Effectiveness of digital health-supported lifestyle modification in patients with non-alcoholic fatty liver disease: A systematic review and meta-analysis (Preprint)

BACKGROUND Lifestyle modification is a key intervention in patients with non-alcoholic fatty liver disease (NAFLD). Digital health technologies have emerged as potential tools to support lifestyle modification; however, current evidence regarding this topic is limited. OBJECTIVE This systematic review and meta-analysis aimed to investigate the effectiveness of digital health-supported lifestyle changes in patients with NAFLD. METHODS Relevant studies were selected from MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials until April 5th, 2023, using the search terms NAFLD and digital health. The primary outcome included change in body weight. Secondary outcomes included changes in alanine aminotransferase (ALT) and aspartate aminotransferase (AST), and attrition rate, the proportion of participants who dropped out of the study before completion. Subgroup analyses of digital health modalities were performed, and the data were pooled using the random effect method. RESULTS Nine studies (967 patients with NAFLD) were analyzed, including eight randomized controlled trials and one prospective study. Digital health-supported lifestyle modification resulted in a greater mean reduction in body weight (weighted mean difference [WMD]: −3.54 kg) and greater reductions in ALT and AST (WMD of ALT: −11.92 U/L and WMD of AST: −6.33 U/L) compared to conventional treatment. The attrition rate was not significantly different between the two groups. Telephone- and mobile phone-based interventions were effective in reducing boDigital health-supported lifestyle modification was effective in lowering body weight and improving laboratory findings in patients with NAFLD. The acceptable attrition rate suggests that patients with NAFLD may benefit from digital health technology.dy weight, and mobile phone-based interventions particularly showed greater reductions in AST levels. CONCLUSIONS Digital health-supported lifestyle modification was effective in lowering body weight and improving laboratory findings in patients with NAFLD. The acceptable attrition rate suggests that patients with NAFLD may benefit from digital health technology.