Randomised controlled trialindependent cross-checkabstract checked★ key study I-FAST-104 in-depth review
Time-restricted eating for fatty liver
Efficacy and safety of time-restricted eating in metabolic dysfunction-associated steatotic liver disease.
Overview
Oh JH et al.. J Hepatol 2025 · PMID 40543603 · DOI 10.1016/j.jhep.2025.06.005
Eating within a time window cut liver fat by about a quarter in 16 weeks, the same as simply eating fewer calories.
Does the study support the specific claim? Partly · Methodological quality: high
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Test TRE in fatty liver disease.
- How was the study done?
337 adults randomised to usual care, calorie restriction or TRE for 16 weeks; liver fat by MRI.
- How many people, animals or samples were studied?
333 Korean adults with MASLD and overweight.
- What was actually found?
TRE -25.8% vs CR -24.7% vs usual care +0.7% liver fat.
- How large was the observed effect?
TRE vs CR p>0.999; TRE vs SOC p<0.001.
- What do the results mean in everyday life?
Fasting windows help fatty liver because people eat less; eating less any other way works too.
- What are the study's limitations?
Short; Korean population; open-label.
- What does it say about Elawady's specific claim?
Contradicts 'intermittent fasting is the only treatment for fatty liver'.
- Do the results apply to Germany and Europe?
Applies; same physiology.
- What can explicitly not be concluded from this study?
Long-term liver outcomes (fibrosis, cirrhosis).
Scientific in-depth review
1. Full reference
- Authors
- Oh JH et al.
- Journal
- J Hepatol
- Year
- 2025
- Identifier
- PMID 40543603 DOI 10.1016/j.jhep.2025.06.005
- Verification
- verified – PubMed efetch 2026-10-26; Crossref update-to/updated-by check
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
Authors declare no competing interests.
2. Research question
Does time-restricted eating reduce liver fat in MASLD compared with standard of care and calorie restriction?
3. Study design and population
- Study design
- Randomised controlled trial – Randomised controlled trial, 3 arms, 16 weeks
- Population
Adults with overweight/obesity and MASLD
- Country
South Korea
- Period
not stated in abstract
- Sample size
337 randomised; 333 analysed (SOC 113, CR 110, TRE 110)
- Inclusion and exclusion criteria
not stated in abstract
4. Methods and endpoints
- Exposure / intervention
Time-restricted eating
- Comparator
Standard of care; calorie restriction
- Endpoints
Primary: hepatic steatosis by MRI-PDFF; secondary: fibrosis, body composition, lipids, glucose, sleep
- Statistical methods
Full analysis set; between-group comparisons
5. Actual results
- Results
Hepatic steatosis changed -25.8% with TRE vs +0.7% with standard of care (p<0.001) and -24.7% with calorie restriction (TRE vs CR p>0.999). TRE reduced weight, waist and fat mass more than SOC; changes comparable to CR. Liver stiffness, glucose homeostasis and sleep similar between TRE and CR. No serious adverse events.
- Absolute risks
not reported
- Authors' conclusion
TRE effectively reduces hepatic steatosis in MASLD, with benefits comparable to calorie restriction; may serve as a practical strategy.
6. Strengths
- Large RCT with MRI-PDFF primary endpoint
- Active comparator (calorie restriction)
7. Weaknesses
- 16 weeks only; no histology
- Open-label dietary intervention
8. Risk of bias
- Orienting tool
- RoB 2
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
Open label (unavoidable); objective imaging endpoint lowers detection bias.
9. Assessment of the statistical interpretation
TRE and CR reduced liver fat by about a quarter; no difference between them, so the benefit is not specific to fasting.
10. Relevance to the specific claim
Real finding that time-restricted eating reduces liver fat - but equally to ordinary calorie restriction, which refutes 'the only treatment'.
11. Independent contrary findings
EASL-EASD-EASO 2024 lists several effective approaches (I-FAST-105).
12. Transferability to Germany and Europe
Korean population; physiology transferable; Egyptian MASLD burden high.
13. Overall methodological judgement
High-quality direct evidence: fasting works for fatty liver about as well as eating less, not uniquely.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | high |
| Risk of bias | some concerns |
| Precision of results | moderate |
| Directness | direct |
| Reproducibility | partly replicated |
| Consistency with the overall evidence | consistent |
| Regional transferability | moderate |
| Adequacy of the interpretation (by the archive) | not applicable |