Lifestyle Intervention Enabled by Mobile Technology on Weight Loss in Patients With Nonalcoholic Fatty Liver Disease: Randomized Controlled Trial

Lim, Su Lin; Johal, Jolyn; Ong, Kai Wen; Han, Chad Yixian; Chan, Yiong Huak; Lee, Yin Mei; Loo, Wai Mun

doi:10.2196/14802

Cited by 55 publications

(99 citation statements)

References 47 publications

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“…Six trials were conducted in middle-income countries, 29,30,31,32,33,34 and the remaining trials were in high-income countries. 27,35,36,37,38,39,40,41,42,43,44,45,46,47,48 The location was unclear for 1 study. 28 Sixteen studies recruited participants with any stage of NAFLD, 27,29,30,31,32,33,34,36,37,39,40,42,43,46,47,48 and 6 recruited only participants with NASH.…”

Section: Resultsmentioning

confidence: 99%

“…27,35,36,37,38,39,40,41,42,43,44,45,46,47,48 The location was unclear for 1 study. 28 Sixteen studies recruited participants with any stage of NAFLD, 27,29,30,31,32,33,34,36,37,39,40,42,43,46,47,48 and 6 recruited only participants with NASH. 28,35,38,41,44,45 Seven studies recruited participants regardless of BMI, 31,32,33,40,46,47,48 whereas 15 of 22 recruited only people above a minimum BMI (median cutoff, 25).…”

Section: Resultsmentioning

confidence: 99%

“…Six studies tested BWLPs against usual care, 29,31,32,35,36,37 9 tested BWLPs against a lower-intensity BWLP, 27,29,33,34,39,40,42,45,46,47 2 tested pharmacotherapy against placebo, 28,38 1 tested pharmacotherapy against a BWLP, 43 3 tested pharmacotherapy with a BWLP against either a BWLP or placebo, 30,41,48 and 1 tested a surgical procedure with a BWLP against a BWLP. 44 The Table presents the key characteristics of the included studies with additional detail provided in eTables 1 and 2 in the Supplement.…”

Section: Resultsmentioning

confidence: 99%

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Association of Weight Loss Interventions With Changes in Biomarkers of Nonalcoholic Fatty Liver Disease

et al. 2019

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IMPORTANCE Nonalcoholic fatty liver disease (NAFLD) affects about 25% of adults worldwide and is associated with obesity. Weight loss may improve biomarkers of liver disease, but its implications have not been systematically reviewed and quantified. OBJECTIVE To estimate the association of weight loss interventions with biomarkers of liver disease in NAFLD. DATA SOURCES MEDLINE, Embase, PsycINFO, CINAHL, Cochrane, and Web of Science databases along with 3 trial registries were searched from inception through January 2019. STUDY SELECTION Randomized clinical trials of people with NAFLD were included if they compared any intervention aiming to reduce weight (behavioral weight loss programs [BWLPs], pharmacotherapy, and surgical procedures) with no or lower-intensity weight loss intervention. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. DATA EXTRACTION AND SYNTHESIS Two independent reviewers screened the studies, extracted the data, and assessed the risk of bias using the Cochrane tool. Pooled mean differences or odds ratios (ORs) were obtained from random-effects meta-analyses. MAIN OUTCOMES AND MEASURES Blood, radiologic, and histologic biomarkers of liver disease. RESULTS Twenty-two studies with 2588 participants (with a mean [SD] age of 45 [14] years and with approximately 66% male) were included. Fifteen studies tested BWLPs, 6 tested pharmacotherapy, and 1 tested a surgical procedure. The median (interquartile range) intervention duration was 6 (3-8) months. Compared with no or lower-intensity weight loss interventions, more-intensive weight loss interventions were statistically significantly associated with greater weight change (-3.61 kg; 95% CI,-5.11 to-2.12; I 2 = 95%). Weight loss interventions were statistically significantly associated with improvements in biomarkers, including alanine aminotransferase (-9.81 U/L; 95% CI,-13.12 to-6.50; I 2 = 97%), histologically or radiologically measured liver steatosis (standardized mean difference:-1.48; 95% CI,-2.27 to-0.70; I 2 = 94%), histologic NAFLD activity score (-0.92; 95% CI,-1.75 to-0.09; I 2 = 95%), and presence of nonalcoholic steatohepatitis (OR, 0.14; 95% CI, 0.04-0.49; I 2 = 0%). No statistically significant change in histologic liver fibrosis was found (-0.13; 95% CI,-0.54 to 0.27; I 2 = 68%). Twelve studies were at high risk of bias in at least 1 domain. In a sensitivity analysis of the 3 trials at low risk of bias, the estimates and precision of most outcomes did not materially change. CONCLUSIONS AND RELEVANCE The trials, despite some heterogeneity, consistently showed evidence of the association between weight loss interventions and improved biomarkers of liver disease in NAFLD in the short to medium term, although evidence on long-term health outcomes was limited. These findings appear to support the need to change the clinical guidelines and to recommend formal weight loss programs for people with NAFLD.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Association of Weight Loss Interventions With Changes in Biomarkers of Nonalcoholic Fatty Liver Disease

et al. 2019

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“… 45 More recently, outcomes from a 6-month RCT using a mobile application to achieve weight loss reported that patients with NAFLD who used the mobile application had a fivefold higher likelihood of achieving ≥5% weight loss compared with the control group. 46 These positive results support a call for large-scale studies of digital health and exercise prescription in patients with risk factors for cardiometabolic disease such as NAFLD.…”

Section: The Future Of Exercise and Pa In Nafldmentioning

confidence: 76%

Exercising in the COVID-19 era: implications in non-alcoholic fatty liver disease (NAFLD)

O’Gorman

Norris

2021

BMJ Open Gastroenterol

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COVID-19 is a major public health pandemic. Risk factors for severe infection and poorer outcomes include cardiovascular disease, obesity, type 2 diabetes mellitus and non-alcoholic fatty liver disease (NAFLD). Lifestyle interventions, including diet and physical activity modifications, are the current recommended treatment for NAFLD. In this communication, the authors discuss the crossover link between NAFLD and severe COVID-19 infection and the impact of essential public health measures to suppress the spread of COVID-19 on exercise and physical activity participation in patients with NAFLD. The future of exercise prescription and the potential use of digital technology in addressing NAFLD healthcare needs in the COVID-19 era are also explored.

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“…The app also offers support from local dietitians familiar with cultural practices and festivities of local ethnic groups, who are able to consider culturally specific notions of stigma and provide recommendations in line with the cultural norms of users. In a 2020 RCT, 32 the app was found to significantly reduce body weight among patients with nonalcoholic fatty liver disease. In this trial, the Diabetes Lifestyle Intervention using Technology Empowerment (D’LITE) study, we compared the effectiveness of a weight loss lifestyle intervention delivered using the app via in-app coaching by dietitians with usual care, focusing on body weight change and metabolic profiles among Asian patients with type 2 diabetes and overweight or obesity who were not receiving insulin.…”

Section: Introductionmentioning

confidence: 99%

Effect of a Smartphone App on Weight Change and Metabolic Outcomes in Asian Adults With Type 2 Diabetes

et al. 2021

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IMPORTANCE Lifestyle interventions are effective in diabetes management, with smartphone apps that manage health data and dietary and exercise schedules gaining popularity. However, limited evidence from randomized clinical trials exists regarding the effectiveness of smartphone-based interventions among Asian adults with type 2 diabetes. OBJECTIVE To compare the effects of a culturally contextualized smartphone-based intervention with usual care on weight and metabolic outcomes. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial conducted at multiple primary care centers in Singapore included 305 adults with type 2 diabetes and body mass index (BMI) of 23 or greater who had literacy in English and smartphone access. Participants were recruited between October 3, 2017, and September 9, 2019, and were randomly assigned (1:1; stratified by gender, age, and BMI) to intervention (99 participants) or control (105 participants) groups. Participants' data were analyzed using intention-to-treat analysis. INTERVENTIONS Both control and intervention participants received diet and physical activity advice from a dietitian at a baseline face-to-face visit. Intervention participants additionally used a smartphone app to track weight, diet, physical activity, and blood glucose and then communicated with dietitians for 6 months. MAIN OUTCOMES AND MEASURES Primary outcome was change in body weight, while secondary outcomes were changes in hemoglobin A 1c (HbA 1c ), fasting blood glucose, blood pressure, lipids, and diet. Post hoc analyses included glycemic changes in the subgroup with HbA 1c levels of 8% or greater and diabetes medication changes. RESULTS Among the 204 randomized participants (mean [SD] age, 51.2 [9.7] years; 132 [64.7%] men), baseline mean (SD) BMI was 30.6 (4.3). Compared with the control group, intervention participants achieved significantly greater reductions in weight (mean [SD] change, −3.6 [4.7] kg vs −1.2 [3.6] kg) and HbA 1c levels (mean [SD] change, −0.7% [1.2] vs −0.3% [1.0]), with a greater proportion having a reduction in diabetes medications (17 participants [23.3%] vs 4 participants [5.4%]) at 6 months. The intervention led to a greater HbA 1c reduction among participants withHbA 1c levels of 8% or higher (mean [SD] change, −1.8% [1.4] vs −1.0% [1.4]; P = .001). Intergroup differences favoring the intervention were also noted for fasting blood glucose, diastolic blood pressure, and dietary changes. (continued) Key Points Question What is the effect of a culturally contextualized smartphonebased lifestyle intervention on weight change and metabolic outcomes in Asian adults who have overweight or obesity and type 2 diabetes compared with usual care? Findings In this randomized clinical trial of 204 adults with type 2 diabetes, the use of a smartphone app tracking personal health data and using integrated behavioral modification strategies led to significantly greater reductions in weight and hemoglobin A 1c , along with a significantly greater proportion of patients with a reduction i...

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Lifestyle Intervention Enabled by Mobile Technology on Weight Loss in Patients With Nonalcoholic Fatty Liver Disease: Randomized Controlled Trial

Cited by 55 publications

References 47 publications

Association of Weight Loss Interventions With Changes in Biomarkers of Nonalcoholic Fatty Liver Disease

Association of Weight Loss Interventions With Changes in Biomarkers of Nonalcoholic Fatty Liver Disease

Exercising in the COVID-19 era: implications in non-alcoholic fatty liver disease (NAFLD)

Effect of a Smartphone App on Weight Change and Metabolic Outcomes in Asian Adults With Type 2 Diabetes

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