ArticleBMC gastroenterology2026
Real-world comparison of GLP-1 agonists versus physical activity in metabolic dysfunction-associated steatotic liver disease.
Article in BMC gastroenterology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
backgroundGlucagon-like peptide-1 (GLP-1) receptor agonists have metabolic and hepatic benefits in metabolic dysfunction–associated steatotic liver disease (MASLD), but their additive benefit compared to lifestyle modification only in real-world settings remains uncertain. This study compared the effects of GLP-1 agonist therapy and physical activity on body mass index (BMI) and noninvasive liver metrics in a predominantly Hispanic clinical population with MASLD.
methodsThis is a retrospective longitudinal study of 202 adults with MASLD evaluated at an outpatient gastroenterology clinic. BMI, controlled attenuation parameter (CAP), liver stiffness (kPa), and Fibrosis-4 (FIB-4) indices were analyzed at baseline and follow-up (1–2 years). Primary analyses compared follow up outcomes between GLP-1 therapy and an unmonitored physical activity comparator group; exploratory analyses assessed whether effects differed by sex or ethnicity.
resultsAmong 193 patients with complete BMI data and 131 with liver metrics, GLP-1 agonist therapy was associated with a greater reduction in BMI (–1.47 kg/m²; 95% CI, − 2.54 to − 0.41; p = 0.007) and in FIB-4 indices (–0.29; 95% CI, − 0.56 to − 0.03; p = 0.029) compared with physical activity only. Adjusted differences in CAP (–3.31 dB/m) and liver stiffness (+ 0.01 kPa) were not statistically significant.
conclusionIn this real-world MASLD cohort, GLP-1 therapy was associated with greater baseline-adjusted improvements in BMI and FIB-4 compared with physical activity alone, while CAP and liver stiffness were not statistically significant. These findings provide supportive real-world evidence for GLP-1 associated metabolic benefit and warrant confirmation of hepatic effects in larger prospective studies, including cohorts with substantial Hispanic representation.
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