High Fat/High Calorie Trial in Amyotrophic Lateral Sclerosis

• Safety Outcomes: Frequency of Adverse Events [ Time Frame: 5 months ] [ Designated as safety issue: Yes ]
• Serious Adverse Events [ Time Frame: 5 months ] [ Designated as safety issue: Yes ]
  SAE were defined using the Common Terminology Criteria for Adverse Events (CTCAE) version 3.0.
• Tolerability [ Time Frame: 5 months ] [ Designated as safety issue: No ]
  Number of participants who completed the study on their assigned study intervention.

• Rate of Change in ALSFRS-R in Units/Month [ Time Frame: Over 5 months ] [ Designated as safety issue: Yes ]
  Rate of change in the ALS Functional Rating Scale-Revised, calculated in units/month. Negative numbers refer to worsening over time.
• Biomarkers of Body Composition and Lipid Metabolism [ Time Frame: 5 months follow-up ] [ Designated as safety issue: No ]

The purpose of this study is to determine the safety, tolerability, and preliminary efficacy of long-term use of high fat/high calorie and high calorie diets in people with amyotrophic lateral sclerosis (ALS) (Lou Gehrig's disease).

Weight loss is a common and severe symptom of amyotrophic lateral sclerosis (ALS), caused both from inadequate calorie intake and an increased metabolic rate. People with ALS are generally instructed to increase their calorie intake; however, the ideal amount and type of calories has not been studied. Several studies in an animal model of motor neuron disease have shown that a high fat/high calorie diet can increase survival by as much as 38%. Mice on a high fat diet also live longer than mice fed diets consisting of high protein or high sugar. We are therefore conducting a phase II safety, tolerability, and preliminary efficacy trial in ALS of high fat versus high calorie versus normal diet. The normal diet will be calculated based on the number of calories needed to replace each participant's measured daily calorie requirement.

• Dietary Supplement: Oxepa
  Oxepa: Tube feed containing 1.5 calories/ml of which 55% calories are from fat, including eicosapentaenoic acid and gamma-linolenic acid. Subjects will receive 1.25 times their daily caloric requirements based on their measured resting energy expenditure. Subjects will receive 4 months of tube feeds and be followed for an additional 1 month to measure adverse events and tolerability.
• Dietary Supplement: Jevity 1.5
  Jevity 1.5: Tube feed containing 1.5 calories/ml of which 29.4% are from fat. Subjects will receive 1.25 times their daily caloric requirements based on their measured resting energy expenditure. Subjects will receive 4 months of tube feeds and be followed for an additional 1 month to measure adverse events and tolerability.
• Dietary Supplement: Jevity 1.0
  Jevity 1.0: Control tube feed. Subjects will receive 1.0 times their daily caloric requirements based on their measured resting energy expenditure. Subjects will receive 4 months of tube feeds and be followed for an additional 1 month to measure adverse events and tolerability.

• Experimental: High fat/high calorie
  High fat/high calorie diet: Oxepa
  Intervention: Dietary Supplement: Oxepa
• Active Comparator: High calorie
  High calorie diet: Jevity 1.5
  Intervention: Dietary Supplement: Jevity 1.5
• Placebo Comparator: Control
  Control diet: Jevity 1.0
  Intervention: Dietary Supplement: Jevity 1.0

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Inclusion Criteria:

1. Clinical diagnosis of ALS
2. Male or female subjects aged 18 years or older
3. Must already be tolerating tube feedings through either a gastrostomy tube (G-tube or PEG) or jejunostomy tube (J-tube)
4. Must require non-invasive ventilation (BIPAP) for less than 10 hours/day
5. Women of childbearing potential must have a negative pregnancy test at screening and be non-lactating.

Exclusion Criteria:

1. History of hepatitis including non-alcoholic steatohepatitis (NASH), cholecystectomy, prior biliary disease such as gallstones
2. History of diabetes
3. History of prior myocardial infarction or stroke
4. Laboratory values: Screening alanine aminotransferase (ALT) or aspartate aminotransferase (AST) greater than 2.0 times the upper limit of normal or total bilirubin greater than 1.5 times the upper limit of normal
5. Allergy to soy, fish, or milk products