Abstract MP17: Sustained Improvements in Liver Fat Reduction and Cardiometabolic Health at Nine Months After a 12 Week Digital Health Program in Individuals With Non-Alcoholic Fatty Liver Disease - A Feasibility Study
Authors: Bjornsdottir Sigridur , Ulfsdottir Hildigunnur , Gudmundsson Elias F , Dobies Bartosz , Sveinsdottir Kolbrun , Isberg Ari P , Bjornsdottir Gudlaug , Sigurdsson Sigurdur , Oddsson Saemundur , Gudnason Vilmundur 
Published: May 2024

Introduction:
Behavioral changes can improve health outcomes, but maintaining improvements can be challenging. A 12-week digital health program for Non-Alcoholic Fatty Liver Disease (NAFLD) was previously shown to be feasible in terms of patient engagement, program retention, and improvements in clinical markers of liver and cardiometabolic health. Here, we report on retention and clinical measurements after a 6-month maintenance program.

Hypothesis:
We hypothesized that improvements in cardiometabolic health can be sustained six months beyond an active program’s duration.

Methods:
A prospective, open label, single arm, 12-week long study was first conducted, where a digital health program was delivered through the Sidekick app with emphasis on disease education, lowering dietary carbohydrates, increasing activity levels, reducing stress and lifestyle coaching. Individuals with either BMI>30, metabolic syndrome or type 2 diabetes were screened for NAFLD with a FibroScan assessment. Data collection included demographics, anthropometric and clinical measurements, MRI-PDFF for liver fat content, dual-energy X-ray absorptiometry for body composition and blood tests. Measurements were done at baseline, 12 weeks and nine months. Once the 12-week program concluded, a six-month maintenance program was initiated with no new educational materials and the health coaching ceased. During the maintenance program the participants retained access to the app with recurring educational content. Summary statistics were calculated for all participants who started the health program. Missing values at follow-up were imputed using baseline observation carried forward.

Results:
In total, 38 individuals were included in the study and 34 (89%) completed the 12-week program, of which 28 (83%) attended the third and final follow-up visit at nine months. The median population age was 59.5 [IQR 46.3,68.8] years and 23 (60.5%) were females. At month nine the mean weight loss compared to baseline was 4.0 kg (SD=5.0) (p<0.001) with 5.2% (SD=10.0) reduction in fat mass (p<0.001). The average relative liver fat reduction was 18.4% (SD=30.5) (p<0.001). Systolic blood pressure decreased by 8.3 mmHg on average (SD=13.4) (p<0.001), diastolic blood pressure by 2.5 mmHg (SD=6.0) (p=0.015) and waist circumference by 4.7 cm (SD=7.1) (p<0.001). According to a sensitivity analysis the observed changes were not explained by changes in medication. Previous changes in triglyceride levels were not maintained. In the final week, 50% (19/38) of the users were retained in the app.

Conclusion:
This study suggests that improvements after a 12-week digital health program can be sustained at nine months despite coaching cessation. We observed sustained improvements for weight loss, liver fat, blood pressure and body composition. This approach could provide a new tool to obtain and maintain improvements in NAFLD.