Background: Cystic fibrosis-related bone disease (CFBD) is a comorbidity whose prevalence is increasing. Conventional areal DXA (aDXA) only assesses part of bone strength, whereas new techniques provide a more comprehensive assessment of bone structure. However, these tools are rarely implemented systematically. Furthermore, the contribution of clinical factors to bone structural parameters remains insufficiently characterized. Therefore, this study aimed to comprehensively assess cortical and trabecular bone alterations in adults with CF, and to explore clinical and lifestyle factors associated with bone health. Methods: A case–control study was conducted including 32 adults with CF and 70 healthy controls matched by age, sex, and BMI. Bone status was assessed using aDXA, trabecular bone score (TBS), and three-dimensional DXA (3D-DXA). Clinical data, body composition, lifestyle variables, and biochemical markers were collected. Multivariate linear regression models were applied to explore factors associated with bone parameters. Results: Twenty-two percent of CF people had prevalent fragility fractures and the percentage with low bone mass was significantly higher (28.1% vs. 5.7%; p < 0.001). TBS categories indicated more degraded microarchitecture in CF (p = 0.002). Cortical and trabecular 3D-DXA values were also significantly lower (p < 0.001). Adherence to the Mediterranean diet (MedDiet) was significantly associated with most of the bone parameters evaluated. Other variables associated with bone parameters included sex, fat-free and fat mass, prolonged corticosteroid use, intake of oral nutritional supplements, FEV₁, disease duration and P1NP-values. Conclusions: Adults with CF revealed significant cortical and trabecular structural deficits. Among the evaluated factors, adherence to MedDiet was associated with several bone parameters, suggesting a potential role of dietary patterns in CF bone health. Further studies are needed to confirm these preliminary results.

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.