Text Message Intervention Could Encourage Lifestyle Change in Patients With NAFLD

At Digestive Disease Week 2017, held May 6-9 in Chicago, Illinois, researchers presented their findings from a trial of a text messaging intervention to encourage weight loss and liver health in patients with non-alcoholic fatty liver disease (NAFLD).

As the FDA has not yet approved a drug for the treatment of NAFLD, it can only be controlled through lifestyle changes aimed at weight loss and reducing risk factors for metabolic syndrome, like serum alanine aminotransferase (ALT) levels. However, adherence to these lifestyle suggestions often drops off between appointments with providers, so researchers from the University of Alabama at Birmingham aimed to determine if a text messaging support program could help boost adherence and help patients lower their weight and ALT.

In the study, NAFLD patients were randomly assigned to either receive traditional care, consisting of counseling on diet and exercise when they visited the clinic, or to receive text messages on their phone in addition to the usual care. Over the 22-week-long study period, participants in the intervention group were sent 3 texts per week about nutrition, exercise, and stress management.

According to lead study author Page Axley, MD, who presented the results, “the topics of these text messages ranged broadly, from healthy eating tips to exercise to stress management” and also general information about NAFLD. The advice was personalized by a once-weekly message asking patients to text back their reply to a question asking, for instance, about their specific obstacles to a healthy diet (such as the high cost of healthy food or not having time to cook); a follow-up message from the service would then offer tips based on the reported challenges. In the first week of the program, 70% of patients replied to the question text, but over the study period participation dropped and leveled off at around 45%.

Although the study was small with a sample size of 21 and its generalizability is limited, the outcomes seen in the text messaging group after 6 months were encouraging. They had lost an average of 11.2 lbs, while the control group had no significant change in weight. Additionally, the intervention group’s ALT levels decreased by a mean of 20 IU/L over the study period; there was no significant change in average ALT levels for the group receiving traditional care. Serum triglycerides dropped by 41 mg/dL in the text message group, whereas there was no significant change for the control group. Neither group saw a change in high-density lipoprotein cholesterol.

At the end of the study period, a survey found that the patients who received the text message intervention reported high levels of satisfaction with the program and said they would recommend it to their friends and relatives. According to Axley, these findings indicate that text messaging “has the potential to lead to significant weight change and improvement in liver enzymes in patients with NAFLD.”

She indicated that future studies “will need to do this intervention with a larger sample size, followed over a longer period of time, with a more diverse patient population, also looking at the impact on actual liver histology and other surrogate markers of the disease.”

“Considering the ease of dissemination of text messaging and its high familiarity, it really has a great potential for improvement of health services utilization and to reduce the financial burden of the disease,” Axley concluded.