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Protein Supplementation: Body Composition, Muscle Strength and Postural Balance

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ClinicalTrials.gov Identifier: NCT03792646
Recruitment Status : Recruiting
First Posted : January 3, 2019
Last Update Posted : January 3, 2019
Sponsor:
Information provided by (Responsible Party):
University of Sao Paulo General Hospital

Brief Summary:
Nutritional interventions witch stimulate the rate of muscle protein synthesis are relevant for the development of therapeutic strategies aimed at attenuating the loss of mass and muscle strength related to aging (sarcopenia). To aim of the study is to investigate the effect of protein supplementation on body composition, muscle activity, muscle strength and plasma concentration of inflammatory biomarkers of elderly with type II diabetic, submitted to 12 weeks of resistance training. This is an interventional, controlled, randomized, double-blind study. The population of the present study will be composed of 40 men with type 2 diabetes aged between 70 and 74 years, whose body mass index (BMI) should be between 22 and 32 kg / m2. It will be composed of patients from the Diabetes Outpatient Clinic of the Endocrinology Department at the Medical School of the University of São Paulo. Elderly subjects will be randomized into two groups (n = 20) who will undergo resistance training for 12 weeks, twice a week, and receive protein or placebo supplementation. Exercises will be performed for the large muscle groups: pectoral press, paddling, leg-press, extensor chair, gastrocnemius plantar flexions and abdominal crunches. Protein supplementation will be performed immediately after strength training by ingestion of 20 g of whey protein diluted in water. Also, immediately after training the placebo group will receive 20 g of maltodextrin diluted in water. All participants will be instructed to ingest 1.0 to 1.2 g of protein / kg of body weight per day. 24-hour food recall and food frequency questionnaires will be performed throughout the study. The following evaluations (before and after 12 weeks training) will be applied: Anthropometric: body mass, height, BMI and hip waist ratio. Functional evaluation through isokinetic dynamometry of knee extensors and flexors and a maximal repetition (1RM). Evaluation of body composition through Bioimpedance balance. Evaluation of food intake will be obtained by means of a 24-hour recall and food frequency questionnaire. All the evaluations will performed after 6 months. The training sessions will have a frequency of twice a week for 12 weeks. Eight exercises will be performed for the main muscle groups. In each exercise, 3 sets will be performed between 8 and 12 repetitions. The intensity should be between 7 - 8 and will be monitored according to Subjective Effort Perception using a scale of 0 to 10.

Condition or disease Intervention/treatment Phase
Diabetes Mellitus, Type 2 Protein Supplementation Body Composition Inflammation Biomarkers Resistance Training Dietary Supplement: Whey protein Other: Exercise training Not Applicable

Detailed Description:

Eligibility Criteria:

Diabetes mellitus type 2 with stable dose of medication (oral antidiabetic or insulin or combination of both) for three months or more.

Glycated hemoglobin between 6 and 8.5% Renal function assessed by MDRD above 60 ml / h AST and ALT up to 2.5 times the upper limit of the No involvement of the musculoskeletal system with pain and any type of incapacitating disease or previous surgeries.

No chronic non-communicable disease not treated properly and decompensated Renal function assessed by MDRD equal to or above 60 ml / h


Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 40 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: Randomized prospective clinical trial, double-blind, placebo-controlled intervention
Masking: Double (Participant, Investigator)
Primary Purpose: Treatment
Official Title: Effect of Protein Supplementation on Body Composition, Muscle Strength and Postural Balance in Elderly Type II Diabetes Subjects Undergoing Resistance Training
Actual Study Start Date : May 1, 2018
Estimated Primary Completion Date : March 1, 2020
Estimated Study Completion Date : March 1, 2020

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: Experimental
The experimental group will inject 20 grams of whey protein diluted in water after the exercise training.
Dietary Supplement: Whey protein
Exercise training + 20g whey protein

Other: Exercise training
Strength exercise

Placebo Comparator: Placebo
The placebo group will inject 20 grams of maltodextrin diluted in water after the exercise training.
Other: Exercise training
Strength exercise




Primary Outcome Measures :
  1. Muscular strength (hand grip) change from baseline [ Time Frame: This measure will be perform before and after the intervention (12 weeks muscular strenght and postural balance exercise) and after 6 months. ]
    Evaluation of muscular strength improvement- hand grip strength (HGS). HGS assessment was performed using a Jamar hand dynamometer, measured in kilograms (kg), which is adopted by the American Society of Hand Therapists.

  2. Muscular strength (peak of torque) change from baseline [ Time Frame: This measure will be perform before and after the intervention (12 weeks muscular strenght and postural balance exercise) and after 6 months. ]
    Isokinetic dynamometry will be use to determine knee extension and flexion strength using the Biodex Multi-Joint System 3 (Biodex MedicalTM, Shirley, NY, USA). The isokinetic variables used was maximum peak torque corrected for body weight (%).

  3. Muscular strength (total work) change from baseline [ Time Frame: This measure will be perform before and after the intervention (12 weeks muscular strenght and postural balance exercise) and after 6 months. ]
    Isokinetic dynamometry will be use to determine knee extension and flexion strength using the Biodex Multi-Joint System 3 (Biodex MedicalTM, Shirley, NY, USA). The isokinetic variables used was total work (J).

  4. Postural Balance (weight transfer) change from baseline [ Time Frame: This measure will be perform before and after the intervention (12 weeks muscular strenght and postural balance exercise) and after 6 months. ]
    The postural balance assessment (posturography) was performed on the NeuroCom Balance Master® force platform system (NeuroCom International, Inc., Clackamas, Oregon, USA). The parameter measured was the mean weight transfer. The weight transfer was the time in seconds required to voluntarily shift the COG forwards, beginning in the seated position and ending with full weight-bearing on the feet.

  5. Postural Balance (sway velocity) change from baseline [ Time Frame: This measure will be perform before and after the intervention (12 weeks muscular strenght and postural balance exercise) and after 6 months. ]
    The postural balance assessment (posturography) was performed on the NeuroCom Balance Master® force platform system (NeuroCom International, Inc., Clackamas, Oregon, USA). The parameter measured was the center of gravity (COG) sway velocity while rising. The COG sway velocity documented the degree of control over the COG above the support base during the rising phase and for 5 seconds thereafter. Sway was expressed in degrees per second.


Secondary Outcome Measures :
  1. Inflammatory biomarkers - plasma concentration change from baseline (Interleukin 6) [ Time Frame: This measure will be perform before and after the intervention (12 weeks muscular strenght and postural balance exercise). ]
    Peripheral blood samples (20 mL) will be collected in tubes containing EDTA anticoagulant at the initial times and 12 weeks of treatment. The total EDTA blood will be centrifuged to obtain the plasma, which will be used to evaluate the concentration of Interleukin 6 (IL-6). IL-6 is an interleukin that acts as a proinflammatory cytokine and an anti-inflammatory miocin. The IL-6 will be measure in microliter (μl)/pictogram (pg). From the whole blood with EDTA will be performed the complete blood count.

  2. Portable Bioelectrical Impedance change from baseline [ Time Frame: This measure will be perform before and after the intervention (12 weeks muscular strenght and postural balance exercise) and after 6 months. ]
    Measure body composition, such as % body fat and fat-free mass (FFM). The total body mass and body composition will be measured using a multipolar bio-impedance scale of the brand INBODY® model 230.

  3. Inflammatory biomarkers - plasma concentration change from baseline (Tumor necrosis factor-alpha) [ Time Frame: This measure will be perform before and after the intervention (12 weeks muscular strenght and postural balance exercise). ]
    Peripheral blood samples (20 mL) will be collected in tubes containing EDTA anticoagulant at the initial times and 12 weeks of treatment. The total EDTA blood will be centrifuged to obtain the plasma, which will be used to evaluate the concentration of tumor necrosis factor (TNF) -alpha. The TNF-alfa is a cell signaling protein (cytokine) involved in systemic inflammation and is one of the cytokines that make up the acute phase reaction. The TNF-alfa wiil be measure in microliter (μl)/pictogram (pg). From the whole blood with EDTA will be performed the complete blood count.



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Ages Eligible for Study:   65 Years to 79 Years   (Older Adult)
Sexes Eligible for Study:   Male
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Diabetes mellitus type 2 with stable dose of medication (oral antidiabetic or insulin or combination of both) for three months or more.
  • Glycated hemoglobin between 6 and 8.5%
  • Renal function assessed by MDRD above 60 ml / h
  • AST and ALT up to 2.5 times the upper limit of the
  • No involvement of the musculoskeletal system with pain and any type of incapacitating disease or previous surgeries.
  • No chronic non-communicable disease not treated properly and decompensated
  • Renal function assessed by MDRD equal to or above 60 ml / h

Exclusion Criteria:

• Impossibility to conduct evaluation and training efficiently


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 ClinicalTrials.gov identifier (NCT number): NCT03792646


Contacts
Contact: Julia Greve, Professor 2661-6908 jgreve@usp.br
Contact: Guilherme Brech 11998117869 guibrech@gmail.com

Locations
Brazil
Julia Maria DÀndrea Greve Recruiting
São Paulo, Brazil, 04503-010
Contact: Guilherme C Brech, PhD    2661-6908    guibrech@gmail.com   
Principal Investigator: Guilherme C Brech, PhD         
Sponsors and Collaborators
University of Sao Paulo General Hospital
Investigators
Principal Investigator: Julia C Greve, Professor University of São Paulo

Responsible Party: University of Sao Paulo General Hospital
ClinicalTrials.gov Identifier: NCT03792646     History of Changes
Other Study ID Numbers: Diabéticos
First Posted: January 3, 2019    Key Record Dates
Last Update Posted: January 3, 2019
Last Verified: March 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided

Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No

Keywords provided by University of Sao Paulo General Hospital:
Supplementary Feeding
Protein
Muscle strenght
Exercise
Aged

Additional relevant MeSH terms:
Diabetes Mellitus
Inflammation
Diabetes Mellitus, Type 2
Glucose Metabolism Disorders
Metabolic Diseases
Endocrine System Diseases
Pathologic Processes