Polyunsaturated Fatty Acids (PUFA) in Diabetic Fatty Liver
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| ClinicalTrials.gov Identifier: NCT00323414 |
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Recruitment Status :
Completed
First Posted : May 9, 2006
Results First Posted : February 23, 2018
Last Update Posted : February 23, 2018
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Non-alcoholic steatohepatitis (NASH), the most severe form of liver injury in the spectrum of non-alcoholic fatty liver disease (NAFLD), has emerged as the major cause of chronic liver disease in developed countries. Among adults in the United States, the prevalence is between 5.7% and 17%. These rates are expected to increase concurrent with the epidemics of obesity and type 2 diabetes mellitus, which are the major risk factors for NAFLD and NASH. In addition to its high prevalence, NASH is also a progressive fibrotic disease that advances to cirrhosis and liver related death in 20% and 12% of patients, respectively. Among NASH patients with cirrhosis, 40% have liver related death. Diabetics are particularly prone to experience these poor outcomes. No therapy has been proven effective for patients with NASH.
The purpose of this study is to find out whether treatment with polyunsaturated fatty acids (eicosapentaenoic acid [EPA] combined with docosahexaenoic acid [DHA] called Opti-EPA) improves NASH compared to treatment with placebo pills. The placebo pills will contain corn oil and will be contained in a capsule, but have no medical effect on the body. The investigators will determine improvement in NASH from microscopic changes in the subject's liver tissue during 48 weeks of treatment. This means that the subject will need to have a liver biopsy before and after the treatment.
Omega-3 fatty acids are a form of polyunsaturated fats, one of the four basic types of fat that the body gets from food. (Cholesterol, saturated fat, and monounsaturated fat are the others.) One's body does not make this type of fat; it comes from food sources. These fats are found in foods like cold water fish (tuna, salmon, and mackerel), and vegetable products like flaxseed oil and walnuts.
Research shows that polyunsaturated fats are good for people. Studies have shown that it is good for heart health by playing a role in keeping blood cholesterol levels low, keeping irregular heart rhythms stable, and reducing blood pressure.
The drug being studied, Opti-EPA, is a nutritional supplement. They do not have to be reviewed by the Food and Drug Administration (FDA) like medicines do. Opti-EPA is considered experimental in this study. This means that the United States Food and Drug Administration (FDA) has not approved it for use in people with nonalcoholic fatty liver disease.
| Condition or disease | Intervention/treatment | Phase |
|---|---|---|
| Fatty Liver | Drug: Polyunsaturated fatty acid (Opti-EPA) Drug: Placebo | Phase 2 |
Although there is no proven effective treatment of NASH, dietary supplementation with long chain omega-3 polyunsaturated fatty acids (PUFA's) may be beneficial. This suggestion is based on three previously reported observations: first, patients with NASH consume less PUFAs and more saturated fats than subjects without NASH. Second, PUFAs are beneficial in patients with hypertension and hypertriglyceridemia. Third, PUFAs decrease lipid peroxidation and ameliorate hepatic steatosis in animal models of NAFLD.
We therefore hypothesize that the administration of these PUFAs, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) will reduce hepatic fat content, inflammation and hepatic injury in patients with type 2 diabetes mellitus who have NASH.
Aims
To determine in patients with type 2 diabetes mellitus who have NASH if dietary supplementation with purified omega-3 fatty acids (EPA and DHA) will:
- Decrease the histologic severity of NASH.
- Alter the expression of genes important in the pathways of hepatic lipid synthesis and oxidation.
Study design:
Patients who meet the inclusion criteria will be randomized to receive omega-3 fatty acids or placebo. Stratified randomization will be done based on the NASH Clinical Research Network pathology score of 5.
| Study Type : | Interventional (Clinical Trial) |
| Actual Enrollment : | 37 participants |
| Allocation: | Randomized |
| Intervention Model: | Parallel Assignment |
| Masking: | Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor) |
| Primary Purpose: | Treatment |
| Official Title: | Randomized Controlled Trial of Omega-3 Fatty Acids in the Treatment of Non-Alcoholic Steatohepatitis in Patients With Type 2 Diabetes Mellitus |
| Study Start Date : | April 2006 |
| Actual Primary Completion Date : | December 2011 |
| Actual Study Completion Date : | December 2011 |
| Arm | Intervention/treatment |
|---|---|
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Active Comparator: Polyunsaturated fatty acid (Opti-EPA)
Polyunsaturated fatty acid will consist of purified EPA:DHA (360 mg EPA and 240 mg DHA) 6 gelcaps-3 capsules by mouth 2x per day x 48 weeks
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Drug: Polyunsaturated fatty acid (Opti-EPA)
Active experimental arm to patients with diabetes mellitus and non alcoholic steatohepatitis: Eicosapentaenoic acid (EPA):Docosahexaenoic acid (DHA)[360 mg EPA and 240 DHA in each capsule] 6 capsules-3 capsules by mouth 2 x per day x 48 weeks
Other Name: Fish oil |
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Placebo Comparator: Placebo
Gelcaps containing corn oil as placebo 6 capsules 3 capsules by mouth 2 x per day for 48 weeks
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Drug: Placebo
Placebo gelcaps containing corn oil identical to the PUFA gelcaps 6 capsules-3 capsules by mouth 2x per day x 48 weeks
Other Name: Corn oil |
- Number of Participants With Improvement of >= 2 Points in NAFLD Activity Score (NAS) [ Time Frame: 48 weeks ]The non-alcoholic fatty liver disease (NAFLD) activity score (NAS) is a score based on the liver biopsy. It represents the sum of scores for steatosis, lobular inflammation, and ballooning, and ranges from 0-8, with high scores indicating more activity.
- Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) Values [ Time Frame: 48 weeks ]Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) measures insulin resistance, calculated by fasting insulin (μU/mL) multiplied by fasting glucose (mg/dL), and divided by a constant (405). A higher score indicates higher insulin resistance.
- Aspartate Amino Transferase (AST) Levels [ Time Frame: 48 weeks ]Aspartate amino transferase (IU/dL) at 48 weeks
- Alanine Amino Transferase (ALT) Levels [ Time Frame: 48 weeks ]Alanine amino transferase (IU/dL) ay 48 weeks
- Blood Glucose Levels [ Time Frame: 48 weeks ]Fasting blood glucose
- HbA1C Levels [ Time Frame: 48 weeks ]Hemoglobin A1c
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| Ages Eligible for Study: | 18 Years and older (Adult, Older Adult) |
| Sexes Eligible for Study: | All |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Adult patients (age >18 years)
- Have type 2 diabetes mellitus with good control of blood sugar (hemoglobin A1c [HbA1c] <7.5%) and will have been on a stable regimen of anti-diabetic agents for more than 4 months.
- NASH established on liver biopsy done within 6 months prior to inclusion in the study as determined by established histologic criteria
Exclusion Criteria:
- Cirrhosis of the liver
- End stage target organ damage in diabetes mellitus: advanced renal failure (serum creatinine > 2.0 mg/dl) with or without dialysis, severe neuropathy, or advanced peripheral vascular disease.
- Any organ dysfunction with anticipated life expectancy of less than 2 years
- Co-existent etiologies for liver disease
- Significant alcohol consumption, defined as more than 30 g per day in men and more than 20 g per day in women.
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00323414
| United States, Ohio | |
| MetroHealth Medical Center | |
| Cleveland, Ohio, United States, 44109 | |
| Cleveland Clinic Foundation | |
| Cleveland, Ohio, United States, 44195 | |
| Principal Investigator: | Arthur J. McCullough, M.D. | MetroHealth Medical Center | |
| Principal Investigator: | Srinivasan Dasarathy, M.D. | The Cleveland Clinic |
Additional Information:
Publications:
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
| Responsible Party: | National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) |
| ClinicalTrials.gov Identifier: | NCT00323414 History of Changes |
| Other Study ID Numbers: |
DK61732 U01DK061732 ( U.S. NIH Grant/Contract ) |
| First Posted: | May 9, 2006 Key Record Dates |
| Results First Posted: | February 23, 2018 |
| Last Update Posted: | February 23, 2018 |
| Last Verified: | October 2017 |
Keywords provided by National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK):
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PUFA NASH Fatty Liver Insulin resistance |
Metabolic syndrome Nonalcoholic fatty liver disease Nonalcoholic steatohepatitis Type 2 Diabetes Mellitus |
Additional relevant MeSH terms:
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Diabetes Mellitus, Type 2 Fatty Liver Diabetes Mellitus Glucose Metabolism Disorders |
Metabolic Diseases Endocrine System Diseases Liver Diseases Digestive System Diseases |