Effectiveness and active ingredients of digital behaviour change interventions for MASLD: A systematic review and...

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 behavior change interventions for improving weight and liver-related outcome measures in patients with MASLD.

Five databases were searched up to 31 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 changes in outcomes of interest were identified using promise analysis.

Eleven studies involving 1,288 participants fulfilled the review criteria. Digital behavior change interventions were not effective for reducing weight (weighted mean difference [WMD] -2.07 kg [-6.08 to 1.94 kg]). Likewise, they did not lead to statistically significant improvements in alanine transaminase and aspartate transaminase (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 and SMS), duration (1-11 months), and frequency of delivery (three times/week to continuous access). Promising intervention features/content included app-based delivery, ≥6-month duration, and self-monitoring of behaviour, feedback on outcomes, and social support.

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

This review is the first of its kind to report on the effectiveness and active ingredients of digital behaviour change interventions for the management of MASLD. Although the interventions reviewed were not effective overall, specific features and content of those interventions were associated with effectiveness. These insights can be used to inform the development of new interventions or to optimise existing interventions that could improve effectiveness. Findings also suggest that digital behaviour change interventions are beneficial for a proportion of individuals, and future research should focus on identifying who those individuals are. Significant heterogeneity between interventions was evident in terms of mode of delivery, behavioural change content, duration, and frequency of delivery. To truly determine the effectiveness of digital behaviour change interventions for patients with MASLD, they should be systematically developed using behaviour change theory and in accordance with a recognised intervention development framework.