Long-Term Feasibility and Outcomes of a Digital Health Program to Improve Liver Fat and Cardiometabolic Markers in Individuals With Nonalcoholic Fatty Liver Disease: Prospective Single-Arm Feasibility Study.

BACKGROUND

A 12-week digital health program for nonalcoholic fatty liver disease (NAFLD) previously showed feasibility in engagement, program retention, and clinical outcomes. This study investigates whether improvements in cardiometabolic risk factors achieved during a 12-week active program were sustained over a subsequent 6-month follow-up period.

OBJECTIVE

The primary objective of this analysis was to evaluate whether the clinical improvements achieved after a 12-week program were maintained over the subsequent 6-month period, which did not include coaching or new intervention materials. In addition, the study aimed to assess participants' retention and engagement with the maintenance program.

METHODS

In a 9-month, single-arm study using the Sidekick app (Sidekick Health), individuals with NAFLD and BMI >30 or metabolic syndrome or type 2 diabetes were included. The initial 12 weeks focused on providing education about diet, physical activity, stress management, and sleep, followed by 6 months without coaching or new intervention materials. The measured outcomes encompassed demographics, body composition, liver fat assessed using magnetic resonance imaging-proton density fat fraction (MRI-PDFF), and blood markers.

RESULTS

Of the 34 participants who completed the first 12 weeks, 28 (82%) completed the 9-month study measurements. The median age was 63.0 years (IQR 53.5-71.0) and 57.1% (16/28) were women. At 9 months, compared to baseline, the mean weight loss was 4.0 kg (SD 5.0; P<.001). Liver fat decreased by 2.5% (SD 4.5; P<.001), with an 18.4% relative reduction. Systolic blood pressure decreased by 8.3 mm Hg (SD 13.4, P<.001) and diastolic by 2.5 mm Hg (SD 6.0; P=.02). Waist circumference decreased by 4.7 cm (SD 7.1; P<.001) and median glycated hemoglobin A1c (HbA1c) decreased by 19.5 mmol/mol (P<.001).

CONCLUSIONS

Sustained improvements in liver fat and metabolic markers suggest that Sidekick Health's digital program is a promising strategy for managing NAFLD without requiring continuous coaching.