Nutritional and Metabolic Diseases

All Conditions

Symptoms and General Pathology

Metabolic Diseases

Weight Loss

Obesity

Body Weight

Obesity, Abdominal

Overweight

Overnutrition

Nutrition Disorders

Body Weight Changes

2 days per week fasting with 25 % energy intake and 5 days per week at 100% energy intake

diet intervention to reduce the risk for obesity associated diseases

Calorie Restriction

Tilman Kühn, PhD

This study evaluates the effect of intermittent calorie restriction versus continued calorie restriction on weight loss, gene expression profile of subcutaneous adipose tissue and abdominal fat distribution.

Since obesity has become a major public health concern appropriate strategies are needed in order to reduce obesity-related health risks in later life span. Obesity is one of the main risk factors not only for diabetes and cardiovascular diseases, but also for several types of cancer. Several key mechanisms, which may link obesity, metabolic dysregulation and cancer risk, such as obesity-driven inflammation, altered adipokine, growth factor and sex hormone signaling, and changes in the microbiota have been identified.

Various studies have shown that continuous calorie restriction (CCR) and exercise are effective strategies to enforce weight-loss and improve biomarker profiles. Intermittent calorie restriction (ICR) as a novel strategy might induce favorable metabolic changes and lead to higher compliance rates. The concept of this diet regime is very simple e.g. 2 days/week of fasting following a standardized diet covering 25 % of energy needs and 5 days/week of ad libitum consumption. To verify the effectiveness of ICR as an alternative weight loss strategy to CCR controlled intervention trials are required. Although both CCR and ICR induce a negative energy balance, the metabolic effect on human physiology might differ.

Within the HELENA-study 50 non-smoking adults (men and women aged 35 to 65 years) with an BMI ≥ 25 kg/m² and ≤ 40 kg/m² will be randomly assigned to each of the intervention arms: (1) ICR arm (2 day/week fasting, i.e. 25% energy intake, energy intake of 100% on 5 days/week leading to a weekly average energy intake of \~80%) (2) CCR arm (daily energy intake of 80%) and 3) control arm (general advice on healthy nutrition).

The trial will last 1 year, with an intervention phase of 12 weeks (weeks 0-12; intervention; close contact with participants), followed by a maintenance phase (weeks 13-24; maintenance; regular, but less frequent contact with participants) and a follow-up phase (weeks 25-52).

Biological specimens will be collected as follows:

Baseline (T0, week 1): Blood, urine, stool and subcutaneous adipose tissue samples; After 3 months (T1, week 13): Blood, urine, stool and subcutaneous adipose tissue samples; After 6 months (T2, week 25): Blood, urine, and stool; After 12 months (T3, week 52): Blood and urine; Magnet resonance tomography imaging (MRI, at T0, T1 and T3) and lifestyle assessments (nutrition behavior, physical activity and quality of life, T0-T3) will be performed to unravel the link to fat distribution, metabolic changes, health and lifestyle. The primary objective of the three-arm randomized controlled intervention trial is to investigate the effect of nutrition intervention on body weight and gene expression profile in subcutaneous adipose tissue of overweight and obese individuals. We hypothesize that better compliance rates will be achieved by the ICR rather than by the CCR group and that ICR will show a higher sustainability with respect to weight loss, weight maintenance, and biomarker profiles. The purpose of this study is further to analyze if the nutrition interventions and associated weight loss have different effects on abdominal fat distribution and liver fat content.

The statistical analysis will be carried out by using the SAS statistical software \[SAS Institute Inc., Cary, NC, USA\] or comparable software. Descriptive statistics, correlations and univariate analyses will be used to get insight on general characteristics of participants in the intervention groups. For the primary objective, two sided t-test and ANCOVA modelling will be performed to investigate whether changes in gene expression levels are affected by nutrition intervention. Comparisons between two groups (e.g. ICR and CCR or CCR/ICR and control group) will be carried out using t-tests and parallel comparison across the three groups will be carried out using ANCOVA models. Where applicable, the analyses will include adjustments for confounders, specially age and gender. Likewise, stratified analysis will be carried out as necessary. ANCOVA models will be performed to evaluate the effects of nutrition intervention on biomarker profiles, adjusted by strata age and gender. Similar evaluations will be performed for fat distribution patterns, quality of life, physical activity and nutrition patterns. In addition, correlation and linear regression analyses will be performed to measure effects of weight-loss, gene expression levels and metabolic profiles, controlled by nutrition intervention group.

Nutrition and Energy Restriction for Cancer Prevention

Healthy Nutrition and Energy Restriction as Cancer Prevention Strategies: a Randomized Controlled Intervention Trial

University Hospital Heidelberg

German Cancer Research Center

Dr. Tilman Kühn

Neoplasms

Digestive System Diseases

Colorectal Neoplasms

Intestinal Neoplasms

Gastrointestinal Neoplasms

Digestive System Neoplasms

Gastrointestinal Diseases

Colonic Diseases

Intestinal Diseases

Rectal Diseases

Herbal and Botanical

All Drugs and Chemicals

Cola

Physical Activity

Energy Restriction

Physical Activity and Energy Restriction

Charles Matthews, PhD

RATIONALE: Calories and physical exercise may affect the risk of developing cancer. It is not yet known whether a low-calorie diet and/or physical activity program is effective in preventing cancer in participants at increased risk of developing colorectal cancer.

PURPOSE: This randomized clinical trial is studying diet and physical activity in healthy overweight, obese, or inactive participants at risk of developing colorectal cancer.

OBJECTIVES:

* To compare four 12-week energy-balance interventions comprising a physical activity intervention (+2,000 kcal/wk), a dietary energy restriction intervention (DER)(-2,000 kcal/wk), or a combined physical activity and DER intervention (+1,000/-1,000 kcal/wk) vs no intervention in healthy, overweight, or moderately obese participants at increased risk for developing colorectal cancer.
* To quantify changes in circulating biomarkers (e.g., insulin, IGF-1, leptin, c-reactive protein, or isoprostanes) proposed to mediate the anticarcinogenic effects of DER in these participants.

OUTLINE: This study consists of a 2-week run-in period (baseline) followed by a 12-week intervention period.

Participants undergo three study visits at Vanderbilt University General Clinical Research Center (GCRC). Beginning at study visit 1, participants undergo a 2-week run-in period to obtain baseline measures of body composition (via dual x-ray absorptiometry), cardiorespiratory fitness (via treadmill testing), physical activity, dietary intake, energy expenditure, and metabolic activity. Dietary assessments using 24-hour dietary recalls are conducted by the GCRC dietitian during the run-in period. GCRC dietitians complete three 24-hour recalls on randomly selected days during the 2-week assessment period to provide an estimate of the participant's habitual food intake at baseline. Baseline energy needs are assessed during activity monitored run-in period to obtain measures of the participant's resting energy expenditure and total daily energy expenditure. Participants are also assessed using a brief psychological profile that is used to individualize the study intervention for each participant.

Approximately 10-14 days after the initial visit and after all baseline assessments have been completed, participants undergo a second study visit. Participants are randomized to 1 of 4 intervention arms.

* Arm I (physical activity): Participants undergo an in-person, 30- to 60-minute counseling visit, followed by five brief 10- to 15-minute telephone-counseling calls over 12 weeks. During the initial counseling session, participants learn about goal setting and how to develop a personalized plan for meeting their intervention goals. Participants are instructed about wearing proper shoes and about monitoring their exercise duration and intensity. Participants are also given pedometers to help track their activity patterns and to monitor their progress in meeting program objectives. Participants must wear the pedometers for 7 days at baseline and again at 12 weeks. The information provided is used to estimate overall physical activity energy expenditure (PAEE), steps per day, and time spent in different levels of activity.

Participants are monitored periodically for adherence to the exercise program through behavioral counseling and self-reported logs of daily exercise and pedometer steps. Dietary intake is measured periodically using multiple 24-hour dietary recalls to carefully assess possible changes in energy intake and dietary quality over the course of the study.

* Arm II (dietary energy restriction \[DER\]): Based on the initial estimate of energy needs determined during the run-in period, participants receive a reduced-calorie, food exchange-based diet for 12 weeks. Each diet is individualized to achieve the desired daily energy deficit of 300 calories per day based on physical activity levels. All meals are prepared by the GCRC metabolic kitchen. Participants receive one multivitamin per day and no other nutritional supplements. Fluids including coffee, water, and other drinks are allowed at the pre-study level. Each week, participants meet with the dietitian to discuss the participant's progress, submit daily reports of food intake, return uneaten food items, and to provide urine samples for assessment of urinary biomarkers.

Adherence to the diet is monitored by compliance with food pick-up, dietary records, and measures of urinary metabolites. Participants are also provided with individual instruction, counseling, and assessment by the study dietitian.

* Arm III (physical activity and DER): Participants undergo a 12-week DER and physical-activity program, as described in arms I and II, with the exception that the dose of PAEE and DER in the combined intervention (i.e., +1,000/-1,000 kcal/week) is half that of each individual intervention (+2,000 kcal/week for arm I and -2,000 kcal/week for arm II). Participants in arm III receive an individualized reduced-calorie diet designed to achieve a desired daily energy deficit of 150 calories per day based on participant physical activity levels.
* Arm IV (wait-list control): Participants are followed periodically. At study visit 3, after completion of the 12-week study interventions, participants undergo repeat assessment of body composition, fitness, diet, and activity measures.

Participants undergo blood and urine sample collection at baseline and at 12 weeks for correlative laboratory studies. Blood samples are assessed for circulating biomarkers that are involved in energy homeostasis and metabolic control (e.g., insulin, IGF, and leptin) and inflammation and oxidative stress (e.g., c-reactive protein, PGE-2, and isoprostanes). Urine samples are examined for biomarkers of dietary protein intake (i.e., nitrogen content), dietary sodium, and potassium intake.

Participants complete the Community Health Activities Model Program for Seniors Physical Activity Questionnaire at baseline and at 12 weeks for assessment of PAEE through non-occupational activities, including social activities, recreation, hobbies, housework, walking, jogging, and 14 other types of exercise.

Energy Balance Interventions for Colorectal Cancer Prevention

National Cancer Institute (NCI)

Vanderbilt University

Research Professor

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization	Link
Nutrition and Energy Restriction for Cancer Prevention	NCT02449148	Obesity Visceral Obesit... Weight Loss Metabolic Disea... Body Compositio...	Calorie Restric...	35 Years - 65 Years	German Cancer Research Center
Energy Balance Interventions for Colorectal Cancer Prevention	NCT00653484	Colorectal Canc... Obesity	Physical Activi... Energy Restrict... Physical Activi...	50 Years -	Vanderbilt University

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