THREE APPROACHES to lifestyle support were associated with reductions in liver fat over 12 months in people with metabolic dysfunction-associated steatotic liver disease (MASLD), a randomised trial has found.
Neither structured coaching nor a mobile health app produced significantly greater improvements than initial lifestyle advice supported by an information brochure.
The single-centre Belgian trial enrolled 297 participants, randomly assigning 102 to minimal intervention, 97 to lifestyle coaching and 98 to mobile health support.
The minimal intervention group received advice on the Mediterranean diet and physical activity, alongside an information brochure. Coaching involved nine individual and seven group sessions. Participants in the mobile health group used the Happi liver app, which offered dietary information, activity tracking and regular lifestyle advice.
Researchers assessed liver fat using the controlled attenuation parameter (CAP), a non-invasive measurement obtained through FibroScan. Liver stiffness and blood markers were also measured.
After 12 months, mean CAP reductions were 23.94 dB/m in the minimal intervention group, 23.66 dB/m with coaching and 21.96 dB/m with mobile health support.
Each group improved significantly from baseline, but there was no statistically significant difference between groups (p=0.998). These findings show that more intensive support did not demonstrate superiority for the primary outcome; they do not establish formal equivalence between approaches.
BMI remained significantly lower than baseline at 12 months in the coaching and mobile health groups. Both also reported improved adherence to the Mediterranean diet.
The mobile health group recorded a small reduction in aspartate aminotransferase of 2.81 U/L. However, this within-group improvement did not translate into a significant difference between interventions.
The authors cautioned that its clinical relevance for individual patients may be limited. Secondary outcomes were exploratory, with no formal correction for multiple testing.
None of the approaches produced a significant change in liver stiffness over 12 months. The study therefore did not demonstrate fibrosis improvement.
The results suggest mobile health could provide a feasible component of lifestyle support, while highlighting the potential value of dedicated advice during clinical consultations. The minimal intervention group received more focused information than may typically be available in routine care.
Important limitations include the single-centre design, incomplete follow-up and reliance on non-invasive measurements rather than liver biopsy. The cohort predominantly represented lower-risk MASLD, limiting applicability to patients with advanced fibrosis or those receiving newer metabolic treatments.
Larger multicentre trials are needed to confirm the findings and establish which approaches best suit different patients.
Reference
Robaeys W et al. Randomised trial of lifestyle interventions for improving metabolic dysfunction-associated steatotic liver disease. Hepatol Int. 2026.DOI:10.1007/s12072-026-11153-w.
Featured image: Oranuch on Adobe Stock
Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.
