Effects of time-restricted eating and supervised exercise on intrahepatic fat and cardiometabolic health in adults with obesity: the TEMPUS randomized controlled trial

Lifestyle interventions targeting intrahepatic fat remain limited. We investigated whether 8-hour time-restricted eating (TRE), supervised exercise, or their combination reduced intrahepatic fat fraction (IHFF) more than usual care (UC; Mediterranean diet and physical activity education) and each other. This investigator-initiated, parallel-group randomized controlled trial was conducted in Granada, Spain. Participants were recruited from May 2023 to April 2024, and the trial was completed on 5 September 2025. Primary outcome assessors and statisticians were blinded to group allocation, whereas intervention personnel were not. All 187 randomized adults with obesity (50% women) were included in the primary intention-to-treat analysis: UC (n = 48), TRE (n = 46), Exercise (n = 47), and TRE+Exercise (n = 46). The primary outcome was change in IHFF measured by magnetic resonance imaging after 12 weeks. IHFF change did not differ with TRE (−0.4%; 95% CI, −2.0 to 1.2; P = 0.93), Exercise (−0.8%; −2.4 to 0.8; P = 0.54), or TRE+Exercise (−1.1%; −2.7 to 0.5; P = 0.28) compared with UC, nor among intervention groups. These findings do not support greater short-term IHFF reductions with TRE, exercise, or their combination than with UC or between intervention groups. Trial registration: NCT05897073. Time-restricted eating and structured exercise training have both been reported to reduce hepatic steatosis and improve cardiometabolic profile. Here the authors report a randomized controlled trial showing that in adults with obesity, time-restricted eating, supervised exercise, or their combination did not reduce intrahepatic fat more than usual care that consisted of Mediterranean diet and physical activity education.

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Nature Communications
Published
2026-10-14
DOI
https://doi.org/10.1038/s41467-026-78625-3
Primary Topic
Dietary Effects on Health
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article
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article

Effects of time-restricted eating and supervised exercise on intrahepatic fat and cardiometabolic health in adults with obesity: the TEMPUS randomized controlled trial

Anna Carlén, Antonio Clavero‐Jimeno, Jonatan R. Ruiz, Rocío Cupeiro et al.
Nature Communications
Dietary Effects on Health
article

Effects of time-restricted eating and supervised exercise on intrahepatic fat and cardiometabolic health in adults with obesity: the TEMPUS randomized controlled trial

Anna Carlén, Antonio Clavero‐Jimeno, Jonatan R. Ruiz, Rocío Cupeiro, Alba Camacho-Cardeñosa, Alejandro De‐la‐O, Almudena Carneiro‐Barrera, Adrián Cortés‐Martín, Francisco J. Amaro‐Gahete, Manuel Muñoz‐Torres, Alessandro Gatti, Rafael de Cabo, Carlos Hernández-Martínez, Lucas Jurado‐Fasoli, Rafael Cabeza, Patricia Virginia García Pérez, Idoia Labayen, Juan J. Martín-Olmedo, Alejandro López-Vázquez, Marcos Molina-Fernandez, José Luis Martín Rodríguez, Sara Corpas-Pérez, Balma Boira-Nacher, Rocio Martín-Márquez, Alberto Suárez-Catalina, Patricia Morillo Moreno-Torres, Carlos de Teresa Galván, Mara Concepción
article en

Abstract

Lifestyle interventions targeting intrahepatic fat remain limited. We investigated whether 8-hour time-restricted eating (TRE), supervised exercise, or their combination reduced intrahepatic fat fraction (IHFF) more than usual care (UC; Mediterranean diet and physical activity education) and each other. This investigator-initiated, parallel-group randomized controlled trial was conducted in Granada, Spain. Participants were recruited from May 2023 to April 2024, and the trial was completed on 5 September 2025. Primary outcome assessors and statisticians were blinded to group allocation, whereas intervention personnel were not. All 187 randomized adults with obesity (50% women) were included in the primary intention-to-treat analysis: UC (n = 48), TRE (n = 46), Exercise (n = 47), and TRE+Exercise (n = 46). The primary outcome was change in IHFF measured by magnetic resonance imaging after 12 weeks. IHFF change did not differ with TRE (−0.4%; 95% CI, −2.0 to 1.2; P = 0.93), Exercise (−0.8%; −2.4 to 0.8; P = 0.54), or TRE+Exercise (−1.1%; −2.7 to 0.5; P = 0.28) compared with UC, nor among intervention groups. These findings do not support greater short-term IHFF reductions with TRE, exercise, or their combination than with UC or between intervention groups. Trial registration: NCT05897073. Time-restricted eating and structured exercise training have both been reported to reduce hepatic steatosis and improve cardiometabolic profile. Here the authors report a randomized controlled trial showing that in adults with obesity, time-restricted eating, supervised exercise, or their combination did not reduce intrahepatic fat more than usual care that consisted of Mediterranean diet and physical activity education.

Nature Communications
Linköping University (SE), Andalusian Health Service (ES), Universidad de Granada (ES), Universidad Pública de Navarra (UPNA) (ES), Universidad Loyola Andalucía (ES), University of Pavia (IT), Instituto de Salud Carlos III (ES), Spanish Biomedical Research Centre in Physiopathology of Obesity and Nutrition (ES), Instituto Andaluz de Ciencias de la Tierra (ES), Navarre Institute of Health Research (ES), Instituto de Investigación Biosanitaria de Granada (ES), Centro de Investigación Biomédica en Red (ES), National Institute on Aging (US), Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (ES), Region Östergötland, Andalusian School of Public Health (ES), Universidad Politécnica de Madrid (ES)
Ministerio de Ciencia, Innovación y Universidades, European Commission, Universidad de Granada, Junta de Andalucía, HORIZON EUROPE Framework Programme, European Regional Development Fund, Agencia Estatal de Investigación, Ministerio de Universidades, NextGenerationEU
Good health and well-being
Openalex Percentile: Top 14%
Dietary Effects on Health
DOIOpen Access PDFOpenAlex
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