An interventional study of Alternate Daily Fasting (ADF) and Caloric Restriction (CR) in NAFLD, Obesity and Diabetes Mellitus, Type 2, sponsored by University of Florida. Terminated at 1 site in United States. Open to participants aged 18 Years to 65 Years. Per ClinicalTrials.gov, last updated 2019-09-23.
Sponsored by University of Florida · Not applicable, Interventional, and Treatment
Non-alcoholic fatty liver disease (NAFLD) in patients with diabetes (T2DM) is increasing in prevalence and can lead to cirrhosis. Lifestyle intervention with caloric restriction (CR) is the cornerstone of treatment but remission is variable. Alternatively, the PI has shown alternate day fasting (ADF) is safe and well tolerated in obese patients and there might be additional beneficial effects. The objective is to combine the expertise of the PI with this novel intervention and the expertise of Dr. Cusi in NAFLD to explore the effects of ADF vs CR in patients with NAFLD and T2DM to test the following hypotheses:
H1: In patients with NAFLD and T2DM, the ADF intervention will result in more favorable metabolic changes than CR:
H1a: Hepatic triglyceride by MRS will decrease more with ADF than CR (Primary Outcome) and remain lower following a period of free living H1b: There will be greater improvements in glucose homeostasis following ADF vs CR H1c: There will be greater improvement in lipid metabolism following ADF vs CR and changes in ketone metabolism will predict changes in hepatic triglyceride content H2: ADF will have similar safety and tolerability and result in a similar degree of weight loss in participants with NAFLD and DM compared to CR
Rationale:
Non alcoholic fatty liver disease (NAFLD) has a prevalence of up to 80% in patients with T2DM and obesity and can lead to steatohepatitis (NASH) and fibrosis as well as cirrhosis and hepatocellular carcinoma. As NAFLD is associated with increased risk of cardiovascular disease and mortality and as NAFLD-induced liver disease is anticipated to be the most common indication for liver transplantation over the next decade, treatment options are desperately needed but very few are available.
Weight loss with caloric restriction (CR) is the preferred treatment of NAFLD, however successful maintenance of a significant weight loss is difficult to achieve. Additionally, despite significant association between degree of weight loss and improvements in NASH and NAFLD, there is extensive overlap in the response among populations. This suggests that it may not be weight loss in general, but rather the mechanistic underpinnings of the weight loss that potentiate the therapeutic effects. A study comparing dietary carbohydrate restriction vs CR in obese subjects with NAFLD found that, despite similar weight loss between groups, there was greater hepatic triglyceride reduction with carbohydrate restriction and this reduction was highly correlated with plasma ketone concentrations. Hence, although weight loss is ostensibly important, there might be additional factors beyond just weight loss per se causing the improvements in NASH. Therefore, rather than weight loss, reduction in intrahepatic triglyceride will be the primary endpoint of this proposal.
Progression to NASH and beyond is largely due to a spectrum of metabolic abnormalities including ectopic hepatic fat accumulation, insulin resistance, and abnormal lipid metabolism. A recent animal study showed blunted ketogenesis in NASH and suggested the overall etiology was due to inefficient oxidation and disposal of free fatty acids in the liver. A fasting paradigm, or facilitating times of ketosis that could then normalize lipid metabolism, might be one of the additional factors beyond weight loss that ensures improvements in NAFLD and NASH.
Intermittent fasting (IF) is a dietary intervention whereby food is restricted for varying timeframes, including alternate day fasting (ADF) where no or very few calories are given for a day or more with ad lib feeding in between. In animal models, IF has been shown to have numerous beneficial effects, many in excess of those seen with CR. In a mouse model of NAFLD, IF resulted in improvements in hepatic steatosis and inflammation along with gene expression changes showing enhanced activation of lipid oxidation and reduction of lipid synthesis. These benefits may be due to "flipping the metabolic switch" from glucose to ketone utilization for primary cellular energy needs. Data are only beginning to emerge on the effects of IF in humans, and very few studies have focused on ketone production as a mediator of positive outcomes. There are no data on the effect of ADF on NAFLD.
Specific Aims:
SA1: To compare the effect of ADF vs CR on metabolic changes including liver fat, glucose homeostasis, lipid metabolism, and inflammation in patients with NAFLD and T2DM SA1a: To determine changes in hepatic triglyceride by MRS after 4 weeks of ADF and after 4 weeks of ad lib diet SA1b: To determine changes in glucose homeostasis SA1c: To determine changes in whole body lipid metabolism and inflammation SA2: To determine the safety, tolerability, and effectiveness on weight loss of ADF vs CR SA2a: To determine safety of ADF SA2b: To compare changes in body weight, body composition, physical activity, physical functioning and physical fitness SA2c: To determine effect on eating behaviors, hunger/satiety, and body image SA2d: To determine effect on cognition and quality of life
1,617 studies on the registry are indexed under Non-alcoholic Fatty Liver Disease; 324 are open to participants now.
This study's enrollment of 7 is below the median of 60 across 1,176 interventional studies indexed under Non-alcoholic Fatty Liver Disease.
Browse Non-alcoholic Fatty Liver Disease studies →University of Florida is the lead sponsor of 1,287 studies on the registry; 199 are open to participants now.
Of its 180 completed or terminated interventional studies of FDA-regulated products, 143 (79%) have results posted.
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Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.
Exclusion Criteria:
Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
A biopsy takes a small piece of tissue to examine. “Archival tissue” is a sample already taken, for example at diagnosis, and kept by the hospital.
Whether a stored sample will do depends on when it was taken, how much there is and what the study needs. Ask whether the study accepts your stored sample or needs a new biopsy.
The protein in red blood cells that carries oxygen. A low level is anaemia, which can cause tiredness and breathlessness. Measured in g/dL or g/L (9 g/dL is 90 g/L).
Ways of preventing pregnancy. “Highly effective” methods fail less than 1% of the time a year when used correctly — for example an IUD or an implant.
Criteria usually say which methods count and how long to keep using them after the last dose, sometimes for male participants too. Some studies accept a partner’s vasectomy if it was confirmed successful and that person is the participant’s only sexual partner.
Cancer that has spread from where it began to other parts of the body. “Metastatic” cancer is cancer that has spread this way.
Neoadjuvant treatment is given before the main treatment (usually surgery), often to shrink a tumour. Adjuvant treatment is given after it, to lower the chance of the cancer coming back.
Informed consent
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Biopsy and archival tissue
A biopsy takes a small piece of tissue to examine. “Archival tissue” is a sample already taken, for example at diagnosis, and kept by the hospital.
Whether a stored sample will do depends on when it was taken, how much there is and what the study needs. Ask whether the study accepts your stored sample or needs a new biopsy.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Hemoglobin (Hb)
The protein in red blood cells that carries oxygen. A low level is anaemia, which can cause tiredness and breathlessness. Measured in g/dL or g/L (9 g/dL is 90 g/L).
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Contraception
Ways of preventing pregnancy. “Highly effective” methods fail less than 1% of the time a year when used correctly — for example an IUD or an implant.
Criteria usually say which methods count and how long to keep using them after the last dose, sometimes for male participants too. Some studies accept a partner’s vasectomy if it was confirmed successful and that person is the participant’s only sexual partner.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Metastases
Cancer that has spread from where it began to other parts of the body. “Metastatic” cancer is cancer that has spread this way.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Adjuvant and neoadjuvant
Neoadjuvant treatment is given before the main treatment (usually surgery), often to shrink a tumour. Adjuvant treatment is given after it, to lower the chance of the cancer coming back.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Participants randomized to the ADF group will alternate between a day of ad lib feeding and a day of nearly no energy intake. Participants will be prescribed a core diet for feeding days that meets 110% of their estimated calorie needs within the fixed macronutrient distribution of 50% CHO, 20% PRO, and 30% FAT. In accordance with the ad lib feeding protocol, optional modules of similar macronutrient content will be prescribed, each providing an additional 200 kcals. Meal timing will not be restricted on these days. On fasting days, participants will be asked to consume 16 oz. of G2 Gatorade (40 kcal) in the morning and then only water or non-caloric beverages for the rest of the day.
Other: Alternate Daily Fasting (ADF)
Participants randomized to the CR group will consume a diet of fixed energy designed to yield a 500 kcal/d deficit with a macronutrient distribution of 50% CHO, 20% PRO, and 30% FAT. Meal timing and caloric distribution will not be restricted.
Other: Caloric Restriction (CR)
See ADF arm for details
See CR arm for details
Hepatic Triglyceride by MRS
To determine changes in hepatic triglyceride by MRS after 4 weeks of ADF (Primary outcome) and after 4 weeks of ad lib diet
Time frame: Baseline up to 8 weeks
Changes in Glucose Homeostasis
To determine changes in glucose homeostasis as measured by: Overall and hepatic insulin sensitivity following OGTT using the Matusda index
Time frame: Baseline through 4 weeks
Changes in whole body lipid metabolism - Adipose tissue insulin sensitivity by AdipoIR and fasting and postprandial free fatty acid excursion
To determine changes in whole body lipid metabolism and inflammation as measured by: Adipose tissue insulin sensitivity by AdipoIR and fasting and postprandial free fatty acid excursion. Adipo-IR index (fasting, FFAs x insulin.
Time frame: Baseline through 4 weeks
Safety of ADF -Liver Magnetic Resonance Spectroscopy (MRS)
MRS to determine hepatic fat content and elasticity
Time frame: Baseline through 4 weeks
Safety of ADF -Fibroscan.
For liver steatosis (CAP) and fibrosis (VCTE) measurements
Time frame: Baseline through 4 weeks
Safety of ADF - blood
To determine safety of ADF measured by complete metabolic panel, glucose, ketones, and free fatty acids
Time frame: Baseline through 4 weeks
To compare changes body composition measured
To compare changes in body weight, body composition measured by: Dual-energy x-ray absorptiometry (DEXA) to include weight
Time frame: Baseline up to 8 weeks
Effect on eating behaviors
Binge Eating Disorder Questionnaire: individuals can be categorized into three groups according to established cut-scores of binge eating severity. These groups are characterized by no binge eating (score ≤ 17), mild to moderate binge eating (score of 18 - 26) and severe binge eating (score ≥ 27)
Time frame: Baseline up to 8 weeks
Cognitive function
Effect on cognition and quality of life NIH Cognitive Toolbox
Time frame: Baseline up to 8 weeks
Diet Tolerability
ADF NAFLD Diet Tolerability a Likert scale design from 1-5, with 5 as strongly agree evaluating feasting days.
Time frame: Baseline up to 8 weeks
Plan to share: Undecided — Need to determine if able to de-identify enough relevant individual participant data to make sharing worthwhile and appropriate for this very small study.
No publications or documents are linked to this record.
Ran from Mar 2018 to primary completion in Jul 2019, 16 months.
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This study is terminated, as verified in Sep 2019. You cannot join it, but the record below documents what was studied.
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Non-alcoholic Fatty Liver Disease →