Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.
Department of Family and Community Medicine, Penn State Health-Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.
Hepatol Commun. 2024 Jul 31;8(8). doi: 10.1097/HC9.0000000000000499. eCollection 2024 Aug 1.
Most patients with metabolic dysfunction-associated steatotic liver disease are unable to achieve clinically significant body weight loss with traditional in-person approaches. Digital therapeutic (DTx)-delivered interventions offer promise to remove barriers to weight loss success inherent to traditional resource-heavy in-person programs and at a population level, but their efficacy remains relatively unknown.
Published studies were identified through May 2023 by searching the following electronic databases: PubMed and Embase (Ovid). DTx intervention was compared to standard of care. The primary outcome was a change in body weight. Secondary outcomes included clinically significant body weight loss (≥5%) and change in liver enzymes.
Eight studies comprising 1001 patients met inclusion criteria (mean age: 47 y; body mass index: 33.2 kg/m2). The overall rate of clinically significant body weight loss was 33%, with DTx lifestyle interventions ranging from 4 to 24 months in length. DTx lifestyle intervention achieved statistically significant body weight loss (absolute change -3.4 kg, 95% CI: -4.8 to -2.0 kg, p < 0.01, relative change -3.9%, 95% CI: -6.6 to -1.3, p < 0.01) as well as clinically significant body weight loss of ≥5% (risk ratio: 3.0, 95% CI: 1.7-5.5, p < 0.01) compared to standard of care. This was seen alongside improvement in liver enzymes.
DTx-delivered lifestyle intervention programs lead to greater amounts of body weight loss than traditional in-person lifestyle counseling. These results further support the role of DTx in delivering lifestyle intervention programs to patients with metabolic dysfunction-associated steatotic liver disease and suggest that this scalable intervention offers promise to benefit the billions of patients worldwide with this condition.
大多数代谢功能障碍相关脂肪性肝病患者无法通过传统的面对面方法实现有临床意义的体重减轻。数字治疗（DTx）提供的干预措施有望消除传统资源密集型面对面计划中固有的减肥成功障碍，并在人群层面上，但它们的疗效仍然相对未知。
通过在以下电子数据库中搜索，于 2023 年 5 月之前确定了已发表的研究：PubMed 和 Embase（Ovid）。将 DTx 干预与标准护理进行比较。主要结果是体重变化。次要结果包括临床显著体重减轻（≥5%）和肝酶变化。
八项研究共纳入 1001 名患者符合纳入标准（平均年龄：47 岁；体重指数：33.2kg/m2）。临床显著体重减轻的总体率为 33%，DTx 生活方式干预的持续时间为 4 至 24 个月。DTx 生活方式干预实现了统计学上显著的体重减轻（绝对变化-3.4kg，95%CI：-4.8 至-2.0kg，p<0.01，相对变化-3.9%，95%CI：-6.6 至-1.3，p<0.01），以及临床显著体重减轻≥5%（风险比：3.0，95%CI：1.7-5.5，p<0.01）与标准护理相比。这与肝酶的改善同时发生。
与传统的面对面生活方式咨询相比，DTx 提供的生活方式干预计划可导致更多的体重减轻。这些结果进一步支持 DTx 在为代谢功能障碍相关脂肪性肝病患者提供生活方式干预计划中的作用，并表明这种可扩展的干预措施有望使全球数十亿患有这种疾病的患者受益。
