Don't get left behind! The modernized is coming. Check it out now.
Say goodbye to!
The new site is coming soon - go to the modernized
Working… Menu

Intermittent Calorie Restriction, Insulin Resistance, and Biomarkers of Brain Function

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT02460783
Recruitment Status : Completed
First Posted : June 2, 2015
Last Update Posted : February 8, 2023
Information provided by (Responsible Party):
National Institutes of Health Clinical Center (CC) ( National Institute on Aging (NIA) )

Brief Summary:


- Insulin removes sugar from the blood to use for energy. Insulin resistance means that cells may not respond to insulin normally. It can lead to serious diseases. Researchers want to see how diet affects insulin resistance, weight, and brain chemicals related to Alzheimer s disease.


- To compare two forms of diet and their effects on insulin resistance and the brain.


- Women ages 55 70 with insulin resistance.


  • This study requires 6 clinic visits over 9 12 weeks. Participants must fast before visits.
  • Visit 1, screening:
  • Medical history, physical exam, and blood and urine tests.
  • Participants will get a wrist device to wear for 4 days.
  • Visit 2:
  • Weight and waist measurement.
  • Blood drawn.
  • Questionnaires and thinking tests.
  • Lumbar puncture. Skin will be numbed and a needle inserted between bones in the back will remove <TAB>fluid.
  • Participants will drink a nutrition shake. Blood will be taken 12 times over 4 <TAB>hours through a thin tube in <TAB>the arm.
  • Brain MRI. Participants will lie on a table that slides in and out of a cylinder in a strong magnetic field. <TAB>They will have a coil on their head and may do tasks.
  • Participants will get advice about healthy eating and be randomly put in one of 2 groups. One group will get <TAB>nutrition shakes to drink.
  • Visits 3 5:
  • Weight and waist measurements, vital signs, blood draw, and questionnaires.
  • Between visits, participants will get a call or email to check how they are doing.
  • Visit 6: Repeat of visit 1.
  • Participants will wear the wrist device for 4 more days, have a follow-up contact, then the study is finished.

Condition or disease Intervention/treatment Phase
Alzheimer's Disease Obesity Diabetes Mellitus Other: Boost (R) 5-2 diet Other: Healthy Living Diet Phase 2

Detailed Description:
Being overweight or obese can cause insulin resistance (IR), which is defined as reduced responsiveness to insulin by the cells of various tissues or organs. IR at midlife increases the risk of developing Alzheimer s disease (AD). We recently discovered novel biomarkers of brain IR (altered Tyr and Ser phosphorylated forms of insulin receptor substrate 1; IRS-1) in plasma exosomes enriched for neuronal origin. Moreover, IR is associated with AD biomarkers including deficits in resting state brain activity and cognitive performance. Calorie restriction is defined as consuming fewer calories than what is considered normal without a lack of nutrients. A certain type of calorie restriction, in which one consumes 500-600 calories a day for two consecutive days, followed by non-restricted eating for 5 days (5-2 CR), has been shown to lower peripheral insulin resistance effectively. Effects of CR and lowering peripheral IR on brain IR and cognition are unknown. The goal of this exploratory pilot study is to provide proof-of-concept that 5-2 CR at midlife can reverse brain IR, lower peripheral IR, improve cognitive performance, and increase brain activation at rest and during tasks. Specifically, we will study the effects of 8 weeks of 5-2 CR versus a control dietary intervention on brain and peripheral IR, memory and executive function, resting state default mode network activity, brain metabolism, and AD biomarkers. Forty overweight to obese women and men (between 55 and 70 years of age) will be randomized 1:1 into 5-2 CR and control groups. In the 5-2 CR group, participants will be offered healthy living dietary counseling at baseline, which they will be instructed to implement for five days/week. For each of the other two consecutive days/week, they will consume two shakes (Boost , CWI Medical), providing a total of 480 Kcal/day. In the control group, participants will be offered healthy living dietary counseling at baseline, which they will be asked to implement for every day of the week. Participants will undergo screening including a history and physical examination, calculation of Body Mass Index (BMI, which must be greater than or equal to 27) and a blood draw for insulin and glucose to determine whether they have insulin resistance. If participants meet eligibility criteria, they will continue with a baseline visit involving anthropometric measures, questionnaires, tests of cognitive function, brain MRI, blood draws for plasma and peripheral blood mononuclear cells, and lumbar puncture for cerebrospinal fluid biomarkers of AD. After 8 weeks, we will collect the same measures. To assess and reinforce compliance with their respective diet, participants will come into the clinic every 2 weeks to discuss compliance, measure their body weight and perform blood draws for measurement of ketones to objectively confirm energy restriction for the 5-2 CR group. We will also contact participants every week to further ensure compliance. To assess the effects of the diets on physical activity, participants will be asked to wear an accelerometer for 96 hours before and after they are on the diet.

Layout table for study information
Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 129 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Basic Science
Official Title: Intermittent Calorie Restriction, Insulin Resistance, and Biomarkers of Brain Function
Actual Study Start Date : June 22, 2015
Actual Primary Completion Date : January 14, 2022
Actual Study Completion Date : December 23, 2022

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: 5-2 CR
Healthy living diet for 5 days/week; Calorie Restriction (530 Kcal in the form of a shake) for 2 days/week.
Other: Boost (R) 5-2 diet
Regular diet for 5 days/week; Calorie Restriction (480 Kcal in the form of a shake) for 2 days/week. Supplement providing 240 Kcal per shake. Participant takes 2 shakes per calorie restriction day.

Active Comparator: Healthy Living Diet
Healthy living diet for 7 days/week
Other: Healthy Living Diet
Counseling and educational material on diet portion, consistency

Primary Outcome Measures :
  1. Exosomal p-S312-IRS-1/p-panY-IRS-1 ratio (index of brain insulin resistance) [ Time Frame: baseline and 8 weeks ]
    index of brain insulin resistance

Secondary Outcome Measures :
  1. DNA methylation [ Time Frame: Baseline, 2, 4, 6, and 8 weeks ]
    Genome-wide methylation in peripheral blood mononuclear cells

  2. Exosomal proteins and mRNA [ Time Frame: Baseliine, week 0 ]
    Other exosomal proteins and mRNA biomarkers of AD

  3. Si and HOMA-IR [ Time Frame: Screening, 8 weeks ]
    Indices of insulin resistance, derived from insulin and glucose values taken from a fasting blood draw

  4. fMRI activation to food preference task [ Time Frame: Baseline, 8 weeks ]
    Activation to appetitive food versus non-appetitive food stimuli

  5. Resting fMRI [ Time Frame: Baseline, 8 weeks ]
    Intrinsic functional connectivity of DMN

  6. fMRI activiation to Stroop [ Time Frame: Baseline, 8 weeks ]
    Behavioral performance and fMRI activation during Color-Word Stroop task

  7. MRS metabolites [ Time Frame: Baseline, 8 weeks ]
    Brain metabolites assessed with Magnetic Resonance spectroscopy and regional perfusion assessed with arterial spin labeling

  8. Cognitive performance [ Time Frame: Baseline, 8 weeks ]
    Memory and executive function scores

  9. Anthropometric measures [ Time Frame: Screening, Baseline, 2, 4, 6, and 8 weeks ]
    Anthropometric measures (weight, waist circumference, sagittal diameter

  10. Clinical labs [ Time Frame: Screening, Outcome ]
    Lipid panel, uric acid

  11. Plasma ketones [ Time Frame: Baseline, 8 weeks ]
    Beta-hydroxybutyrate and other metabolites

  12. Hormones during a mixed meal [ Time Frame: Baseline, 8 weeks ]
    Plasma metabolites and hormones(GLP-1, insulin) during mixed meal tolerance test

  13. CSF, plasma AD biomarkers [ Time Frame: Baseline, 8 weeks ]
    CSF and plasma AD biomarkers, including A(Beta)1-42 and p181Tau

  14. Plasma and CSF neurotrophic factors [ Time Frame: Baseline, 8 weeks ]
    Plasma and CSF neurotrophic factors, such as BDNF

  15. Plasma and CSF reactive oxygen species [ Time Frame: Baseline, 8 weeks ]
    Plasma and CSF reactive oxygen species, advanced glycation end-products and advanced oxidation protein products

  16. Cytokines [ Time Frame: Baseline, 8 weeks ]
    Plasma and CSF pro-inflammatory cytokines, such as IL-6, IL-8, IL-12 and IL-23;

  17. Rating of symptoms [ Time Frame: Every week from 0 to 8 ]
    Symptoms that can occur with 5-2 CR, mood and quality of life changes, recorded during both the 5-2 CR and control diet phases

  18. Physical acttivity measurement [ Time Frame: Screening and week 0 ]
    Physical activity measured using an accelerometer

  19. Gene expression [ Time Frame: Baseline, 2, 4, 6, and 8 weeks ]
    Global gene expression pattern, mitochondria gene expression and expression of other gene pathways responding to CR

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

Layout table for eligibility information
Ages Eligible for Study:   55 Years to 70 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
  • BMI greater than or equal to 27; in addition, weight less than or equal to 350 lbs (weight limit for MRI scanner);
  • Age of 55-70 years;
  • HOMA-IR greater than or equal to 1.8;
  • MMSE greater than or equal to 26


  • History of clinically significant cardiovascular disease for the purpose of this study, such as chronic heart failure, coronary disease, cardiomyopathy, clinically significant cardiac valvular disease or clinically significant peripheral vascular disease. Cardiovascular conditions that are clinically non-significant for the purpose of this study, such as controlled hypertension, minor EKG abnormalities, mitral valve prolapse or benign murmurs are permissible;
  • History of clinically significant stroke or other neurological disease of the central nervous system;
  • History of substance abuse in the past 6 months or positive urine drug screen;
  • History of clinically significant endocrine disorders (common mild endocrine disorders, such as untreated subclinical hypothyroidism with TSH < 10 mU/l or successfully treated hypothyroidism may be allowed);
  • History of eating disorders, significant GI disorders or malabsorption disorders;
  • History of type 2 diabetes; and/or use of anti-diabetes medications or insulin; and/or type 2 diabetes diagnosed during the screening visit based on fasting glucose > 125 mg/dL;
  • History of hypoglycemia; and/or a fasting glucose < 70 mg/dL during the screening visit.
  • Current use of systemic corticosteroids;
  • Positive screening tests for HIV, HCV or HBV;
  • Hematocrit less than 35% or hemoglobin less than 11 mg/dL;
  • ALT or AST > 1.5 times the upper normal limit;
  • Contraindications for MRI (pacemakers, ferrous metal implants or shrapnel in or around the head, etc.).
  • Contraindications to LP, such as Coumadin, coagulopathy (international normalized ratio, or INR > 1.5; prothrombin time (PT), partial prothrombin time (PTT) > 1.5 x upper normal limit). Aspirin 81 mg qd is allowed. Aspirin up to 325 mg qd is allowed, if withheld for 7 days prior to the LP.
  • Pregnancy or nursing.
  • Refusal to consent to genetic testing for APOE.

Information from the National Library of Medicine

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 identifier (NCT number): NCT02460783

Layout table for location information
United States, Maryland
National Institute of Aging, Clinical Research Unit
Baltimore, Maryland, United States, 21224
Sponsors and Collaborators
National Institute on Aging (NIA)
Layout table for investigator information
Principal Investigator: Dimitrios I Kapogiannis, M.D. National Institute on Aging (NIA)
Additional Information:
Layout table for additonal information
Responsible Party: National Institute on Aging (NIA) Identifier: NCT02460783    
Other Study ID Numbers: 150123
First Posted: June 2, 2015    Key Record Dates
Last Update Posted: February 8, 2023
Last Verified: January 30, 2023
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided
Plan Description: .There is ongoing discussion within the NIA IRP and a plan has not been finalized yet.

Layout table for additional information
Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by National Institutes of Health Clinical Center (CC) ( National Institute on Aging (NIA) ):
Dementia of the Alzheimer Type
Functional Magnetic Resonance Imaging (fMRI)
Additional relevant MeSH terms:
Layout table for MeSH terms
Alzheimer Disease
Insulin Resistance
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Neurodegenerative Diseases
Neurocognitive Disorders
Mental Disorders
Glucose Metabolism Disorders
Metabolic Diseases