Effects of GLP-1 RAs on changes in serum liver enzyme levels and liver fat content (assessed by imaging methods) in the eligible RCTs, stratified by study country, methods used for the diagnosis of NAFLD, individual GLP-1 RA drug used and duration of the trial

ALT (IU/L) AST (IU/L) GGT (IU/L) Liver fat content (%)
Study Country
Asia WMD −11.1
(95% CI −25.7 to 3.6)
I2 = 93%
n = 4 studies
WMD −4.3
(95% CI −14.2 to 5.6)
I2 = 92%
n = 4 studies
WMD −10.1
(95% CI −14.3 to 5.9)
I2 = 0%
n = 2 studies
WMD −4.9
(95% CI −7.8 to −2.0)
I2 = 57%
n = 3 studies
Europe WMD −4.6
(95% CI −17.4 to 8.3)
I2 = 58%
n = 3 studies
WMD −1.0
(95% CI −14.6 to 12.5)
I2 = 37%
n = 2 studies
WMD −12.1
(95% CI −31.8 to 7.6)
I2 = 0%
n = 2 studies
WMD −9.0
(95% CI −10.2 to −7.8)
I2 = 0%
n = 1 study
Diagnosis of NAFLD
Ultrasonography WMD −14.7
(95% CI −44.9 to 15.4)
I2 = 97%
n = 2 studies
WMD −4.5
(95% CI −22.3 to 13.3)
I2 = 96%
n = 2 studies
WMD −9.8
(95% CI −14.1 to −5.5)
I2 = 0%
n = 1 study
WMD −6.0
(95% CI −7.2 to −4.8)
I2 = 0%
n = 1 study
Biopsy WMD −22.0
(95% CI −42.8 to −1.3)
I2 = 0%
n = 1 study
WMD −7.0
(95% CI −20.4 to 6.4)
I2 = 0%
n = 1 studies
WMD −38.0
(95% CI −109 to 33.9)
I2 = 0%
n = 1 study
Not available on imaging methods
MRI-PDFF or spectroscopy WMD −3.6
(95% CI −11.4 to 4.3)
I2 = 54%
n = 4 studies
WMD −2.2
(95% CI −11.8 to 7.4)
I2 = 64%
n = 3 studies
WMD −13.6
(95% CI −28.8 to 1.6)
I2 = 0%
n = 2 studies
WMD −6.1
(95% CI −11.2 to −0.9)
I2 = 85%
n = 3 studies
Individual GLP-1 RA drug used
Exenatide WMD −16.3
(95% CI −31.8 to −0.87)
I2 = 81%
n = 3 studies
WMD −8.6
(95% CI −16.8 to −0.38)
I2 = 60%
n = 3 studies
WMD −10.1
(95% CI −14.2 to −5.9)
I2 = 0%
n = 3 studies
WMD −8.9
(95% CI −10.1 to −7.8)
I2 = 0%
n = 2 studies
Liraglutide WMD −0.43
(95% CI −4.9 to 4.1)
I2 = 37%
n = 4 studies
WMD 2.5
(95% CI −2.2 to 7.2)
I2 = 35%
n = 3 studies
WMD −38.0
(95% CI −109 to 33.9)
I2 = 0%
n = 1 study
WMD −4.4
(95% CI −8.2 to −0.5)
I2 = 77%
n = 2 studies
Median length of trial
Length ≤ 24 weeks WMD −13.9
(95% CI −32.8 to 4.8)
I2 = 95%
n = 3 studies
WMD −6.1
(95% CI −18.8 to 6.7)
I2 = 95%
n = 3 studies
WMD −10.1
(95% CI −14.2 to −5.9)
I2 = 0%
n = 2 studies
WMD −6.0
(95% CI −7.2 to −4.9)
I2 = 0%
n = 2 studies
Length > 24 weeks WMD −2.5
(95% CI (−10.5 to 5.6)
I2 = 37%
n = 4 studies
WMD 0.8
(95% CI −6.7 to 6.8)
I2 = 0%
n = 3 studies
WMD −12.1
(95% CI −31.8 to 7.6)
I2 = 0%
n = 2 studies
WMD −5.7
(95% CI −12.6 to −1.1)
I2 = 92%
n = 2 studies

MRI-PDFF: magnetic resonance imaging-proton density fat fraction