Effectiveness and active ingredients of digital behaviour change interventions for MASLD: A systematic review and meta-analysis

Background and aims: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent liver condition worldwide. Successful management relies on targeting changes in lifestyle behaviours. Digital behaviour change interventions present a scalable approach to lifestyle change. The aim of this systematic review was to determine the effectiveness and active ingredients of digital interventions for improving weight and liver-related outcome measures in patients with MASLD.

Methods: Five databases were searched up to 31st January 2025 for studies reporting on digital lifestyle behaviour change interventions for patients with MASLD. Data were meta-analysed or narratively synthesised depending on study design. Intervention content and features positively associated with change in outcomes of interest were identified using promise analysis.

Results: Eleven studies involving n=1288 participants fulfilled the review criteria. Digital interventions were not effective for reducing weight (Weighted Mean Difference (WMD) -2.07kg [-6.08 to 1.94]). Likewise, digital interventions did not lead to statistically significant improvements in ALT and AST (WMD -9.14 [-20.33 to 2.05] and WMD -5.81 [-12.96 to 1.35] respectively). Interventions varied in terms of mode of delivery (e.g., app, SMS), duration (1 to 11 months), and frequency of delivery (three times/week to continuous access). Promising intervention features/content were app-based delivery, ≥6-months duration, and including self-monitoring of behaviour, feedback on outcomes, and social support.

Conclusions: Digital behaviour change interventions did not improve weight and liver-related outcomes measures in patients with MASLD. However, inclusion of proposed specific intervention ingredients are likely to improve effectiveness.