College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Republic of Korea.
College of Nursing, Yonsei University, Seoul, Republic of Korea.
J Med Internet Res. 2023 Jan 23;25:e37487. doi: 10.2196/37487.
The prevalence of nonalcoholic 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.
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.
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 November 3, 2022. 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.
In total, 2688 records were identified, and 41 full-text articles were assessed. Seven studies were included in the systematic review. The participants of all interventions were 1257 individuals with NAFLD, and the mean age ranged from 38.3 to 57.9 years. The duration of the interventions was 3-24 months, and all interventions were categorized into 3 types: internet-based computers, telephones, and mobile apps. Of these, 4 studies were randomized controlled trials and were included in the meta-analysis: 3 studies for body weight and BMI and 4 studies for alanine aminotransferase (ALT) and aspartate aminotransferase (AST). According to the meta-analysis, clear improvements in BMI (P=.02; 95% CI -1.01 to -0.10), AST (P=.02; 95% CI -1.22 to -0.13), and ALT (P=.01; 95% CI -1.28 to -0.15) were observed in the eHealth intervention as compared with the control groups.
Lifestyle modification interventions using eHealth technologies are significantly effective for BMI, AST, and ALT in patients with NAFLD. 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.
非酒精性脂肪性肝病（NAFLD）的患病率与肥胖症和代谢综合征的流行呈平行上升趋势。生活方式改变是治疗 NAFLD 的关键策略，可导致肝脂肪减少和体重减轻。使用电子健康技术是改善患者健康结果的有效方法，因为它们没有任何时间和空间限制。
本研究旨在评估已发表的使用电子健康技术改善 NAFLD 患者生活方式改变的干预研究，并为未来的研究提供建议。
我们进行了系统评价和荟萃分析。从成立到 2022 年 11 月 3 日，我们在五个电子数据库（PubMed、Cochrane 中央、CINAHL、Embase 和 Web of Science）中搜索了报告使用电子健康技术改善 NAFLD 患者生活方式改变的干预研究。由 3 名研究人员独立进行研究选择、数据提取和质量评估。使用 Cochrane 偏倚风险工具和非随机研究偏倚风险评估工具评估纳入研究的质量。
共确定了 2688 条记录，评估了 41 篇全文文章。有 7 项研究纳入了系统评价。所有干预措施的参与者均为 1257 名 NAFLD 患者，平均年龄为 38.3 至 57.9 岁。干预持续时间为 3-24 个月，所有干预措施均分为 3 种类型：基于互联网的计算机、电话和移动应用程序。其中，4 项研究为随机对照试验，并纳入了荟萃分析：3 项研究用于体重和 BMI，4 项研究用于丙氨酸氨基转移酶（ALT）和天冬氨酸氨基转移酶（AST）。根据荟萃分析，与对照组相比，电子健康干预组 BMI（P=.02；95%CI -1.01 至 -0.10）、AST（P=.02；95%CI -1.22 至 -0.13）和 ALT（P=.01；95%CI -1.28 至 -0.15）的改善更为明显。
使用电子健康技术的生活方式改变干预措施对 NAFLD 患者的 BMI、AST 和 ALT 非常有效。未来的研究应该进行更大样本量的干预，并评估这些干预措施是否具有持续的益处，以及我们如何在大规模上使这些电子健康方法最有效。
