Almonds and Health Effects on Metabolism, Vascular Function and Cognition
Primary Purpose
PreDiabetes, Impaired Glucose Tolerance, Impaired Fasting Glucose
Status
Completed
Phase
Not Applicable
Locations
Netherlands
Study Type
Interventional
Intervention
Almonds
Sponsored by
About this trial
This is an interventional supportive care trial for PreDiabetes
Eligibility Criteria
Inclusion Criteria:
- Aged between 40-70 years
- Men and women
- BMI between 25-35 kg/m2 (overweight and obese)
- Being classified as having impaired glucose tolerance (IGT) and/or impaired fasting glucose (IFG). IGT is defined according the criteria of the WHO and American Diabetes Association (ADA) as two-hour glucose concentrations of 7.8 to 11.0 mmol/l (140 to 199 mg per dL) during the 75-g oral glucose tolerance test. IFG is defined as having a fasting plasma glucose between 6.1 and 7.0 mmol/l (110 to 125 mg per dL) and a two-hour glucose concentration below 7.8 mmol/l (140 mg per dL).
- Serum total cholesterol < 8.0 mmol/L (further testing is recommended for excessive hyperlipidemia [serum total cholesterol ≥ 8.0 mmol/L] according to the Standard for cardiovascular risk management of the Dutch general practitioners community [NHG])
- Serum triacylglycerol < 4.52 mmol/L
- No current smoker
- No diabetic patients
- No familial hypercholesterolemia
- No abuse of drugs
- Not more than 4 alcoholic consumption per day with a maximum of 21 per week
- Stable body weight (weight gain or loss < 3 kg in the past three months)
- No use of medication known to treat blood pressure, lipid or glucose metabolism
- No use of an investigational product within another biomedical intervention trial within the previous 1-month
- No severe medical conditions that might interfere with the study, such as epilepsy, asthma, kidney failure or renal insufficiency, chronic obstructive pulmonary disease, inflammatory bowel diseases, auto inflammatory diseases and rheumatoid arthritis
- No active cardiovascular disease like congestive heart failure or cardiovascular event, such as an acute myocardial infarction or cerebrovascular accident
- Willingness to give up being a blood donor from 8 weeks before the start of the study, during the study and for 4 weeks after completion of the study
- No difficult venipuncture as evidenced during the screening visit
- Willing to comply to study protocol during study
- Informed consent signed
Exclusion Criteria:
- Allergy or intolerance to almonds
- Serum total cholesterol ≥ 8.0 mmol/L
- Serum triacylglycerol ≥ 4.52 mmol/L
- Current smoker, or smoking cessation <12 months
- Diabetic patients
- Familial hypercholesterolemia
- Abuse of drugs
- More than 4 alcoholic consumptions per day or 21 per week
- Unstable body weight (weight gain or loss > 3 kg in the past three months)
- Use medication known to treat blood pressure, lipid or glucose metabolism
- Use of an investigational product within another biomedical intervention trial within the previous 1-month
- Severe medical conditions that might interfere with the study, such as epilepsy, asthma, kidney failure or renal insufficiency, chronic obstructive pulmonary disease, inflammatory bowel diseases, auto inflammatory diseases and rheumatoid arthritis
- Active cardiovascular disease like congestive heart failure or cardiovascular event, such as an acute myocardial infarction or cerebrovascular accident
- Not willing to give up being a blood donor from 8 weeks before the start of the study, during the study or for 4 weeks after completion of the study
- Not or difficult to venipuncture as evidenced during the screening visit
- Use of over-the-counter and prescribed medication or supplements, which may interfere with study measurements to be judged by the principal investigator;
- Use of oral antibiotics in 40 days or less prior to the start of the study;
- Blood donation in the past 3 months before the start of the study
- Not willing to comply to study protocol during study or sign informed consent
Sites / Locations
- Maastricht University, Department of Nutrition and Movement Sciences
Arms of the Study
Arm 1
Arm 2
Arm Type
No Intervention
Experimental
Arm Label
Control
Experimental
Arm Description
No almonds
Almonds
Outcomes
Primary Outcome Measures
Insulin sensitivity
Glucose infusion rate during a hyper-insulinemic euglycemic clamp.
Secondary Outcome Measures
Glucose concentrations
Fasting plasma glucose concentrations will be determined in blood samples.
Markers for fasting lipid metabolism
Markers for fasting lipid metabolism include serum total cholesterol (mmol/L), HDL cholesterol (mmol/L), and triacylglycerol (mmol/L) concentrations.
LDL cholesterol concentrations
Fasting LDL cholesterol concentrations will be determined in blood samples using the Friedewald equation.
C-reactive protein concentrations
Concentrations of CRP will be determined in blood samples.
Blood pressure
Systolic and diastolic blood pressure.
Body weight
Body weight in kg.
Body circumferences
Waist and hip circumferences.
Pulse Wave Analysis
Vascular function (arterial stiffness).
Pulse Wave Velocity
Vascular function (arterial stiffness).
Retinal microvascular caliber
Arteriovenous ratio and diameter of retinal arterioles and venules will be measured by retinal microvascular imaging.
Cognitive performance
Cambridge Neuropsychological Test Automated Battery.
Markers for low-grade systemic inflammation
Markers for low-grade systemic inflammation include IL-6, IL-8, TNF-alpha and SAA.
Markers for endothelial dysfunction
Markers for endothelial dysfunction include sVCAM-1, sICAM-1 and soluble E-selectin.
Markers for postprandial lipid metabolism
Markers for postprandial lipid metabolism include triacylglycerol (mmol/L) and NEFA concentrations.
Markers for fasting and postprandial glucose and insulin metabolism
Markers for fasting and postprandial glucose and insulin metabolism include plasma glucose, serum insulin, C-peptide and HbA1c concentrations. Also HOMA-IR will be calculated.
Markers for liver function
Markers for liver function include ALAT and ASAT concentrations.
Markers for nerve growth
Markers for nerve growth include BDNF concentrations.
Markers for advanced glycation endproducts
Markers for advanced glycation endproducts include dicarbonyl, CML, CEL and MG-H1 concentrations.
Nitric oxides concentrations
Concentrations of NOx will be determined in blood samples.
Cerebral blood flow
Arterial Spin labeling will be performed to determine cerebral blood flow.
Fat distribution in abdomen
Magnetic Resonance Imaging measurements will be included to quantify abdominal fat compartments (i.e. subcutaneous and visceral fat) and fat content of abdominal organs (i.e. liver and pancreas).
Biopsies adipose tissue
Fat biopsies to examine fat cell size and inflammation in adipose tissue.
Biopsies muscle tissue
Muscle biopsies to examine mitochondrial function.
Lipid oxidation
Energy expenditure and substrate metabolism will be calculated from measurements via indirect calorimetry during the postprandial test.
Glucose oxidation
Energy expenditure and substrate metabolism will be calculated from measurements via indirect calorimetry during the postprandial test.
Blood pressure profiles
Blood pressure profiles will be measured for 48 hr via a Mobil-O-Graph.
Glucose profiles
Glucose profiles will be measured for 48 hr using the FreeStyle Libre Pro.
Physical activity profiles
Physical activity patterns will be monitored for 48 hr with the MOX device.
Microbiota composition
Fecal samples to be used for analysing microbiota composition will be collected.
General well-being
Quality of life and Affect grid questionnaires will be assessed.
Food frequency
Food frequency questionnaire will be assessed.
Skinfold measurements
Calliper testing for determining body fat composition.
Full Information
NCT ID
NCT03419702
First Posted
January 9, 2018
Last Updated
March 3, 2022
Sponsor
Maastricht University Medical Center
Collaborators
Almond Board of California
1. Study Identification
Unique Protocol Identification Number
NCT03419702
Brief Title
Almonds and Health Effects on Metabolism, Vascular Function and Cognition
Official Title
Effects of Almond Consumption on Chronic Glucose Regulation, Vascular Function and Cognitive Performance: The AL-INCLUSIVE Trial
Study Type
Interventional
2. Study Status
Record Verification Date
March 2022
Overall Recruitment Status
Completed
Study Start Date
January 10, 2018 (Actual)
Primary Completion Date
December 3, 2021 (Actual)
Study Completion Date
December 3, 2021 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Maastricht University Medical Center
Collaborators
Almond Board of California
4. Oversight
Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes
5. Study Description
Brief Summary
The primary objective of the proposed study is to examine and understand the impact of long-term almond consumption on chronic glucose metabolism in subjects with impaired glucose tolerance and/or impaired fasting glucose.
Detailed Description
Objectives:
Secondary objectives are to investigate if improved chronic glucose metabolism in subjects with impaired glucose tolerance and/or impaired fasting glucose after long-term almond consumption translates into improved peripheral and brain vascular function, and enhanced cognitive performance. In addition, the investigators will address to what extent improved chronic glucose metabolism in subjects with impaired glucose tolerance and/or impaired fasting glucose after long-term almond consumption can be explained by (combined) effects of lowered hepatic lipid accumulation and inflammation, skeletal muscle characteristics, visceral and subcutaneous fat accumulation, pancreatic function or fecal microbiota composition.
Study design:
The proposed study will be a 12 months randomised, controlled trial with a cross-over design. Two experimental periods of five months will be separated by a two months washout period.
Study population:
Forty-three impaired glucose tolerant and/or impaired fasting glucose subjects, with overweight and mild obesity (BMI 25-35 kg/m2), aged 40-70 years.
Intervention:
During the intervention period of 5 months, subjects will receive daily 50 gr almonds, but not in the 2 months washout and 5 months control periods.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
PreDiabetes, Impaired Glucose Tolerance, Impaired Fasting Glucose, Overweight and Obesity
7. Study Design
Primary Purpose
Supportive Care
Study Phase
Not Applicable
Interventional Study Model
Crossover Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
43 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Control
Arm Type
No Intervention
Arm Description
No almonds
Arm Title
Experimental
Arm Type
Experimental
Arm Description
Almonds
Intervention Type
Dietary Supplement
Intervention Name(s)
Almonds
Intervention Description
During the intervention period of 5 months, subjects will receive daily 50 gr almonds. Subjects are free to consume the almonds during the day whenever they want to, i.e. there will not be guidelines when to consume the almonds.
Primary Outcome Measure Information:
Title
Insulin sensitivity
Description
Glucose infusion rate during a hyper-insulinemic euglycemic clamp.
Time Frame
Change from control period (week 22 and week 52)
Secondary Outcome Measure Information:
Title
Glucose concentrations
Description
Fasting plasma glucose concentrations will be determined in blood samples.
Time Frame
Glucose will be measured at week 0, week 5, week 10, week 21, week 22, week 30, week 35, week 40, week 51, week 52
Title
Markers for fasting lipid metabolism
Description
Markers for fasting lipid metabolism include serum total cholesterol (mmol/L), HDL cholesterol (mmol/L), and triacylglycerol (mmol/L) concentrations.
Time Frame
These markers will be measured at week 0, week 5, week 10, week 21, week 22, week 30, week 35, week 40, week 51, week 52
Title
LDL cholesterol concentrations
Description
Fasting LDL cholesterol concentrations will be determined in blood samples using the Friedewald equation.
Time Frame
These markers will be calculated from measurements at week 0, week 5, week 10, week 21, week 22, week 30, week 35, week 40, week 51, week 52
Title
C-reactive protein concentrations
Description
Concentrations of CRP will be determined in blood samples.
Time Frame
CRP will be measured at week 0, week 5, week 10, week 21, week 22, week 30, week 35, week 40, week 51, week 52
Title
Blood pressure
Description
Systolic and diastolic blood pressure.
Time Frame
Blood pressure will be measured at week 0, week 5, week 10, week 21, week 22, week 30, week 35, week 40, week 51, week 52
Title
Body weight
Description
Body weight in kg.
Time Frame
Body weight will be measured at week 0, week 5, week 10, week 21, week 22, week 30, week 35, week 40, week 51, week 52
Title
Body circumferences
Description
Waist and hip circumferences.
Time Frame
Waist and hip circumferences will be measured at week 0, week 5, week 10, week 21, week 22, week 30, week 35, week 40, week 51, week 52
Title
Pulse Wave Analysis
Description
Vascular function (arterial stiffness).
Time Frame
Change from control period (week 21 and week 51)
Title
Pulse Wave Velocity
Description
Vascular function (arterial stiffness).
Time Frame
Change from control period (week 21 and week 51)
Title
Retinal microvascular caliber
Description
Arteriovenous ratio and diameter of retinal arterioles and venules will be measured by retinal microvascular imaging.
Time Frame
Change from control period (week 21 and week 51)
Title
Cognitive performance
Description
Cambridge Neuropsychological Test Automated Battery.
Time Frame
Cognition will be tested at week 0, week 10, week 21, week 30, week 40, week 51.
Title
Markers for low-grade systemic inflammation
Description
Markers for low-grade systemic inflammation include IL-6, IL-8, TNF-alpha and SAA.
Time Frame
Change from control period (week 21 and week 51)
Title
Markers for endothelial dysfunction
Description
Markers for endothelial dysfunction include sVCAM-1, sICAM-1 and soluble E-selectin.
Time Frame
Change from control period (week 21 and week 51)
Title
Markers for postprandial lipid metabolism
Description
Markers for postprandial lipid metabolism include triacylglycerol (mmol/L) and NEFA concentrations.
Time Frame
Change from control period (week 21 and week 51)
Title
Markers for fasting and postprandial glucose and insulin metabolism
Description
Markers for fasting and postprandial glucose and insulin metabolism include plasma glucose, serum insulin, C-peptide and HbA1c concentrations. Also HOMA-IR will be calculated.
Time Frame
Change from control period (week 21 and week 51)
Title
Markers for liver function
Description
Markers for liver function include ALAT and ASAT concentrations.
Time Frame
Change from control period (week 21 and week 51)
Title
Markers for nerve growth
Description
Markers for nerve growth include BDNF concentrations.
Time Frame
Change from control period (week 21 and week 51)
Title
Markers for advanced glycation endproducts
Description
Markers for advanced glycation endproducts include dicarbonyl, CML, CEL and MG-H1 concentrations.
Time Frame
Change from control period (week 21 and week 51)
Title
Nitric oxides concentrations
Description
Concentrations of NOx will be determined in blood samples.
Time Frame
Change from control period (week 21 and week 51)
Title
Cerebral blood flow
Description
Arterial Spin labeling will be performed to determine cerebral blood flow.
Time Frame
Change from control period (week 22 and week 52)
Title
Fat distribution in abdomen
Description
Magnetic Resonance Imaging measurements will be included to quantify abdominal fat compartments (i.e. subcutaneous and visceral fat) and fat content of abdominal organs (i.e. liver and pancreas).
Time Frame
Change from control period (week 22 and week 52)
Title
Biopsies adipose tissue
Description
Fat biopsies to examine fat cell size and inflammation in adipose tissue.
Time Frame
Change from control period (week 22 and week 52)
Title
Biopsies muscle tissue
Description
Muscle biopsies to examine mitochondrial function.
Time Frame
Change from control period (week 22 and week 52)
Title
Lipid oxidation
Description
Energy expenditure and substrate metabolism will be calculated from measurements via indirect calorimetry during the postprandial test.
Time Frame
Indirect calorimetry will be performed at week 21, week 22, week 51, week 52 at several time slots.
Title
Glucose oxidation
Description
Energy expenditure and substrate metabolism will be calculated from measurements via indirect calorimetry during the postprandial test.
Time Frame
Indirect calorimetry will be performed at week 21, week 22, week 51, week 52 at several time slots.
Title
Blood pressure profiles
Description
Blood pressure profiles will be measured for 48 hr via a Mobil-O-Graph.
Time Frame
Change from control period (week 21 and week 51)
Title
Glucose profiles
Description
Glucose profiles will be measured for 48 hr using the FreeStyle Libre Pro.
Time Frame
Change from control period (week 21 and week 51)
Title
Physical activity profiles
Description
Physical activity patterns will be monitored for 48 hr with the MOX device.
Time Frame
Change from control period (week 21 and week 51)
Title
Microbiota composition
Description
Fecal samples to be used for analysing microbiota composition will be collected.
Time Frame
Change from control period (week 21 and week 51)
Title
General well-being
Description
Quality of life and Affect grid questionnaires will be assessed.
Time Frame
General well-being will be tested at week 0, week 10, week 21, week 30, week 40, week 51.
Title
Food frequency
Description
Food frequency questionnaire will be assessed.
Time Frame
Food frequency will be tested at week 0, week 10, week 21, week 30, week 40, week 51.
Title
Skinfold measurements
Description
Calliper testing for determining body fat composition.
Time Frame
Change from control period (week 22 and week 52)
10. Eligibility
Sex
All
Minimum Age & Unit of Time
40 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Aged between 40-70 years
Men and women
BMI between 25-35 kg/m2 (overweight and obese)
Being classified as having impaired glucose tolerance (IGT) and/or impaired fasting glucose (IFG). IGT is defined according the criteria of the WHO and American Diabetes Association (ADA) as two-hour glucose concentrations of 7.8 to 11.0 mmol/l (140 to 199 mg per dL) during the 75-g oral glucose tolerance test. IFG is defined as having a fasting plasma glucose between 6.1 and 7.0 mmol/l (110 to 125 mg per dL) and a two-hour glucose concentration below 7.8 mmol/l (140 mg per dL).
Serum total cholesterol < 8.0 mmol/L (further testing is recommended for excessive hyperlipidemia [serum total cholesterol ≥ 8.0 mmol/L] according to the Standard for cardiovascular risk management of the Dutch general practitioners community [NHG])
Serum triacylglycerol < 4.52 mmol/L
No current smoker
No diabetic patients
No familial hypercholesterolemia
No abuse of drugs
Not more than 4 alcoholic consumption per day with a maximum of 21 per week
Stable body weight (weight gain or loss < 3 kg in the past three months)
No use of medication known to treat blood pressure, lipid or glucose metabolism
No use of an investigational product within another biomedical intervention trial within the previous 1-month
No severe medical conditions that might interfere with the study, such as epilepsy, asthma, kidney failure or renal insufficiency, chronic obstructive pulmonary disease, inflammatory bowel diseases, auto inflammatory diseases and rheumatoid arthritis
No active cardiovascular disease like congestive heart failure or cardiovascular event, such as an acute myocardial infarction or cerebrovascular accident
Willingness to give up being a blood donor from 8 weeks before the start of the study, during the study and for 4 weeks after completion of the study
No difficult venipuncture as evidenced during the screening visit
Willing to comply to study protocol during study
Informed consent signed
Exclusion Criteria:
Allergy or intolerance to almonds
Serum total cholesterol ≥ 8.0 mmol/L
Serum triacylglycerol ≥ 4.52 mmol/L
Current smoker, or smoking cessation <12 months
Diabetic patients
Familial hypercholesterolemia
Abuse of drugs
More than 4 alcoholic consumptions per day or 21 per week
Unstable body weight (weight gain or loss > 3 kg in the past three months)
Use medication known to treat blood pressure, lipid or glucose metabolism
Use of an investigational product within another biomedical intervention trial within the previous 1-month
Severe medical conditions that might interfere with the study, such as epilepsy, asthma, kidney failure or renal insufficiency, chronic obstructive pulmonary disease, inflammatory bowel diseases, auto inflammatory diseases and rheumatoid arthritis
Active cardiovascular disease like congestive heart failure or cardiovascular event, such as an acute myocardial infarction or cerebrovascular accident
Not willing to give up being a blood donor from 8 weeks before the start of the study, during the study or for 4 weeks after completion of the study
Not or difficult to venipuncture as evidenced during the screening visit
Use of over-the-counter and prescribed medication or supplements, which may interfere with study measurements to be judged by the principal investigator;
Use of oral antibiotics in 40 days or less prior to the start of the study;
Blood donation in the past 3 months before the start of the study
Not willing to comply to study protocol during study or sign informed consent
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jogchum Plat, PhD
Organizational Affiliation
Maastricht University
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Ronald P Mensink, PhD
Organizational Affiliation
Maastricht University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Maastricht University, Department of Nutrition and Movement Sciences
City
Maastricht
State/Province
Limburg
ZIP/Postal Code
6200 MD
Country
Netherlands
12. IPD Sharing Statement
Plan to Share IPD
No
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Almonds and Health Effects on Metabolism, Vascular Function and Cognition
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