# Real-world comparison of GLP-1 agonists versus physical activity in metabolic dysfunction-associated steatotic liver disease

## TL;DR

This study compares GLP-1 agonist therapy and physical activity in treating liver disease linked to metabolic dysfunction, finding that GLP-1 therapy leads to better weight and liver health improvements in a Hispanic population.

## Contribution

Provides real-world evidence comparing GLP-1 agonists and physical activity for MASLD in a predominantly Hispanic population.

## Key findings

- GLP-1 therapy was associated with greater BMI reduction compared to physical activity alone.
- FIB-4 indices improved more with GLP-1 therapy, but CAP and liver stiffness changes were not significant.

## Abstract

Glucagon-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.

This 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.

Among 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.

In 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.

The online version contains supplementary material available at 10.1186/s12876-026-04626-7.