Cephalic Phase in Anorexia Nervosa,Bulimia Nervosa and Obese Binge Eaters (Cephalic 1)
Recruitment status was Recruiting
|First Received Date ICMJE||June 27, 2007|
|Last Updated Date||July 4, 2007|
|Start Date ICMJE||July 2007|
|Primary Completion Date||Not Provided|
|Current Primary Outcome Measures ICMJE
||VAS, EDI, Blood test for glucose, insulin, PP, shame feed procedure [ Time Frame: 1 year ]|
|Original Primary Outcome Measures ICMJE||Same as current|
|Change History||Complete list of historical versions of study NCT00493519 on ClinicalTrials.gov Archive Site|
|Current Secondary Outcome Measures ICMJE||Not Provided|
|Original Secondary Outcome Measures ICMJE||Not Provided|
|Current Other Outcome Measures ICMJE||Not Provided|
|Original Other Outcome Measures ICMJE||Not Provided|
|Brief Title ICMJE||Cephalic Phase in Anorexia Nervosa,Bulimia Nervosa and Obese Binge Eaters|
|Official Title ICMJE||Cephalic Phase in Anorexia Nervosa,Bulimia Nervosa and Obese Binge Eaters|
The objective of this trial is to examine the cephalic phase insulin response (CPIR) and pancreatic polypeptide (PP) release as indicators of the cephalic phase occurrence and magnitude to palatable food stimulus in anorectic and bulimic subgroups as compared to healthy controls
Food stimulation of gastric and pancreatic secretion is classically divided into cephalic, gastric and intestinal phases.
Cephalic phase refers to a simultaneous activation of gastrointestinal motility, gastric acid and pancreatic enzyme secretion ,as well as, release of hormones from the endocrine pancreas which occurs through activation of vagal -efferents as a result of food-related sensory stimuli such as taste and smell prior to nutrient absorption and which coincides with a thermogenic response.
Of the cephalic phase secretions, cephalic phase insulin release (CPIR) has received the most attention, but pancreatic polypeptide (PP) and glucagon responses have also been studied. While the magnitude of cephalic phase insulin release is relatively small (25% above baseline), pancreatic polypeptide increases 100% above baseline. The large magnitude of the PP response makes it a sensitive indicator of vagal activation to food stimuli.
In most experiments, subjects are either exposed to visual and olfactory stimulation by seeing and smelling the food stimulus or are required to perform a modified sham-feed, i.e. to taste, chew and then expectorate the food stimulus.
In general, cephalic phase are thought to be preparatory response before ingestion of food. Because of their small magnitude, the physiological significance of the cephalic phase hormonal responses has been largely discounted. However, there is evidence that experimental prevention of CPIR lead to hyperinsulinemia and hyperglycemia. Therefore, CPIR may contribute to glucose homeostasis /regulation. Moreover CPIR may be an indicator of hunger and could be important for understanding eating disorders.
In parallel with these hormonal secretion ,an increase in energy expenditure has also been observed . This thermogenic response to food is even greater with sham feeding than with normal feeding and is paralleled by changes in RQ showing enhanced carbohydrate oxidation.
Studies conducted in obese humans demonstrate exaggerated absolute magnitude of CPIR .However basal hyper-insulinemia which is typically observed in obese individuals may clouds this observation. Moreover, it has been hypothesized that CPIR is attenuated in obese when is expressed as a percentage of baseline and therefore they may not secrete enough insulin during pre-absorptive period to regulate postprandial glucose levels.
There is also evidence that obese people with insulin resistance have a reduced thermogenic response to feeding .
Only limited numbers of studies have been done on the cephalic phase in anorexia and bulimia. There are findings of a significant CPIR in anorexics as compared to controls which tends to rule out a deficient cephalic insulin response as a contributor to the self-starvation observed in anorexia nervosa. As to bulimics who often show endocrine abnormalities, their CPIR was only slightly differ or from controls.
These findings suggest more complex determinants of eating disorders than physiological state alone.
|Study Type ICMJE||Interventional|
|Study Phase||Not Provided|
|Study Design ICMJE||Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Basic Science
|Intervention ICMJE||Procedure: chocolate cake|
|Study Arm (s)||Not Provided|
|Publications *||Not Provided|
* Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
|Recruitment Status ICMJE||Recruiting|
|Estimated Enrollment ICMJE||75|
|Estimated Completion Date||December 2007|
|Primary Completion Date||Not Provided|
|Eligibility Criteria ICMJE||
75 patients will be divided into the following 4 subgroups;
Non diabetic and non-pregnant patients above 18 years of age without gastrointestinal diseases and without medications which can affect gastrointestinal motility and appetite.
|Ages||18 Years and older|
|Accepts Healthy Volunteers||Yes|
|Location Countries ICMJE||Israel|
|NCT Number ICMJE||NCT00493519|
|Other Study ID Numbers ICMJE||TASMC-07-NV-219-CTIL|
|Has Data Monitoring Committee||Yes|
|Responsible Party||Not Provided|
|Study Sponsor ICMJE||Tel-Aviv Sourasky Medical Center|
|Collaborators ICMJE||Not Provided|
|Information Provided By||Tel-Aviv Sourasky Medical Center|
|Verification Date||April 2007|
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