP <130 mmHg) was also assessed. Results: Among 18,965 patients (mean [SD] age, 42.9 [11.6] years; 15,770 [83.2%] female), significant changes from baseline to 6 months included: LDL cholesterol (-14.0 mg/dL [SE, 0.56]); total cholesterol (-19.4 mg/dL [SE, 0.61]); HDL cholesterol (-0.5 mg/dL [SE, 0.15]); triglycerides (-28.6 mg/dL [SE, 1.06]); SBP (-5.5 mmHg [SE, 0.16]); DBP (-4.5 mmHg [SE, 0.11]); and HbA1c (-1.37 percentage points [SE, 0.04]) (all P<.001). Among those with elevated SBP, 57.3% achieved <130 mmHg by 6 months; among those with elevated HbA1c, 54.7% achieved <7.0%. Outcomes among patients with stable medication regimens were similar to the full cohort. Conclusions and Relevance: In this study of 18,965 patients, vMNT delivered through a technology-enabled care model was associated with clinically meaningful improvement across three prevalent cardiometabolic conditions. These findings support technology-enabled virtual care as a scalable approach to delivering effective MNT.