DISCUSSION
extrahepatic cancers, NASH, metabolic syndrome, weight loss, diabetes
EVENTS, METABOLIC DISEASE, METABOLIC SYNDROME, HYPERTENSION, DIABETES
This is the first study to examine an mHealth-delivered lifestyle intervention program in adults with NASH. Among patients with NASH, 16 weeks of NW was superior to standard clinical care with respect to body weight loss because patients who completed NW lost 5 times more body weight overall, with nearly half of the NW patients achieving clinically significant body weight loss of 5% or greater. This was seen independent of baseline body weight, BMI, individual components of the metabolic syndrome (eg, diabetes and hypertension), or NASH severity. Moreover, the NW lifestyle intervention program is feasible, acceptable, and safe as the Because at this time there is no known cure or regulatory agency-approved drug therapy for patients with NASH, an effective lifestyle intervention program will be crucial in improving patient-oriented outcomes, including the reduction of major adverse liver outcomes, major adverse cardiovascular events, and primary liver as well as extrahepatic cancers. Clinical guidelines from multiple leading academic societiesBased on the findings of Vilar Gomez et al,We also found a shift in behavior with the NW smartphone application. Over the duration of the 16-week program, participants initiated more interactions with the NW mobile application and spent a greater percentage of their time engaged with the application in self-monitoring and feedback activities such as meal logging or weigh-ins. This is important because self-monitoring has long been thought to be a central component of the behavioral treatment for weight loss,Our study has multiple strengths inherent to the study design (eg, in the use of a commercial mHealth smartphone app-delivered lifestyle intervention program that incorporates human coaching, NW is efficacious in other populations with metabolic disease), study population (eg, a well phenotyped cohort of patients with NASH), possibly cost (eg, a monthly NW subscription may be less costly than a fitness center membership, personal training, or dietary counseling with a Registered Dietitian),Future studies with large sample sizes, blinded assessors, and longer follow-up are necessary to confirm the results of this pilot study and to ascertain the sustainability of the findings. However, the present study demonstrates that clinically significant body weight loss is possible with only a short-term mHealth smartphone app-delivered lifestyle intervention. This finding is meaningful because it provides the basis for future large-scale use of smartphone-based lifestyle intervention for the clinical management of patients with NASH.