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.