Lifestyle Guidance App May Be Effective in NASH

A smartphone chatbot that gives lifestyle advice may help people with nonalcoholic steatohepatitis (NASH) improve their liver health, researchers say.

After 48 weeks, nonalcoholic fatty liver disease activity scores (NAS) improved in 13 out of 19 patients who used the NASH App developed by CureApp, according to Masaya Sato of the University of Tokyo, Japan, and colleagues.

If confirmed by a controlled trial, these preliminary results could show promise for digital therapeutics, the researchers state in an article published in The American Journal of Gastroenterology.

“The widespread use of smartphones, which can process and communicate data in real time, makes them an ideal platform for therapeutic interventions,” they say.

Although lifestyle changes can reduce NASH activity, many patients have difficulty keeping up these changes. Not enough counselors are available to guide patients in healthy practices, and hiring the counselors is expensive, the researchers write.

Smartphone applications aimed at instilling healthy behavior have been tried in diabetes, smoking, hypertension, alcoholism, and even cancer, they note. They wanted to see whether something similar could be done with NASH.

Researchers recruited 19 patients with biopsy-confirmed NASH who consumed no more than moderate amounts of alcohol and had a body mass index (BMI) of at least 25. Their mean age was 52 years, mean BMI was 32, and mean NAS was 5.0.

The patients downloaded the NASH App onto their phones and entered their baseline profile information, including age, gender, diet and exercise practices, and social characteristics. On the basis of this information and daily weight measurements, the system proposed lifestyle improvement programs tailored to each individual. Its chatbot presented them in the form of behavioral goals and lectures from virtual nurses.

While patients used the app for 48 weeks, they also received standard outpatient care for NASH from live physicians, who also promoted the use of the app and provided additional education related to NASH.

The patients underwent liver biopsies within 90 days prior to beginning the study and at the end of 48 weeks. The researchers compared the changes in these patients vs those in a hypothetical control group, which they based on the placebo group in a previous study.

In the patients who used the app, the mean NAS change from baseline to week 48, the main endpoint, was -2.05 ± 1.96 (95% CI, -3.00 to -1.11). This result was statistically significant compared with the hypothetical control group, in which the mean change in NAS was -0.7 (P < .001).

In 11 of the patients, NAS decreased by at least 2 points without worsening of liver fibrosis. In eight patients, the researchers observed resolution of steatohepatitis, which they defined as disappearance of hepatocyte ballooning.

In 12 patients with stage F2 or F3 fibrosis, the average stage went from 2.5 to 2.0 (P = .02). No patient with stage F1 fibrosis showed a reduction in fibrosis stage. The scores for steatosis decreased in 11 patients, for lobular inflammation in nine patients, and for ballooning in 10 patients.

The patients lost an average of 8.3% of their body weight, which was significant compared with their baseline (P < .001).

The patients also notched significant reductions in average serum levels of aspartate aminotransferase, alanine aminotransferase, gamma-glutamyltransferase, alkaline phosphatase, and triglycerides.

The researchers note that the lack of a real control group and the small size of the study population limited the importance of their findings. A larger randomized, controlled trial is needed to confirm their results, they add.

During the study, physicians browsed the patients’ data and provided them with feedback about it, the researchers note. But the study did not measure the amount of time the physicians spent on this activity, they add.

CureApp founded the study, and one of the authors is a consultant for the company.

Am J Gastroenterol. Published online December 13, 2022. Abstract

Laird Harrison writes about science, health and culture. His work has appeared in national magazines, in newspapers, on public radio, and on websites. He is at work on a novel about alternate realities in physics. Harrison teaches writing at the Writers Grotto. Visit him at or follow him on Twitter: @LairdH

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