Lifestyle Intervention on Metabolic Homeostasis

Exploratory Personalized Lifestyle Intervention on Metabolic Homeostasis in Overweight or Obese Chinese Population

This is an exploratory controlled before-after study, which involves 112 participants, of whom 28 are with normal weight and 84 are overweight or obese. Twelve weeks of personalized nutritional and lifestyle weight reduction intervention will be conducted in the overweight or obese participants. The objectives of this study are to 1) characterize metabolic homeostasis under resting and exercise conditions, 2) to explore the potential impact factors on metabolic homeostasis, and 3) to investigate whether personalized nutritional and lifestyle weight reduction intervention can improve metabolic health in overweight or obese Chinese individuals and how is it comparable to healthy normal weight Chinese population.

The objectives of this study are to 1) characterize metabolic homeostasis under resting and exercise conditions, 2) to explore the potential impact factors on metabolic homeostasis, and 3) to investigate whether personalized nutritional and lifestyle weight reduction intervention can improve metabolic health in overweight or obese Chinese individuals and how is it comparable to healthy normal weight Chinese population. In this study, 84 overweight or obese participants (BMI ≥ 24 kg/m2) and 28 normal weight participants (18.5 ≤ BMI<24 kg/m2) will be recruited and receive 12-week personalized weight reduction or weight maintenance nutritional and lifestyle interventions. Before and after the 12-week interventions, metabolic homeostasis will be used to characterize metabolic health and to be determined using comprehensive measurements of dynamic changes in postprandial metabolic responses (including energy metabolism, multiple clinical biomarkers, metabolomic signatures, gut microbiota, genetic signatures etc.) after the standardized mixed-nutrient dietary challenges (75 g glucose, 60 g fat and 20 g protein) in whole room indirect calorimeter under both resting and exercise conditions. In addition, data from dietary intake, anthropometric measurements, body composition, psychosocial measures, behavior questionnaires and 14-day continuous glucose monitoring will also be collected to characterize metabolic homeostasis. During the interventions, participants will receive personalized dietary advice, behavior guidance and nutritional and lifestyle education by dietitian and physicians. APP-connected wearable devices will be utilized to monitor their dietary intakes, physical activities and sleep conditions, and an application-connected scale will be used to monitor their weight changes during interventions. The study's protocol has been approved by the Ethics Committee of Sir Run Run Shaw Hospital.

They will receive personalized nutritional and lifestyle weight reduction intervention including dietary advice, behavior guidance and nutritional and lifestyle education by dietitian and physicians.

Participants will receive general dietary advice, behavior guidance and nutritional and lifestyle education based on dietary guidelines.

Participants will receive personalized dietary advice, behavior guidance and nutritional and lifestyle education by dietitian and physicians. APP-connected wearable devices will be utilized to monitor their dietary intakes, physical activities and sleep conditions and APP-connected scale will be used to monitor their weight changes during interventions.

A metabolic homeostasis score is a composite score that includes aggregated changes in blood biomarkers (metabolites or biomarkers or index involved in carbohydrates metabolism such as glucose, C-peptide, Matsuda index etc.; metabolites or biomarkers involved in lipid metabolism such as high-density lipoprotein cholesterol, total cholesterol, triglyceride etc.; metabolites or biomarkers involved in protein/vitamin metabolism such as creatinine; inflammatory or cytokines such as interleukin-6 etc.; hormones; anthropometric measures etc.). The metabolic homeostasis score is a composite score, that is calculated by the average of the scores of above-mentioned features using a certain computational algorithm. The larger the metabolic homeostasis score is, the worse the homeostatic resilience of the person, and vice versa.

The change between the baseline and after 12-week lifestyle intervention. Weight will be assessed by Seca-255 (ScalesGalore).

The change between the baseline and after 12-week lifestyle intervention. Weight and height will be assessed by Seca-255 (ScalesGalore).

The change between the baseline and after 12-week lifestyle intervention. Waist circumference will be assessed by Seca-201(ScalesGalore).

The change between the baseline and after 12-week lifestyle intervention. Waist circumference will be assessed by Seca-201(ScalesGalore).

The change of systolic and diastolic blood pressures between the baseline and after 12-week lifestyle intervention. Both systolic pressure and diastolic pressure will be assessed using electronic blood pressure monitor (Omron J750).

The change of systolic and diastolic blood pressures between the baseline and after 12-week lifestyle intervention. Heart rate will be assessed using Omron J750.

The change between the baseline and after 12-week lifestyle intervention. Body composition will assessed using dual energy x-ray absorptiometry (DXA) (GE).

The change between the baseline and after 12-week lifestyle intervention. Energy expenditure will be assessed using whole room indirect calorimeter.

The change between the baseline and after 12-week lifestyle intervention. Respiratory quotient will be assessed using whole room indirect calorimeter.

The change between the baseline and after 12-week lifestyle intervention. Glucose homeostasis will be assessed by Continuous Glucose Monitoring (FreeStyle Libre).

The dynamic change of glucose from 0 to 30, 60, 120, 180, 240, 300 minutes pre- and post-oral mixed-nutrient dietary challenge between the baseline and after 12-week lifestyle intervention.

The dynamic change of C-peptide from 0 to 30, 60, 120, 180, 240, 300 minutes pre- and post-oral mixed-nutrient dietary challenge between the baseline and after 12-week lifestyle intervention.

The dynamic change of insulin indices from 0 to 30, 60, 120, 180, 240, 300 minutes pre- and post-oral mixed-nutrient dietary challenge between the baseline and after 12-week lifestyle intervention.

The dynamic change of lipid parameters from 0 to 30, 60, 120, 180, 240, 300 minutes pre- and post-oral mixed-nutrient dietary challenge between the baseline and after 12-week lifestyle intervention.

The dynamic change from 0 to 30, 60, 120, 180, 240, 300 minutes pre- and post-oral mixed-nutrient dietary challenge between the baseline and after 12-week lifestyle intervention.

The dynamic change from 0 to 30, 60, 120, 180, 240, 300 minutes pre- and post-oral mixed-nutrient dietary challenge between the baseline and after 12-week lifestyle intervention.

The dynamic change in gastrointestinal hormones from 0 to 30, 60, 120, 180, 240, 300 minutes pre- and post-oral mixed-nutrient dietary challenge between the baseline and after 12-week lifestyle intervention.

The dynamic change in cell adhesion molecules from 0 to 30, 60, 120, 180, 240, 300 minutes pre- and post-oral mixed-nutrient dietary challenge between the baseline and after 12-week lifestyle intervention.

The dynamic change in adipokines from 0 to 30, 60, 120, 180, 240, 300 minutes pre- and post-oral mixed-nutrient dietary challenge between the baseline and after 12-week lifestyle intervention.

The dynamic change in metabolomics including profiling of free fatty acids and other metabolites from 0 to 30, 60, 120, 180, 240, 300 minutes pre- and post-oral mixed-nutrient dietary challenge between the baseline and after 12-week lifestyle intervention. Metabolomics will be measured by LC-MS.

Inclusion Criteria: 20-70 years of age, inclusive BMI ≥ 24kg/m2 Not in other clinical studies currently or in the past three months Exclusion Criteria: Fasting glucose >7.0mmol/L or diagnosed diabetes or taking insulin or other blood glucose-lowering drugs Blood pressure > 160/100 mmHg; diagnosed phase II or III hypertension or cannot decrease SBP under 160mmHg after anti-hypertension drugs Fasting blood TG≥ 5.7 mmol/L or fasting LDL-C≥ 4.9 mmol/L or cannot control TG < 5.7 mmol/L or LDL-C < 4.9 mmol/L after taking lipid lowering drugs Pregnant or lactating Attempting to change body weight in the past 3 months Use of antibiotic in the preceding 3 months for 3-serial days Use of estrogen therapy or hormonal drugs in the preceding 6 months Smokers History of alcohol abuse or other substance abuse (Alcohol abuse is defined as regular alcohol consumption > 40 g/day for females or > 80 g/day for males) Severe renal disease or liver disease Severe gastrointestinal diseases Surgical events preceding 1 year (except appendicitis or hernia surgery) Severe cardiovascular or cerebrovascular diseases Implantation of heart stent or any device containing metal material Cancer or receiving radiotherapy and chemotherapy within 5 years Hyperthyroidism or hypothyroidism Suffering from AIDS, hepatitis A, hepatitis B and other infectious diseases Claustrophobia Physical disability Any mental disorders or current use of antidepressants Cognitive disability