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Can a Modified Fat Diet With Low Glycaemic Load Improve Insulin Sensitivity and Inflammatory Mediators in Overweight People With Chronic Heart Failure?

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: NCT00163904
Recruitment Status : Unknown
Verified September 2005 by Bayside Health.
Recruitment status was:  Recruiting
First Posted : September 14, 2005
Last Update Posted : August 1, 2007
Information provided by:
Bayside Health

Brief Summary:

This study is looking at overweight patients with chronic heart failure (CHF), to compare the effects of a modified fat diet with a reduced glycaemic load (diet 1); and a conventional low fat, high carbohydrate diet (diet 2) on:

  • insulin sensitivity (using the homeostasis model assessment [HOMA] model)
  • lipid profile
  • symptomatic status (6 minute walk distance and Heart Failure Quality of Life [HF QOL] Questionnaire)
  • body weight
  • inflammatory mediators (tumor necrosis factor [TNF] alpha, C-reactive protein [CRP], interleukin-6 [IL-6])

The hypotheses of this study are:

  • Diet 1 will be associated with lower insulin resistance than diet 2.
  • The lipid profile will be better in CHF patients on diet 1 than on diet 2.
  • Patients on diet 1 will have a better symptomatic status than patients on diet 2.
  • Diet 1 will maintain body weight in patients with CHF as well as diet 2.
  • Diet 1 will suppress the expression of TNF-alpha, CRP and IL-6 more than diet 2.

Condition or disease Intervention/treatment Phase
Heart Failure Behavioral: High mono-unsaturated fat/low carbohydrate diet Behavioral: High carbohydrate/low fat diet Phase 1

Detailed Description:

There is an increasing prevalence of chronic heart failure (CHF) in Western societies. In the last decade, progress has been made in understanding the neurohormonal involvement in the progression of the disease and consequently, new treatments have been developed although the mortality rate still remains high. Chronic heart failure is associated with marked insulin resistance as well as increasing plasma levels of pro-inflammatory markers such as Tumor Necrosis Factor-alpha (TNF-alpha) and Interleukin-6 (IL-6) with increasing severity of the disease. This has recently become an area of increased research interest. In CHF, insulin resistance may be present even when blood glucose levels appear normal. Independently of its influence on risk of arteriosclerosis, insulin resistance supports further progression of heart failure. Hyperinsulinaemia has also been found to worsen symptomatic status in CHF patients.

The introduction of beta-blockers in the treatment of CHF may have a beneficial effect on insulin resistance. However, so far tested drugs seem to have little influence on production of pro-inflammatory markers in CHF patients. The use of beta-blockers in the clinical setting is also associated with weight gain. While weight gain is of benefit to patients with cachexia, a common problem in CHF, it is problematic in CHF patients who are already overweight, particularly since obesity is known to be implicated in the development of insulin resistance. Because of this, it would seem to be beneficial to prevent further weight gain in those patients with heart failure who are not cachexic. Weight loss in these patients, however should also be prevented since obese patients with CHF appear to have the better prognosis. As change in body weight has important implications for disease progression, choice of dietary treatment is of particular importance in CHF patients. Ideally in CHF patients, we should be maintaining body weight while still attempting to reduce other coronary risk factors such as insulin resistance and atherogenic dyslipidemia.

Traditionally, diet for people with insulin resistance and other features of the metabolic syndrome has been based on a low fat, high carbohydrate dietary prescription. This has been questioned recently with emerging clear endorsement of diets that are restricted in saturated fat (< 10% of total energy [%E]) but by allowing higher amounts of monounsaturated fat (MUFA), also reduce the diet carbohydrate content and thus the glycaemic load. Metabolic studies in people with diabetes have shown that modified fat (high MUFA) diets are more effective than a low fat high carbohydrate diet in improving insulin resistance although no similar studies are yet available for people with heart failure.

Studies in people with diabetes have also indicated that modified fat (high MUFA) diets are clearly more beneficial than low fat diets in the effects on triacylglycerols and HDL cholesterol and they also favorably influence blood pressure, coagulation, endothelial activation, inflammation, and thermogenic capacity. Modified fat (high MUFA) diets therefore reduce heart disease risk. Moreover, when the energy density is controlled through inclusion of plenty of fruit and vegetables, modified fat (high MUFA) diets do not promote obesity. One final benefit is better acceptance and compliance long term.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 50 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Official Title: Can a Modified Fat Diet With Low Glycaemic Load Improve Insulin Sensitivity and Inflammatory Mediators in Overweight People With Chronic Heart Failure?
Study Start Date : January 2005

Resource links provided by the National Library of Medicine

Primary Outcome Measures :
  1. Body mass index (BMI)
  2. Blood lipids
  3. Inflammatory mediators
  4. HOMA

Secondary Outcome Measures :
  1. Heart Failure Quality of Life Questionnaire
  2. 6 minute walk test

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 75 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • English speaking heart failure patients (New York Heart Association [NYHA] Classes 1 - 3) attending the Alfred Hospital outpatient clinic will be enrolled.

Exclusion Criteria:

  • Patients will be excluded if they are below the healthy weight range (BMI < 25 kg/m2) or if they are morbidly obese (BMI > 35 kg/m2).
  • Patients with heart failure NYHA Class 4 will be excluded due to their increased risk of developing cachexia.

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): NCT00163904

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Contact: Fiona J Adams, BSc. Grad Dip Diet +613 9276 3063
Contact: Rachel M Stoney, BSc. MDiet, PhD +613 9276 3063

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Australia, Victoria
Alfred Hospital Recruiting
Melbourne, Victoria, Australia, 3004
Contact: Fiona J Adams, BSc. Grad Dip Diet    +613 9276 3063 ext 3063   
Contact: Rachel M Stoney, BSc. MDiet, PhD    +613 9276 3063 ext 3063   
Principal Investigator: Fiona J Adams, BSc. Grad Dip Diet         
Sponsors and Collaborators
Bayside Health
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Principal Investigator: Fiona J Adams, BSc. Grad Dip Diet Dietition on Staff, Alfred Hospital
Layout table for additonal information Identifier: NCT00163904    
Other Study ID Numbers: 12/05
Small Project Grant - T10513
Allied Health Grant - A10501
First Posted: September 14, 2005    Key Record Dates
Last Update Posted: August 1, 2007
Last Verified: September 2005
Keywords provided by Bayside Health:
Heart Failure
Inflammatory mediators
insulin sensitivity
high monounsaturated diet
Additional relevant MeSH terms:
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Heart Failure
Insulin Resistance
Heart Diseases
Cardiovascular Diseases
Body Weight
Signs and Symptoms
Immune System Diseases
Glucose Metabolism Disorders
Metabolic Diseases