Mobile application-enabled lifestyle interventions for metabolic dysfunction-associated steatotic liver disease: a systematic review and meta-analysis
- 1St George’s University Hospitals NHS Trust, London, UK
- 2University of London, London, UK
Abstract
Objectives: To evaluate the effectiveness, feasibility and acceptability of mobile application-enabled lifestyle interventions in adults with metabolic dysfunction-associated steatotic liver disease (MASLD).
Design: Systematic review and meta-analysis following Cochrane Handbook and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidance.
Data sources: Medline (via PubMed), EMBASE, Scopus and ClinicalTrials.gov, inception to 12 August 2026, with reference-list and citation searching.
Eligibility criteria: English-language randomised controlled trials (RCTs) and single-arm prospective studies of interventions delivered primarily by mobile application in adults with, or at risk of, MASLD, reporting a liver-specific outcome (enzymes, steatosis or fibrosis).
Data extraction and synthesis: Two reviewers independently extracted data and assessed risk of bias (Cochrane Risk of Bias 2; National Heart, Lung and Blood Institute tool). RCT outcomes were pooled by random-effects meta-analysis and other outcomes synthesised narratively. Certainty was assessed using the Grading of Recommendations Assessment, Development and Evaluation.
Results: 12 studies (6 RCTs, 6 single-arm studies; n=756) were included. There was no significant pooled effect on weight (k (number of studies)=6: mean difference −1.14 kg, 95% CI −2.93 to 0.65; I²=69%), alanine aminotransferase (ALT; k=5: −7.6 U/L, −20.8 to 5.6; I²=79.7%) or aspartate aminotransferase (k=4: −5.7 U/L, −12.5 to 1.0; I²=0%). Prespecified subgroup analysis showed ALT effect differed by intervention type (p=0.011; human-supported, k=4: −10.94 U/L, −26.45 to 4.57; automated, k=1: +2.87 U/L, −1.87 to 7.61), though neither was significant. Median retention was 83% (range 49%–95%).
Conclusions: Feasibility and retention signals are encouraging, but controlled evidence does not support consistent efficacy. Larger, longer trials with standardised endpoints, diverse populations and cost-effectiveness analyses are needed and should test whether human support is the active ingredient before recommendation alongside MASLD pharmacotherapies.
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BibTeX
@article{gosson2026mobile,
title = {{Mobile application-enabled lifestyle interventions for metabolic dysfunction-associated steatotic liver disease: a systematic review and meta-analysis}},
author = {Caroline Gosson and Maria Megapanou and Sarah White and Daniel Forton},
journal = {BMJ Open Gastroenterology},
year = {2026},
month = oct,
doi = {10.1136/bmjgast-2026-002514},
url = {https://doi.org/10.1136/bmjgast-2026-002514},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Mobile application-enabled lifestyle interventions for metabolic dysfunction-associated steatotic liver disease: a systematic review and meta-analysis
AU - Caroline Gosson
AU - Maria Megapanou
AU - Sarah White
AU - Daniel Forton
PY - 2026
DA - 2026/10/27
JO - BMJ Open Gastroenterology
DO - 10.1136/bmjgast-2026-002514
UR - https://doi.org/10.1136/bmjgast-2026-002514
AB - Objectives: To evaluate the effectiveness, feasibility and acceptability of mobile application-enabled lifestyle interventions in adults with metabolic dysfunction-associated steatotic liver disease (MASLD). Design: Systematic review and meta-analysis following Cochrane Handbook and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidance. Data sources: Medline (via PubMed), EMBASE, Scopus and ClinicalTrials.gov, inception to 12 August 2026, with reference-list and citation searching. Eligibility criteria: English-language randomised controlled trials (RCTs) and single-arm prospective studies of interventions delivered primarily by mobile application in adults with, or at risk of, MASLD, reporting a liver-specific outcome (enzymes, steatosis or fibrosis). Data extraction and synthesis: Two reviewers independently extracted data and assessed risk of bias (Cochrane Risk of Bias 2; National Heart, Lung and Blood Institute tool). RCT outcomes were pooled by random-effects meta-analysis and other outcomes synthesised narratively. Certainty was assessed using the Grading of Recommendations Assessment, Development and Evaluation. Results: 12 studies (6 RCTs, 6 single-arm studies; n=756) were included. There was no significant pooled effect on weight (k (number of studies)=6: mean difference −1.14 kg, 95% CI −2.93 to 0.65; I²=69%), alanine aminotransferase (ALT; k=5: −7.6 U/L, −20.8 to 5.6; I²=79.7%) or aspartate aminotransferase (k=4: −5.7 U/L, −12.5 to 1.0; I²=0%). Prespecified subgroup analysis showed ALT effect differed by intervention type (p=0.011; human-supported, k=4: −10.94 U/L, −26.45 to 4.57; automated, k=1: +2.87 U/L, −1.87 to 7.61), though neither was significant. Median retention was 83% (range 49%–95%). Conclusions: Feasibility and retention signals are encouraging, but controlled evidence does not support consistent efficacy. Larger, longer trials with standardised endpoints, diverse populations and cost-effectiveness analyses are needed and should test whether human support is the active ingredient before recommendation alongside MASLD pharmacotherapies.
SN - 2054-4774
ER -