JMIR Publications

ABSTRACT

Background:

The prevalence of non-alcoholic fatty liver disease (NAFLD) is increasing in parallel with the epidemic of obesity and metabolic syndrome. Lifestyle modification is a crucial strategy for the treatment of NAFLD, which can lead to a reduction in liver fat with concomitant weight loss. The use of eHealth technologies is an effective approach to improve health outcomes in patients as they do not have any time and space limitations.

Objective:

This study aimed to evaluate published eHealth intervention studies for the improvement of lifestyle modifications among patients with NAFLD and to provide recommendations for future studies.

Methods:

We conducted a systematic review and meta-analysis. Five electronic databases (PubMed, Cochrane Central, CINAHL, EMBASE, and Web of Science) were searched for studies reporting the effect of lifestyle modification intervention using eHealth in patients with NAFLD published from inception to April 15, 2021. Study selection, data extraction, and quality assessment were performed by 3 researchers independently. The quality of included studies was assessed using the Cochrane risk of bias tool and the Risk of Bias Assessment Tool for Nonrandomized Studies.

Results:

In total, 2506 records were identified, and 37 full-text articles were assessed. Six studies were included in the systematic review. The participants of all interventions were 1,217 individuals with NAFLD, and the mean age ranged from 38.3 to 57.9 years. The duration of the interventions was 6-24 weeks, and all interventions were categorized into 3 types: internet-based computers, telephones, and mobile applications. Of these, 4 studies were randomized controlled trials. According to the meta-analysis, clear improvements in the eHealth intervention were observed in weight (p=.001; 95% CI −0.53 to −0.36), BMI (p<.001; 95% CI −0.61 to −0.21), AST (p<.001; 95% CI −6.50 to −2.16), and ALT (p<.001; 95% CI −0.61 to −0.18), compared with the control groups.

Conclusions:

Lifestyle modification interventions using eHealth technologies are significantly effective for weight, BMI, AST, and ALT in NAFLD patients. Future research should conduct interventions with larger sample sizes and evaluate whether these interventions have sustained benefits, and how we can make these eHealth methods most effective on a large scale.