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CompletedNCT03339245Updated Mar 26, 2021Results posted

Effects of Dietary Fructose on Gut Microbiota and Fecal Metabolites in Obese Men and Postmenopausal Women: A Pilot Study

An interventional study of Fructose Solution (75 Grams) and Glucose Solution (75 grams) in Non-Alcoholic Fatty Liver Disease and Obesity, sponsored by Rockefeller University. Completed at 1 site in United States. Open to participants aged 45 Years to 70 Years, including healthy volunteers. Per ClinicalTrials.gov, last updated 2021-03-26.

Sponsored by Rockefeller University · Not applicable, Interventional, and Basic science

Phase
Not applicable
Study type
Interventional
Enrollment
13
Allocation
Randomized
Ages
45 Years to 70 Years
Sex
All
01

Study summary

Non alcoholic fatty liver disease (NAFLD) is the most common cause of abnormal liver function tests in the U.S. (Browning, et al., 2004), ranging from steatosis to end-stage liver disease. Fructose ingestion by the American public has steadily increased since the 1980's, and with it increases in NAFLD, fatty liver hepatitis (NASH), diabetes, obesity, and cardiovascular disease. Foods and beverage in the U.S. are typically sweetened with sucrose (50% glucose and 50% fructose) or high fructose corn syrup (45-58% glucose and 42-55% fructose) (Stanhope, et al., 2009). Research into the role that added fructose plays in the emerging chronic health issues is necessary to affect public policy and provide the connection between fructose and the increasing incidence of these co-morbidities.

There is evidence that gut bacteria contribute to a range of human diseases including those of the liver and gastrointestinal tract. Dietary fructose has been suggested to play a role in the development of these diseases and has been shown to alter gut microbes in animals. If the investigators find that dietary fructose alters bacteria in the human gut, this would suggest a potential targetable link between high fructose diet and disease.

Read the detailed description

Non- alcoholic fatty liver disease (NAFLD) occurs in 30% of the adult US population (Luther, J., et al., 2015). Eating large amounts of fructose (a dietary sugar) increases liver fat accumulation and worsens NAFLD. In addition, fructose consumption has been shown to greatly increase triglycerides(fat) in the blood after meals, increasing the risk of heart disease,(Stanhope,et al., 2009) insulin resistance and diabetes. Current theories on liver disease caused by consuming fructose focuses on changes in the breakdown of fat by the liver. In experimental animals, fructose feeding changes the bacteria population (microbiota) in the gut, causes NAFLD and NASH, and increases leaking of toxins from the intestine (intestinal permeability) to the blood stream resulting in inflammation.

In humans, fructose consumption rapidly increases liver fat. However, changes in gut microbiota have not been studied. The proposed study will compare the addition of fructose or glucose to the study subjects' usual diet in a crossover design. They will not know which sugar they are receiving.

The Investigators plan to study postmenopausal, moderately obese but healthy women, and moderately obese but healthy men (age 45-70 years) to find out the effect of fructose verses glucose on the bacteria in their stool and inflammation in the bowel. The Investigators hypothesize that adding fructose to the participant's usual diet, compared to glucose, will change stool bacteria composition and the products that the bacteria produce, which may increase intestinal leakage, and increase markers of inflammation in the stool and blood due to this leakage. These changes may contribute to fructose -induced liver disease.

02

Conditions studied

  • Non-Alcoholic Fatty Liver Disease
  • Obesity

Keywords

  • obesity
  • fructose
  • glucose
  • fecal microbiota
  • intestinal permiability
  • fecal metabolites
03

Who can participate

Ages eligible
45 Years to 70 Years
Sexes eligible
All
Accepts healthy volunteers
Yes

Inclusion criteria

  • Post menopausal female, last menstrual period at least 24 months ago OR male
  • Age 45-70
  • Willing to consume usual diet with either fructose or glucose added during (2) 16-18 day inpatient stays
  • Willing to consume usual diet during 2 week wash-out period at home
  • BMI 30.0-39.9
  • Willingness not to travel long distances while on study, including wash-out period
  • Willingness not to be exposed to new pets while on study including wash-out period

Exclusion criteria

Exclusion Criteria:

  • Fasting serum triglycerides >200mg/dl
  • Fasting blood glucose >126mg/dl
  • Renal function tests >2x Upper limit of normal
  • Liver Function Tests > 1.5x Upper limit of normal
  • Currently on statins
  • Daily use of a cathartic
  • Broad spectrum antibiotic use within the past 45 days
  • Currently on proton pump inhibitor
  • Currently on insulin or oral hypoglycemic agents
  • Active viral Hepatitis
  • Chronic constipation
  • Inflammatory bowel disease
  • Chronic diarrhea
  • GI resection
  • Any evidence of cardiovascular disease on EKG
  • History of cardiovascular disease such as coronary artery disease, Coronary Artery Bypass Graft, valve replacement, Myocardial Infarction, stroke / Transient Ischemic attack.
  • History of macronutrient malabsorption
  • Current smoker. Stopped \< 3 months ago.
  • Daily alcohol intake equal to 1.5 oz of 40 proof alcohol.
  • HIV positive
  • Any medical, psychological or social condition that, in the opinion of the Investigator, would jeopardize the health or well-being of the participant during any study procedures or the integrity of the data
  • Persons taking probiotics
04

Study design

Phase
Not applicable
Primary purpose
Basic science
Allocation
Randomized
Intervention model
Crossover assignment
Masking
Double (Participant, Investigator)
Enrollment
13 participants (actual)

Study arms

  • Experimental
    Glucose, Then Fructose

    Participants first receive Glucose Solution (75 grams) from Day 3 through Day 16 of an inpatient stay with usual diet. After a 2-3 week washout period, they will then receive Fructose Solution (75 Grams) from Day 3 through Day 16 on a second inpatient stay with usual diet.

    Other: Fructose Solution (75 Grams) · Other: Glucose Solution (75 grams)

  • Experimental
    Fructose, Then Glucose

    Participants first receive Fructose Solution (75 grams) from Day 3 through Day 16 of an inpatient stay with usual diet. After a 2-3 week washout period, they will then receive Glucose Solution (75 grams) from Day 3 through Day 16 on a second inpatient stay with usual diet.

    Other: Fructose Solution (75 Grams) · Other: Glucose Solution (75 grams)

Interventions

  • OtherFructose Solution (75 Grams)

    Fructose given in divided doses at breakfast and dinner.

  • OtherGlucose Solution (75 grams)

    Glucose given in divided doses at breakfast and dinner.

    Also known as: Dextrose

05

What researchers measure

Primary outcomes

  1. Difference in the Distribution of Fecal Microbiota in Each Participant

    Difference in the distribution of fecal microbiota in each participant, between the fructose versus glucose supplemented diet arms of the study, as measured at the end of each intervention.

    Time frame: assessed at Day 16 of each intervention, up to 64 days

06

Results

Posted Mar 26, 2021

Participant flow

Participant flow — Overall Study
MilestoneFructose, Then GlucoseGlucose, Then Fructose
Started67
Completed46
Not completed21
Withdrew: Adverse event11
Withdrew: Withdrawal by subject10

Outcome measures

PrimaryDifference in the Distribution of Fecal Microbiota in Each Participant

Difference in the distribution of fecal microbiota in each participant, between the fructose versus glucose supplemented diet arms of the study, as measured at the end of each intervention.

Time frame:
assessed at Day 16 of each intervention, up to 64 days

No measurements were reported for this outcome.

Adverse events

Collected over 10 months. Non-serious events are listed at a 0% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
Fructose, Then Glucose0/4 (0%)0/4 (0%)3/4 (75%)
Glucose, Then Fructose0/6 (0%)0/6 (0%)3/6 (50%)
Most frequent other events
Most frequent other events
EventFructose, Then GlucoseGlucose, Then Fructose
BloatingGastrointestinal disorders2/43/6
nauseaGastrointestinal disorders1/40/6
elevated blood glucoseMetabolism and nutrition disorders1/41/6
lightheadednessNervous system disorders1/40/6
low back painMusculoskeletal and connective tissue disorders0/41/6

Baseline characteristics

Glucose to Fructose group, 1 was withdrawn due to A/E Total evaluated = 6 Fructose to Glucose group: 1 was withdrawn due to A/E, 1 due to personal reason Total evaluated = 4

Age, Categorical
Age, Categorical(Participants)Glucose, Then FructoseFructose, Then GlucoseTotal
<=18 years000
Between 18 and 65 years6410
>=65 years123
Age, Continuous
Age, Continuous(years)Glucose, Then FructoseFructose, Then GlucoseTotal
Mean58 (50 to 67)57 (52 to 65)57.6 (50 to 67)
Sex: Female, Male
Sex: Female, Male(Participants)Glucose, Then FructoseFructose, Then GlucoseTotal
Female336
Male437
Ethnicity (NIH/OMB)
Ethnicity (NIH/OMB)(Participants)Glucose, Then FructoseFructose, Then GlucoseTotal
Hispanic or Latino112
Not Hispanic or Latino6511
Unknown or Not Reported000
Race (NIH/OMB)
Race (NIH/OMB)(Participants)Glucose, Then FructoseFructose, Then GlucoseTotal
American Indian or Alaska Native000
Asian000
Native Hawaiian or Other Pacific Islander000
Black or African American549
White224
More than one race000
Unknown or Not Reported000
Region of Enrollment
Region of Enrollment(participants)Glucose, Then FructoseFructose, Then GlucoseTotal
United States7613
07

Study locations

1 site
  • The Rockefeller University
    New York, New York 10065, United States
08

References and documents

Publications

  • Browning JD, Szczepaniak LS, Dobbins R, Nuremberg P, Horton JD, Cohen JC, Grundy SM, Hobbs HH. Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology. 2004 Dec;40(6):1387-95. doi: 10.1002/hep.20466. PubMed 15565570 ↗
  • Luther J, Garber JJ, Khalili H, Dave M, Bale SS, Jindal R, Motola DL, Luther S, Bohr S, Jeoung SW, Deshpande V, Singh G, Turner JR, Yarmush ML, Chung RT, Patel SJ. Hepatic Injury in Nonalcoholic Steatohepatitis Contributes to Altered Intestinal Permeability. Cell Mol Gastroenterol Hepatol. 2015 Mar;1(2):222-232. doi: 10.1016/j.jcmgh.2015.01.001. PubMed 26405687 ↗
  • Stanhope KL, Schwarz JM, Keim NL, Griffen SC, Bremer AA, Graham JL, Hatcher B, Cox CL, Dyachenko A, Zhang W, McGahan JP, Seibert A, Krauss RM, Chiu S, Schaefer EJ, Ai M, Otokozawa S, Nakajima K, Nakano T, Beysen C, Hellerstein MK, Berglund L, Havel PJ. Consuming fructose-sweetened, not glucose-sweetened, beverages increases visceral adiposity and lipids and decreases insulin sensitivity in overweight/obese humans. J Clin Invest. 2009 May;119(5):1322-34. doi: 10.1172/JCI37385. Epub 2009 Apr 20. PubMed 19381015 ↗
  • Boursier J, Mueller O, Barret M, Machado M, Fizanne L, Araujo-Perez F, Guy CD, Seed PC, Rawls JF, David LA, Hunault G, Oberti F, Cales P, Diehl AM. The severity of nonalcoholic fatty liver disease is associated with gut dysbiosis and shift in the metabolic function of the gut microbiota. Hepatology. 2016 Mar;63(3):764-75. doi: 10.1002/hep.28356. Epub 2016 Jan 13. PubMed 26600078 ↗

Study documents

  • Protocol and statistical analysis plan · Oct 9, 2020

Documents are hosted by the registry — open the source record to download them.

Individual participant data

Plan to share: Undecided

09

Registry details

Key details

Study ID
NCT03339245
Lead sponsor
Rockefeller University
Collaborators
Weill Medical College of Cornell University, National Institutes of Health (NIH)
Responsible party
Sponsor
First posted
Nov 13, 2017
Start date
Dec 5, 2017
Primary completion
Oct 2, 2018
Completion
Oct 2, 2018
Results posted
Mar 26, 2021
Last update
Mar 26, 2021

Study contacts

Peter Holt, MD
principal investigator · Rockefeller University

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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