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Diet, Immunometabolism and Non-alcoholic Fatty Liver Disease

Primary Purpose

Non-Alcoholic Fatty Liver Disease, Liver Fat, Obesity

Status
Recruiting
Phase
Not Applicable
Locations
Ireland
Study Type
Interventional
Intervention
Standard healthy eating advice
eTRE plus Mediterranean diet
Sponsored by
University College Dublin
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Non-Alcoholic Fatty Liver Disease

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Males and females Age 18-65 years, from all ethnic groups, capable of providing informed consent to participate Obesity (body mass index >30kg/m^2) and of stable body weight (±3% for ≥3 months) Fasting blood glucose <7.0 mmol/L and HbA1c <6.5%. Liver fat >10% (CAP score >238 dB/m) and no fibrosis (liver stiffness score 2-7 kPa) as assessed by liver elastography (FibroScan) Exclusion Criteria: Impaired renal function Abnormal hematocrit History of cardiovascular events Uncontrolled hypertension Type 2 diabetes Medications or supplements known to affect glucose or lipid metabolism Active inflammatory, autoimmune, infectious, gastrointestinal, or malignant disease Uncontrolled neurological or psychiatric disease Iron deficiency anemia, (hemoglobin < 12g/dl men, < 11g/dl women) Fatty acid supplements and consumers of high doses of anti- antioxidant vitamins (A, C, E, b-carotene)

Sites / Locations

  • University College DublinRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Experimental

Arm Label

Standard healthy eating advice

eTRE plus Mediterranean diet

Arm Description

Subjects in this group will be counselled according to the Irish National Healthy Eating Guidelines.

Subjects in this group will be asked to restrict their eating to 8-hours daily (8am - 4pm) and to adhere to a Mediterranean style diet.

Outcomes

Primary Outcome Measures

Change in plasma inflammatory response to a high-fat meal: C-reactive protein (CRP)
Postprandial changes in CRP (mg/L) will be measured in response to a high-fat meal
Change in plasma inflammatory response to a high-fat meal: Interleukin-6 (IL-6)
Postprandial changes in IL-6 (pg/mL) will be measured in response to a high-fat meal
Change in plasma inflammatory response to a high-fat meal: Interleukin-1-beta (IL-1β)
Postprandial changes in IL-1β (pg/mL) will be measured in response to a high-fat meal
Change in plasma inflammatory response to a high-fat meal: Tumor necrosis factor alpha (TNF-α)
Postprandial changes in (TNF-α) (pg/mL) will be measured in response to a high-fat meal

Secondary Outcome Measures

Change in metabolic response to a high-fat meal: Glucose
Plasma glucose (mg/dL) response to a high-fat meal will be assessed
Change in metabolic response to a high-fat meal: Insulin
Plasma insulin (μU/mL) response to a high-fat meal will be assessed
Change in metabolic response to a high-fat meal: Glucagon
Plasma glucagon (pg/mL) response to a high-fat meal will be assessed
Change in metabolic response to a high-fat meal: Triglycerides
Plasma triglycerides (mg/dL) response to a high-fat meal will be assessed
Change in metabolic response to a high-fat meal: Non-esterified fatty acids (NEFA)
Plasma NEFA (mmol/L) response to a high-fat meal will be assessed
Innate immune function
8-week change in innate immune function will be assessed ex-vivo using whole blood simulation assay.
Innate immune training
8-week change in innate immune function will be assessed in isolated monocytes stimulated with beta glucan and restimulated with lipopolysaccharide.
Insulin resistance
8-week change in insulin resistance using Homeostatic Model Assessment for Insulin Resistance (HOMA-IR).
Adipose tissue insulin resistance
8-week change in adipose tissue insulin resistance using the adipose tissue insulin resistance index (Adipo-IR).
Change in intrahepatic triglyceride content
Liver elastography (FibroScan) will be used to determine change in liver fat after the 8-week intervention.
Change in liver stiffness measurement
Liver elastography (FibroScan) will be used to determine change in liver stiffness after the 8-week intervention.
HDL Proteome
8-week change in the composition of the HDL proteome.
Body weight
8-week change in body weight in kilograms
Body mass index (BMI)
8-week change in BMI
Body fat percentage
8 week change in body fat percentage using bioelectrical impedance analysis
Waist and hip circumferences
8-week change in waist and hip circumference measured in centimeters using a body tape measure
Gut microbiome composition and function
8-week functional changes in gut microbiome will be assessed by integrating 16S sequencing of fecal samples with fecal water metabolomics.
Dietary intake
8-week change in dietary intake using a 3-day semi-weighed food diary.
Physical activity level (PAL)
8-week change in PAL using the International Physical Activity Questionnaire - Short form (IPAQ-SF). This form has 7 questions about time spent doing physical activity(leisure time, work, domestic tasks, and travel) in the last 7 days. Activities are grouped according to vigorous or moderate intensity, and walking. Each intensity is assigned a metabolic equivalent (MET). The time spent at each intensity is used to estimate weekly physical activity using the associated METs. Minimum and maximum values are 0 and 154,224 METs. Classification as 'sufficiently active' requires ≥600 METs/week which may be achieved through a combination of intensities. Classification as 'highly active' requires: a) vigorous-intensity activity on ≥3 days achieving a minimum of ≥1500 METs/week OR b) ≥7 days of any combination of walking, moderate-intensity or vigorous-intensity activities achieving ≥ 3000 METs/week. A physical activity level below these categories is undesirable.
Mediterranean diet adherence
8-week change in Mediterranean diet adherence score using the PREDIMED 14-item Mediterranean Diet Assessment Tool. This questionnaire is used to assess adherence to the traditional Mediterranean Diet. Two of the 14 questions relate to the use of olive oil, a key component of the Mediterranean Diet, and 12 questions relate to the consumption of foods which characterize the Mediterranean Diet. Each item has a criteria which must be met to achieve 1 point e.g., at least 3 pieces of fruit daily. The minimum score is 0 and the maximum is 14, where a score of ≤ 5 indicates low adherence, 6-9 moderate adherence, and > 9 high adherence.

Full Information

First Posted
June 26, 2023
Last Updated
July 26, 2023
Sponsor
University College Dublin
Collaborators
St. James's Hospital, Ireland
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1. Study Identification

Unique Protocol Identification Number
NCT05968378
Brief Title
Diet, Immunometabolism and Non-alcoholic Fatty Liver Disease
Official Title
Immunometabolic Effects of Time Restricted Eating in Non-alcoholic Fatty Liver Disease
Study Type
Interventional

2. Study Status

Record Verification Date
July 2023
Overall Recruitment Status
Recruiting
Study Start Date
June 1, 2023 (Actual)
Primary Completion Date
June 2024 (Anticipated)
Study Completion Date
July 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
University College Dublin
Collaborators
St. James's Hospital, Ireland

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
This study will assess the impact of 8-hour time restricted eating (8 hours of eating, 16 hours fasting) combined with a Mediterranean diet on metabolism and inflammation in adults with non-alcoholic fatty liver disease (NAFLD).
Detailed Description
Non-alcoholic fatty liver disease (NAFLD), defined as the accumulation of fat in the liver that is not related to alcohol intake, is the number 1 global cause of chronic liver disease. Excessive consumption of energy, saturated fat, and simple sugars is a key contributor to hepatic lipid accumulation and obesity-induced metabolic inflammation, reflecting cross-talk between immune and metabolic pathways. Moreover, dietary factors including saturated fatty acids, cholesterol, and their derivatives, as well as gut-derived metabolites, can prime innate immune cells to induce an exaggerated pro-inflammatory response upon re-exposure to such stimuli and may contribute to chronic low grade inflammation. Dietary strategies focusing on replacing inflammatory dietary triggers with monounsaturated fats, fiber and complex carbohydrates have been shown to improve metabolic dysfunction, but how this relates to a rewiring of the innate immune system is less clear. Time-restricted eating (TRE) is another dietary strategy which has been shown to elicit beneficial effects that reduce the risk of chronic metabolic disease and consolidates eating to a 6-10 hour period daily. Early TRE (eTRE), wherein eating occurs from morning to early afternoon, is associated with greater cardiometabolic health benefits than eating late in the evening. This includes improved insulin sensitivity, glucose tolerance and lipid metabolism, and reduced inflammatory markers. This study will determine the impact of an 8-week intervention of 8-hour eTRE combined with an anti-inflammatory Mediterranean diet on the metabolic and immune phenotype of individuals with NAFLD, a population at high risk of progressive cardiometabolic decline and chronic inflammation. By focusing on improving both nutrient quality and nutrient timing, a greater understanding of the interaction between systemic metabolism and immune cell rewiring will be gained.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Non-Alcoholic Fatty Liver Disease, Liver Fat, Obesity, Inflammation

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
60 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Standard healthy eating advice
Arm Type
Active Comparator
Arm Description
Subjects in this group will be counselled according to the Irish National Healthy Eating Guidelines.
Arm Title
eTRE plus Mediterranean diet
Arm Type
Experimental
Arm Description
Subjects in this group will be asked to restrict their eating to 8-hours daily (8am - 4pm) and to adhere to a Mediterranean style diet.
Intervention Type
Behavioral
Intervention Name(s)
Standard healthy eating advice
Intervention Description
Subjects in this group will be provided with standard healthy eating advice according to the Irish National Healthy Eating Guidelines and Food Pyramid and will be asked to follow this advice for 8-weeks.
Intervention Type
Behavioral
Intervention Name(s)
eTRE plus Mediterranean diet
Intervention Description
Subjects in this group will be asked to consume all meals between 8am - 4pm and to adhere to a Mediterranean style diet daily for 8-weeks.
Primary Outcome Measure Information:
Title
Change in plasma inflammatory response to a high-fat meal: C-reactive protein (CRP)
Description
Postprandial changes in CRP (mg/L) will be measured in response to a high-fat meal
Time Frame
To be assessed at baseline and post 8-week intervention
Title
Change in plasma inflammatory response to a high-fat meal: Interleukin-6 (IL-6)
Description
Postprandial changes in IL-6 (pg/mL) will be measured in response to a high-fat meal
Time Frame
To be assessed at baseline and post 8-week intervention
Title
Change in plasma inflammatory response to a high-fat meal: Interleukin-1-beta (IL-1β)
Description
Postprandial changes in IL-1β (pg/mL) will be measured in response to a high-fat meal
Time Frame
To be assessed at baseline and post 8-week intervention
Title
Change in plasma inflammatory response to a high-fat meal: Tumor necrosis factor alpha (TNF-α)
Description
Postprandial changes in (TNF-α) (pg/mL) will be measured in response to a high-fat meal
Time Frame
To be assessed at baseline and post 8-week intervention
Secondary Outcome Measure Information:
Title
Change in metabolic response to a high-fat meal: Glucose
Description
Plasma glucose (mg/dL) response to a high-fat meal will be assessed
Time Frame
To be assessed at baseline and post 8-week intervention
Title
Change in metabolic response to a high-fat meal: Insulin
Description
Plasma insulin (μU/mL) response to a high-fat meal will be assessed
Time Frame
To be assessed at baseline and post 8-week intervention
Title
Change in metabolic response to a high-fat meal: Glucagon
Description
Plasma glucagon (pg/mL) response to a high-fat meal will be assessed
Time Frame
To be assessed at baseline and post 8-week intervention
Title
Change in metabolic response to a high-fat meal: Triglycerides
Description
Plasma triglycerides (mg/dL) response to a high-fat meal will be assessed
Time Frame
To be assessed at baseline and post 8-week intervention
Title
Change in metabolic response to a high-fat meal: Non-esterified fatty acids (NEFA)
Description
Plasma NEFA (mmol/L) response to a high-fat meal will be assessed
Time Frame
To be assessed at baseline and post 8-week intervention
Title
Innate immune function
Description
8-week change in innate immune function will be assessed ex-vivo using whole blood simulation assay.
Time Frame
To be assessed at baseline and post 8-week intervention
Title
Innate immune training
Description
8-week change in innate immune function will be assessed in isolated monocytes stimulated with beta glucan and restimulated with lipopolysaccharide.
Time Frame
To be assessed at baseline and post 8-week intervention
Title
Insulin resistance
Description
8-week change in insulin resistance using Homeostatic Model Assessment for Insulin Resistance (HOMA-IR).
Time Frame
To be assessed at baseline and post 8-week intervention
Title
Adipose tissue insulin resistance
Description
8-week change in adipose tissue insulin resistance using the adipose tissue insulin resistance index (Adipo-IR).
Time Frame
To be assessed at baseline and post 8-week intervention
Title
Change in intrahepatic triglyceride content
Description
Liver elastography (FibroScan) will be used to determine change in liver fat after the 8-week intervention.
Time Frame
To be assessed at baseline and post 8-week intervention
Title
Change in liver stiffness measurement
Description
Liver elastography (FibroScan) will be used to determine change in liver stiffness after the 8-week intervention.
Time Frame
To be assessed at baseline and post 8-week intervention
Title
HDL Proteome
Description
8-week change in the composition of the HDL proteome.
Time Frame
To be assessed at baseline and post 8-week intervention
Title
Body weight
Description
8-week change in body weight in kilograms
Time Frame
To be assessed at baseline and post 8-week intervention
Title
Body mass index (BMI)
Description
8-week change in BMI
Time Frame
To be assessed at baseline and post 8-week intervention
Title
Body fat percentage
Description
8 week change in body fat percentage using bioelectrical impedance analysis
Time Frame
To be assessed at baseline and post 8-week intervention
Title
Waist and hip circumferences
Description
8-week change in waist and hip circumference measured in centimeters using a body tape measure
Time Frame
To be assessed at baseline and post 8-week intervention
Title
Gut microbiome composition and function
Description
8-week functional changes in gut microbiome will be assessed by integrating 16S sequencing of fecal samples with fecal water metabolomics.
Time Frame
To be assessed at baseline and post 8-week intervention
Title
Dietary intake
Description
8-week change in dietary intake using a 3-day semi-weighed food diary.
Time Frame
To be assessed at baseline and post 8-week intervention
Title
Physical activity level (PAL)
Description
8-week change in PAL using the International Physical Activity Questionnaire - Short form (IPAQ-SF). This form has 7 questions about time spent doing physical activity(leisure time, work, domestic tasks, and travel) in the last 7 days. Activities are grouped according to vigorous or moderate intensity, and walking. Each intensity is assigned a metabolic equivalent (MET). The time spent at each intensity is used to estimate weekly physical activity using the associated METs. Minimum and maximum values are 0 and 154,224 METs. Classification as 'sufficiently active' requires ≥600 METs/week which may be achieved through a combination of intensities. Classification as 'highly active' requires: a) vigorous-intensity activity on ≥3 days achieving a minimum of ≥1500 METs/week OR b) ≥7 days of any combination of walking, moderate-intensity or vigorous-intensity activities achieving ≥ 3000 METs/week. A physical activity level below these categories is undesirable.
Time Frame
To be assessed at baseline and post 8-week intervention
Title
Mediterranean diet adherence
Description
8-week change in Mediterranean diet adherence score using the PREDIMED 14-item Mediterranean Diet Assessment Tool. This questionnaire is used to assess adherence to the traditional Mediterranean Diet. Two of the 14 questions relate to the use of olive oil, a key component of the Mediterranean Diet, and 12 questions relate to the consumption of foods which characterize the Mediterranean Diet. Each item has a criteria which must be met to achieve 1 point e.g., at least 3 pieces of fruit daily. The minimum score is 0 and the maximum is 14, where a score of ≤ 5 indicates low adherence, 6-9 moderate adherence, and > 9 high adherence.
Time Frame
To be assessed at baseline and post 8-week intervention

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Males and females Age 18-65 years, from all ethnic groups, capable of providing informed consent to participate Obesity (body mass index >30kg/m^2) and of stable body weight (±3% for ≥3 months) Fasting blood glucose <7.0 mmol/L and HbA1c <6.5%. Liver fat >10% (CAP score >238 dB/m) and no fibrosis (liver stiffness score 2-7 kPa) as assessed by liver elastography (FibroScan) Exclusion Criteria: Impaired renal function Abnormal hematocrit History of cardiovascular events Uncontrolled hypertension Type 2 diabetes Medications or supplements known to affect glucose or lipid metabolism Active inflammatory, autoimmune, infectious, gastrointestinal, or malignant disease Uncontrolled neurological or psychiatric disease Iron deficiency anemia, (hemoglobin < 12g/dl men, < 11g/dl women) Fatty acid supplements and consumers of high doses of anti- antioxidant vitamins (A, C, E, b-carotene)
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Helen M Roche, Professor
Phone
+353017164031
Email
helen.roche@ucd.ie
First Name & Middle Initial & Last Name or Official Title & Degree
Christopher E Shannon, PhD
Email
christopher.shannon@ucd.ie
Facility Information:
Facility Name
University College Dublin
City
Dublin
State/Province
Leinster
ZIP/Postal Code
D04 V1W8
Country
Ireland
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Helen M Roche, Professor
Phone
+353 01 7164031
Email
helen.roche@ucd.ie
First Name & Middle Initial & Last Name & Degree
Christopher E Shannon, PhD
Email
christopher.shannon@ucd.ie
First Name & Middle Initial & Last Name & Degree
Helen M Roche, Professor

12. IPD Sharing Statement

Learn more about this trial

Diet, Immunometabolism and Non-alcoholic Fatty Liver Disease

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