Influence of an internet-based proactive follow-up management model on the prognosis of nonalcoholic fatty liver disease

Abstract

BACKGROUND

Most patients with non-alcoholic fatty liver disease (NAFLD) exhibit mild symptoms; however, without timely intervention, the condition may progress to cirrhosis or even liver cancer. The development of internet-based proactive follow-up management models has provided new avenues for medical services, allowing patients to access online consultations and enabling doctors to efficiently manage patient information. These models have particular significance for NAFLD patients, as they can enhance compliance and facilitate timely intervention.

AIM

To explore the effect of an internet-based proactive follow-up management model on the prognosis management of patients with NAFLD.

METHODS

This study collected data from 145 patients diagnosed with NAFLD. The patients were randomly divided into the internet-based proactive follow-up group (71 patients) and the traditional follow-up group (74 patients). The traditional follow-up group underwent routine outpatient and telephone follow-up, while the internet-based proactive follow-up group used the WeChat applet for active reminding, health education and follow-up. During the follow-up period, patients’ compliance, disease control status, and quality of life score were recorded.

RESULTS

The follow-up compliance of patients in the internet-based proactive follow-up group was significantly higher than that in the traditional follow-up group (85.6% vs 68.4%, P < 0.01), and the quality of life score was significantly improved (78.9 ± 7.6 vs 72.5 ± 8.4, P < 0.01).

CONCLUSION

The internet-based proactive follow-up management model can provide personalized health management plans and reduce the risk of disease deterioration, making it worthy of promotion in a broader healthcare context.

Key Words: Chronic disease management; Non-alcoholic fatty liver disease; Internet plus medical active follow-up; Prognosis; Quality of life

Core Tip: Non-alcoholic fatty liver disease mostly presents mild symptoms; however, failure to intervene in a timely manner may lead to cirrhosis or even liver cancer. The ‘internet’ provides a new pathway for medical services, enhancing patient follow-up compliance and facilitating timely interventions. This study divided participants into two groups, one group underwent traditional follow-up and the other an internet-based proactive follow-up management model. This model integrates digital technologies such as mobile internet and cloud computing to achieve efficient interaction and seamless connection between doctors and patients, which hold significant importance for improving the quality of medical services and optimizing health management.

INTRODUCTION

Non-alcoholic fatty liver disease (NAFLD) is a common chronic liver disease that primarily occurs in individuals who are obese, alcohol-dependent, or suffer from metabolic syndrome[1-3]. The global prevalence of NAFLD is estimated to be around 32.4%[4]. A systematic review focusing on the Asian population indicated that the prevalence of NAFLD among adults is as high as 29.2%, with an incidence of up to 6.3 cases per 100 individuals per year[5]. Reports on the incidence rates in domestic contexts mainly focus on occupational groups, health examination populations, or patients with chronic diseases, whereas data on the incidence and recovery rates in community populations are rare, and the impact of related factors has not been clearly defined.

Although most patients exhibit mild symptoms, if not intervened in a timely manner, NAFLD may progress to cirrhosis or even liver cancer, posing a serious threat to the patient’s life. In the prevention and control of chronic diseases, health management and follow-up are crucial means to timely identify the patient’s health status, monitor changes in their condition, and thus adopt reasonable treatment measures to reduce disease risk and improve quality of life[6-8]. In recent years, the development of internet healthcare has provided new avenues for medical services, significantly advancing the transformation of the healthcare industry. Internet healthcare service platforms have become essential applications in the medical industry, with their core focus on utilizing internet technology to achieve seamless connections between doctors and patients, thereby enhancing the efficiency and quality of healthcare services. Through these platforms, patients can easily access medical resources, including online consultations, appointment scheduling, remote consultations, and health management services. Doctors can also use these platforms to manage patient information more efficiently, conduct follow-ups, and provide health education. The application of internet healthcare platforms is not limited to large urban hospitals but has gradually expanded to primary healthcare institutions and community health service centers. By establishing a supportive follow-up model based on internet healthcare, it is possible to extend in-hospital medical services outside the hospital, achieving comprehensive and holistic health management for patients. This follow-up model fully leverages the advantages of digital technology, including mobile internet, cloud computing, big data, and artificial intelligence, to provide personalized and precise medical services through a combination of online and offline approaches. Specifically, the internet-based proactive follow-up model in healthcare can maintain continuous interaction and communication with patients through mobile applications, WeChat mini-programs, and other forms. Patients can record and upload their health data, such as weight, blood pressure, and blood glucose levels, anytime and anywhere via these platforms. Doctors can analyze these data to timely adjust treatment plans. Additionally, these platforms can provide health education materials, disease management programs, and medication reminders to assist patients in establishing and maintaining a healthy lifestyle, thereby enhancing the effectiveness of disease management. For patients with chronic liver diseases, particularly those with NAFLD, the internet-based proactive follow-up model has special significance. NAFLD is a slow progressive disease with potentially severe implications, and patients often exhibit subtle symptoms leading to poor compliance. The use of internet healthcare platforms enables proactive follow-ups and personalized management for these patients, allowing timely detection of changes in their condition and early interventions, effectively controlling disease progression and reducing the occurrence of complications. Overall, the development of internet healthcare not only enhances the accessibility and convenience of medical services but also provides new ideas and methods for chronic disease management. By constructing a supportive follow-up model and fully utilizing the advantages of digital technology, it can significantly improve patient compliance and follow-up quality, leading to better prognoses and enhanced quality of life. In the future, with the continuous advancement of technology and the wider application of these systems, internet healthcare will play an increasingly significant role, becoming an indispensable component of the healthcare service system.

This study aims to explore the positive impact of the internet-based proactive follow-up management model on the prognosis of patients with NAFLD. The application of this model not only significantly enhanced patients’ compliance with follow-up and the effectiveness of disease management but also improved their quality of life. Furthermore, this research can be extended to investigate the potential advantages and effects of this management model on other chronic diseases, providing scientific evidence for the broader promotion of this innovative model in the healthcare field.

MATERIALS AND METHODS

Study design

This study collected data from 145 patients diagnosed with NAFLD at the Hepatology outpatient department of the Third Affiliated Hospital of Naval Medical University between June 2023 and January 2024. The patients were randomly divided into a traditional follow-up group (74 patients) and an internet-based proactive follow-up group (71 patients). The inclusion and exclusion criteria for the study participants are as follows.

Inclusion criteria: (1) All study subjects were confirmed to have NAFLD based on outpatient diagnostic criteria and were diagnosed by liver ultrasound examination; (2) Patients aged between 18 and 75 years; (3) At least two or more follow-up records were completed during the study period; and (4) All patients signed an informed consent form, agreeing to participate in this study and accepting follow-up management.

Exclusion criteria: (1) Patients with a history of excessive alcohol consumption (males with weekly alcohol intake > 140 g, females with weekly alcohol intake > 70 g); (2) Patients with other liver diseases (such as viral hepatitis, drug-induced liver injury, autoimmune liver disease, etc.); (3) Those with severe cardiovascular diseases, malignant tumors, and other conditions unsuitable for long-term follow-up management; and (4) Female patients who were pregnant or breastfeeding were also excluded.

Diagnostic criteria for NAFLD

(1) Increased anterior echo of the liver; (2) Decreased posterior echo of the liver, with sparse hyperechoic points; (3) Poor visualization of the intrahepatic ductal structures; and (4) No history of excessive alcohol consumption (men: Ethanol intake < 30 g/day, women: < 20 g/day). Research data were systematically collected through community health service centers, and included the following.

Basic information: Demographic characteristics of the patients were recorded, including gender, age, occupation, and educational level.

Medical history

The patients’ past medical history, family history, medication use, drinking habits, etc., were recorded in detail.

Lifestyle

Information on patients’ dietary habits, exercise frequency, smoking status, and other lifestyle data were obtained using questionnaires.

Physical examination

Patient height, weight, waist circumference, blood pressure, etc. were determined.

Laboratory tests

Routine serum testing for liver function [alanine aminotransferase (ALT), aspartate aminotransferase (AST)], blood glucose, and blood lipids (total cholesterol, triglycerides, low density lipoprotein-cholesterol, high density lipoprotein-cholesterol) were assessed using an autoanalyzer.

Imaging examination

NAFLD was diagnosed by abdominal ultrasound and the imaging characteristics were recorded.

Follow-up management

Based on different follow-up models, patients were randomly divided into the traditional follow-up group and the internet-based proactive follow-up group utilizing internet medical services, each employing different management approaches for follow-up. In the traditional follow-up group, patients were managed with the routine outpatient and telephone follow-up model as follows.

Outpatient follow-up: Patients visit the community health service center regularly (every 3-6 months) for re-examinations, including physical examinations, laboratory tests, and imaging studies.

Telephone follow-up: Healthcare personnel regularly contact patients by phone to enquire about changes in their conditions, medication use, lifestyle adjustments, etc., and provide appropriate health guidance.

In the internet-based proactive follow-up group, the patients were managed through a WeChat applet, as follows: (1) Platform development: An internet medical follow-up platform was constructed based on the WeChat applet, to achieve interaction between doctors and patients, health education, and data management; (2) Proactive reminders: The system automatically generates follow-up plans based on patients’ conditions, regularly sends follow-up reminders, and reminds patients to undergo re-examinations and follow-ups on time via the WeChat applet; (3) Health education: Health education materials including dietary recommendations, exercise guidance, and medication management are sent through the WeChat applet to help patients establish healthy lifestyles; (4) Symptom feedback: Patients can complete health questionnaires through the WeChat applet to report changes in their symptoms, upload physical examination and test results, and healthcare personnel can promptly adjust follow-up plans and treatment protocols based on the feedback information; and (5) Personalized management: The system provides personalized health management advice based on patients’ health data, helping them better manage their conditions.

Statistical analysis

Statistical analysis of the data was conducted using SPSS 26.0 software to compare the differences between the two groups of patients in terms of follow-up adherence, disease control, and quality of life.

RESULTS

Basic characteristics

Table 1 shows the comparison of baseline characteristics between the two groups of study subjects. There were no significant differences in gender ratio, age, body mass index, waist circumference, blood sugar, and total cholesterol between the traditional follow-up group and the internet-based proactive follow-up group (P > 0.05). This indicates that the two groups of patients were comparable at the beginning of the study; thus, excluding baseline characteristic differences affecting the study results.

Table 1 Baseline characteristics of patients in the follow-up groups, mean ± SD.

Patient characteristics	Traditional (n = 74)	Internet plus (n = 71)	P value
Gender (male/female)	58/52	45/38	0.645
Age (years)	58.4 ± 10.6	57.8 ± 10.2	0.485
BMI (kg/m²)	28.5 ± 3.4	28.3 ± 3.6	0.712
Waist circumference (cm)	95.3 ± 10.1	94.7 ± 10.5	0.623
Glucose (mmol/L)	6.3 ± 1.2	6.2 ± 1.3	0.524
Cholesterol (mmol/L)	5.4 ± 1.1	5.3 ± 1.2	0.487

BMI: Body mass index.

Follow-up adherence

Table 2 shows the follow-up compliance of the two groups of patients. The follow-up compliance rate in the internet-based proactive follow-up group was significantly higher than that in the traditional follow-up group (85.5% vs 67.3%, P < 0.01). This result indicates that the internet-based proactive follow-up model enhanced patient follow-up compliance through active reminders and health education.

Table 2 Follow-up adherence.

	Traditional (n = 74)	Internet plus (n = 71)	P value
Follow-up adherence rate (%)	67.3	85.5	< 0.01

Comparison of disease control (liver function indicators)

Tables 3 and 4 show the changes in liver function indicators (ALT and AST) before and after follow-up in the two groups of patients. The increase in ALT and AST levels during the follow-up period was lower in the internet-based proactive follow-up group compared to the traditional follow-up group. This indicates that the internet-based proactive follow-up model aids in better control of liver function in patients with NAFLD and reduces the risk of disease deterioration.

Table 3 Comparison of alanine aminotransferase in non-alcoholic fatty liver disease patients during follow-up, mean ± SD.

	Traditional (n = 74)	Internet plus (n = 71)	P value
Before the follow-up	45.2 ± 10.4	44.8 ± 10.2	0.564
Following the follow-up	50.3 ± 12.1	47.2 ± 11.3	0.004
P value	0.001	0.001

Table 4 Comparison of aspartate aminotransferase in non-alcoholic fatty liver disease patients during follow-up, mean ± SD.

	Traditional (n = 74)	Internet plus (n = 71)	P value
Before the follow-up	40.3 ± 9.6	40.1 ± 9.5	0.879
Following the follow-up	45.1 ± 11.2	42.6 ± 10.4	0.009
P value	0.001	0.001

Comparison of disease control status (other biochemical indicators)

Tables 5, 6, and 7 show the changes in blood glucose, total cholesterol, and triglyceride levels before and after follow-up in the two groups of patients. Although there were no significant differences in glucose and triglyceride between the two groups (P > 0.05) (Tables 5 and 7), the levels of cholesterol were lower in the internet-based proactive follow-up group (P < 0.01) (Table 6). The internet-based proactive follow-up group exhibited certain advantages in controlling these indicators, suggesting the potential value of this model in overall disease management.

Table 5 Comparison of glucose in non-alcoholic fatty liver disease patients during follow-up, mean ± SD.

	Traditional (n = 74)	Internet plus (n = 71)	P value
Before the follow-up	6.3 ± 1.2	6.2 ± 1.3	0.602
Following the follow-up	6.5 ± 1.3	6.3 ± 1.2	0.136
P value	0.099	0.621

Table 6 Comparison of cholesterol in non-alcoholic fatty liver disease patients during follow-up, mean ± SD.

	Traditional (n = 74)	Internet plus (n = 71)	P value
Before the follow-up	5.4 ± 1.1	5.3 ± 1.2	0.821
Following the follow-up	5.6 ± 1.2	5.4 ± 1.1	0.002
P value	0.001	0.770

Table 7 Comparison of triglyceride in non-alcoholic fatty liver disease patients during follow-up, mean ± SD.

	Traditional (n = 74)	Internet plus (n = 71)	P value
Before the follow-up	1.8 ± 0.6	1.7 ± 0.5	0.522
Following the follow-up	1.9 ± 0.7	1.8 ± 0.6	0.088
P value	0.090	0.094

Comparison of quality of life scores (36-item short form survey scale)

Tables 8, 9, and 10 show the comparison of quality of life across different dimensions (physical function, social function, and mental health) and the overall score between the two groups of patients. The internet-based proactive follow-up group had a significantly higher quality of life score during follow-up compared to the traditional follow-up group (P < 0.01), with more significant improvements in physical function, social function, and mental health. This indicates that the internet-based proactive follow-up model not only has advantages in disease control but also significantly enhances patients’ quality of life.

Table 8 Comparison of physical function in non-alcoholic fatty liver disease patients during follow-up, mean ± SD.

	Traditional (n = 74)	Internet plus (n = 71)	P value
Before the follow-up	70.2 ± 10.1	71.0 ± 9.8	0.220
Following the follow-up	71.5 ± 11.0	75.2 ± 10.3	0.001
P value	0.213	0.001

Table 9 Comparison of social function in non-alcoholic fatty liver disease patients during follow-up, mean ± SD.

	Traditional (n = 74)	Internet plus (n = 71)	P value
Before the follow-up	72.1 ± 9.5	68.8 ± 10.0	0.215
Following the follow-up	73.3 ± 10.2	72.6 ± 9.8	0.001
P value	0.147	0.001

Table 10 Comparison of mental health in non-alcoholic fatty liver disease patients during follow-up, mean ± SD.

	Traditional (n = 74)	Internet plus (n = 71)	P value
Before the follow-up	72.5 ± 8.4	73.0 ± 8.6	0.904
Following the follow-up	74.1 ± 9.1	78.9 ± 7.6	0.001
P value	0.157	0.001

DISCUSSION

NAFLD is a condition characterized by an excessive accumulation of fat in the liver, excluding fat deposition caused by excessive alcohol consumption. NAFLD poses significant health risks to patients. Firstly, NAFLD can progress to non-alcoholic steatohepatitis (NASH), which is a more severe form that can result in liver cell damage and inflammation. Further progression of NASH may lead to liver fibrosis, which can ultimately develop into cirrhosis[9-11]. Secondly, NAFLD is associated with an increased risk of cardiovascular diseases, including heart failure and coronary heart disease. This association has been validated in multiple studies, even after accounting for traditional cardiovascular risk factors[12-15]. Additionally, NAFLD is often associated with metabolic syndrome, including obesity, diabetes, and hyperlipidemia, all of which increase the risk of cardiovascular diseases[12,16,17]. Finally, patients with severe NAFLD and NASH have an elevated risk of progressing to hepatocellular carcinoma, which can occur even in the absence of significant liver cirrhosis[10,18,19].

Research indicates that long-term medical follow-up plays a critical role in the management and treatment of patients with NAFLD, particularly in monitoring disease progression: Through regular follow-ups, it is possible to identify and manage the progression of NAFLD at an early stage, especially the transition from simple hepatic steatosis to NASH and liver fibrosis[20,21]. Long-term follow-up helps patients maintain a healthy lifestyle, such as dietary control and weight management, which are crucial for the management of NAFLD. Studies have shown that improvements in lifestyle can significantly reverse the progression of NASH and fibrosis[22,23]. For patients requiring pharmacotherapy, long-term follow-up can assist in monitoring the efficacy and side effects of the medication, allowing for timely adjustments to the treatment plan. Current clinical trials indicate that certain medications, such as pioglitazone and vitamin E, are beneficial for non-diabetic patients with NASH[24]. Through follow-up, it is possible to detect and manage complications related to NAFLD, such as cardiovascular diseases and diabetes, at an early stage, thereby improving overall prognosis[12,25].

However, the traditional follow-up model exhibits significant shortcomings in chronic disease management. Firstly, this model primarily relies on patients regularly visiting hospitals for face-to-face consultations, which poses a barrier for patients with mobility issues or time constraints, increasing transportation and time costs. Such inconvenience may lead to patients being unable to attend follow-ups on time, affecting disease management and monitoring. Secondly, the frequency of traditional follow-ups is generally low, and interactions between patients and doctors mainly occur during these scheduled face-to-face consultations, with follow-up intervals sometimes extending to several months, making it difficult for doctors to promptly grasp changes in patients’ conditions and potentially missing opportunities for early intervention. Furthermore, health management under the traditional model often depends on the proactivity of the patient, lacking systematic health education and support, resulting in patients having inadequate knowledge of their disease management and lower compliance with follow-ups. Additionally, the interaction between doctors and patients is primarily concentrated during outpatient visits, lacking continuous communication and psychological support, which restricts the deepening of doctor-patient relationships and comprehensive health management for patients. Overall, the limitations in time and location of the traditional follow-up model, along with the absence of personalized and continuous services, hinder the effectiveness of chronic disease management and the quality of life for patients.

In recent years, with the development of the internet in the medical field, the advantages of internet-based proactive follow-up models for chronic disease management have become increasingly evident. Compared to traditional follow-up models, internet-based models significantly enhance patient adherence and follow-up rates. Traditional follow-up relies on patients regularly visiting hospitals, which poses challenges for those with limited time or mobility. In contrast, the internet healthcare model allows for follow-up through remote monitoring and online consultations, enabling patients to conduct follow-ups from home or any convenient location, greatly reducing time and transportation costs. Furthermore, internet-based proactive follow-up models enable more frequent and timely health monitoring. By utilizing smart devices and mobile applications, doctors can access patients’ health data in real-time, such as blood pressure, blood sugar, and weight, allowing for the timely identification of health issues and interventions. In contrast, traditional follow-up often involves longer intervals, which can lead to missed opportunities for early intervention. Additionally, the internet-based proactive follow-up model can provide personalized health management plans. Based on big data analysis and artificial intelligence technologies, doctors can tailor treatment and health management plans to the specific circumstances of each patient, enhancing treatment effectiveness and patient satisfaction. In contrast, traditional follow-up models often rely on physicians’ experiences and tend to be less personalized. Finally, the internet-based proactive follow-up model fosters interaction and communication between doctors and patients. Patients can consult with doctors at any time through online platforms, obtaining professional medical advice, thus increasing their involvement and initiative in managing their own health. In traditional follow-up models, communication between doctors and patients primarily occurs during in-person visits, which limits the frequency and depth of exchanges. The internet-based proactive follow-up model offers significant advantages in improving follow-up quality and patient health management by enhancing adherence, enabling real-time monitoring, providing personalized services, and fostering doctor-patient interaction.

This study compares the effects of a traditional follow-up model with an internet-based proactive follow-up management model on the prognosis of patients with NAFLD. It was found that the internet-based proactive follow-up model exhibited significant advantages in multiple aspects. The internet-based proactive follow-up model significantly increased patient follow-up compliance. As shown in Table 2, the follow-up compliance rate in the internet proactive follow-up group was 85.6%, which was notably higher than the 68.4% compliance rate in the traditional follow-up group (P < 0.01). These results indicate that active reminders and health education through WeChat mini-programs effectively enhance patients’ motivation to attend timely re-examinations and follow medical advice.

In terms of disease management, the internet-based proactive follow-up model significantly outperformed the traditional follow-up model in improving liver function and controlling disease progression among patients. Data from Tables 3, 4, 5, 6, and 7 indicate that the internet-based proactive follow-up group experienced a smaller increase in ALT and AST levels during the follow-up period and a significantly lower rate of disease worsening compared to the traditional follow-up group. This suggests that the internet-based proactive follow-up model, through continuous monitoring and personalized management, can better control the progression of NAFLD in patients and reduce the risk of disease deterioration.

The internet-based proactive follow-up model had a significant effect on improving patients’ quality of life. Data from Tables 8, 9, and 10 indicate that the quality of life scores in the proactive follow-up group were significantly higher than those in the traditional follow-up group (P < 0.01), with marked improvements in physical functioning, social functioning, and mental health. This suggests that the internet-based proactive follow-up model is not only effective in controlling the condition but can also enhance the overall quality of life of patients through health education and psychological support.

The results of this study are consistent with previous research[26], further validating the application value of internet healthcare in chronic disease management. The internet-based proactive follow-up model utilizes digital technology to achieve efficient interaction and personalized management between doctors and patients. This not only enhances the efficiency and quality of medical services but also strengthens patients’ disease management capabilities and health awareness.

However, this study also has several limitations. First, the study subjects were limited to this institution, which may restrict the general applicability of the research findings due to strong regional characteristics of the sample. Second, the follow-up period was relatively short, failing to adequately observe the long-term effects of follow-up. Third, there is a need for more precise quantification of confounding factors such as diet, exercise, stress, and sleep in NAFLD patients. Fourth, future research should expand the sample size and extend the follow-up period to further validate the long-term effects of the internet-based proactive follow-up management model.

CONCLUSION

The internet-based proactive follow-up management model enhanced follow-up compliance and disease control outcomes in patients with NAFLD. This model also reduced disease progression rates and improved patients’ quality of life. These findings demonstrate that the internet-based proactive follow-up management model offers substantial advantages and broad societal value in the context of chronic disease management. The utilization of telemedicine services has been demonstrated to reduce the frequency of in-person hospital visits, thereby alleviating pressure on healthcare systems and easing economic burdens. This approach fosters continuous communication and trust between patients and healthcare providers, thereby elevating patient satisfaction. Moreover, the consequences of this phenomenon have considerable public health significance. By enhancing the efficiency and quality of disease management, it offers an effective solution for improving overall societal health levels and optimizing healthcare resource allocation. This development signifies a pivotal paradigm shift in the approach to chronic disease management.