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The Effect of Different Diets on Arterial Stiffness in Obese Patients on Liraglutide

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ClinicalTrials.gov Identifier: NCT04990024
Recruitment Status : Recruiting
First Posted : August 4, 2021
Last Update Posted : July 20, 2022
Sponsor:
Information provided by (Responsible Party):
Marlene Chakhtoura, American University of Beirut Medical Center

Study Description
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Brief Summary:
In patients initiating Liraglutide for weight management, the objective is to compare the effect of Med diet, high protein/low carbohydrate (HP/LC) diet and low fat (LF) control diet on CV parameters, namely arterial stiffness, measured by carotid-femoral pulse wave velocity (cfPWV), and visceral adipose tissue, in addition to other metabolic indicators.

Condition or disease Intervention/treatment Phase
Obesity Weight Loss Other: Dietary Intervention Med Diet Other: Dietary Intervention HP/LC Diet Other: Dietary Intervention LF Diet Not Applicable

Detailed Description:
This is a 6-month open label pilot RCT that will be conducted on Lebanese participants with obesity, upon the initiation of Liraglutide for medical weight management, as recommended by their physician. Patients will be randomized to 3 treatment arms: Mediterranean (Med) diet, high protein/ low carbohydrate (HP/LC) diet, and control low fat (LF) diet. While both Med diet and LF diet will be both hypocaloric, allowing the same energy restriction, of 500 Kcal/d, the HP/LC diet will be ad libitum. Participants will be recruited from the Endocrine clinics at AUB-MC (in Building 23 and at the Metabolic and Bariatric Surgery Unit), and from satellite clinics next to AUB- MC. Brochures and posters of the trial will be available in the clinic waiting areas. Patients of both participating and non-participating physicians will be recruited in the study.
Study Design
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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 150 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description:

A computer-generated allocation sequence will be used, with a permuted block randomization (1:1:1). The biostatistician (MB) will generate the randomization sequence and will share it with a trial coordinator (MR) who is independent of the study team. Upon the recruitment of every participant, the study RA will contact the independent trial coordinator to receive the randomization code, in an opaque and sealed envelope.

Randomization will take place at 1-30 days after starting Liraglutide. Treatment allocation will be in batches at the end of each month, and therefore allows for group sessions.
Masking: None (Open Label)
Masking Description: The design is open label as it is impossible to blind the participants and the research team for the study intervention. Each of the dietary interventions will be delivered in the format of intensive, individual and group sessions about the diet, food selection and food recipes.
Primary Purpose: Treatment
Official Title: The Effect of Mediterranean, Low Carbohydrate/High Protein and Low-fat Diet on Arterial Stiffness in Obese Patients on Liraglutide: a Randomized Controlled Trial
Actual Study Start Date : July 1, 2021
Estimated Primary Completion Date : June 15, 2023
Estimated Study Completion Date : June 15, 2023

Resource links provided by the National Library of Medicine

Drug Information available for: Liraglutide

Arms and Interventions
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Arm Intervention/treatment
Experimental: Mediterranean Diet
50 participants will be randomized to this arm. The intervention consists of 5 individual (visits 1,3,5,7,9) and 8 group (visits 1,2,3,4,5,6,7,8) educational sessions on Mediterranean diet in patients on Liraglutide, over a period of 24 weeks. Dietary assessments and adherence questionnaires will be held on several visits to assess adherence.
 Other: Dietary Intervention Med Diet
The diet will consist of a calorie-restricted Med diet, with 500 Kcal/d energy restriction. The intervention consists of individual and group educational sessions on Med diet. During the group sessions, the RA will go over the benefits of Med diet, what composition it should have, and how to make appropriate choices for meal planning, in addition to providing food lists, by season. The individual sessions with subjects will also allow to individualize the diet plan.
Experimental: High protein/Low Carbohydrate Diet
50 participants will be randomized to this arm. The intervention consists of 5 individual (visits 1,3,5,7,9) and 8 group (visits 1,2,3,4,5,6,7,8) educational sessions on HP/LC diet in patients on Liraglutide, over a period of 24 weeks. Dietary assessments and adherence questionnaires will be held on several visits to assess adherence.
 Other: Dietary Intervention HP/LC Diet
This is a non-ketogenic diet consisting of ad libitum intake of proteins, fat, and vegetables, with restriction of daily carbohydrates to <130 g/d. The intervention consists of group educational sessions on HP/LC, same as with Med diet (above). The individual sessions with subjects will also allow to individualize the diet plan.
Active Comparator: Low Fat Diet
50 participants will be randomized to this arm. The intervention consists of 5 individual (visits 1,3,5,7,9) and 8 group (visits 1,2,3,4,5,6,7,8) educational sessions on low fat diet in patients on Liraglutide, over a period of 24 weeks. Dietary assessments and adherence questionnaires will be held on several visits to assess adherence.
 Other: Dietary Intervention LF Diet
In this arm, participants will be advised to follow a calorie restricted LF diet with 500 Kcal/d energy restriction. Group and individual educational sessions will be held at the same frequency as the Med and HP/LC diets, and will have a similar content but targeting LF diet.


Outcome Measures
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Primary Outcome Measures :
  1. cfPWV measurement and pulse wave analysis (PWA) using SphygmoCorCvMS V9 (AtCor Medical) [ Time Frame: 6 months after enrollment ]
    Measured by an RA or a technician, based on the American Heart Association Council recommendations on arterial stiffness measurement in research. The distance from the suprasternal notch to the carotid pulse, and to the femoral site on the same side will be measured; the former distance is subtracted from the latter one. Ten seconds of carotid and 10 seconds of femoral arterial waveforms will be recorded, and the average of the data will be obtained for each of the sites.


Secondary Outcome Measures :
  1. Body composition - visceral adipose tissue using dual x-ray absorptiometry (DXA) [ Time Frame: 6 months after enrollment ]
    Measured by an RA or a technician, assessed using dual x-ray absorptiometry (DXA), Hologic machine, version 13.6.0.5, the preferred method for the assessment of body composition. The ISCD recommendations will be followed for body composition measurement.

  2. Body composition - percent fat-free body mass using dual x-ray absorptiometry (DXA) [ Time Frame: 6 months after enrollment ]
    Measured by an RA or a technician, assessed using dual x-ray absorptiometry (DXA), Hologic machine, version 13.6.0.5, the preferred method for the assessment of body composition. The ISCD recommendations will be followed for body composition measurement.

  3. Body composition - percent body fat using dual x-ray absorptiometry (DXA) [ Time Frame: 6 months after enrollment ]
    Measured by an RA or a technician, assessed using dual x-ray absorptiometry (DXA), Hologic machine, version 13.6.0.5, the preferred method for the assessment of body composition. The ISCD recommendations will be followed for body composition measurement.


Other Outcome Measures:
  1. Dietary Assessment using 24-hour recalls [ Time Frame: 6 months after enrollment ]
    Three-repeated 24-hour recalls (24 HR) administered via phone (2-week days and one week-end day, during one specific week). During the phone call, the participant will be asked to recall all what she/he has consumed during the past 24 hours, and the multiple pass approach of the USDA will be adopted.

  2. Dietary Assessment using adherence questionnaires [ Time Frame: 6 months after enrollment ]
    During the individual sessions, brief adherence assessment questionnaires for each diet, adapted from PREDIMED protocol, will be administered to calculate dietary adherence scores.

  3. Anthropometric measurements - weight in kilograms, height in centimetres, aggregated into BMI (kilogram per meter squared). [ Time Frame: 6 months after enrollment ]
    Weight and height will be measured following standard operating procedures (SOP) and BMI will be computed by dividing weight by height squared.

  4. Anthropometric measurements - waist and hip circumference in centimetres, aggregated into waist to hip ratio ratio [ Time Frame: 6 months after enrollment ]
    Waist and hip circumference will be measured following standard operating procedures (SOP).

  5. Vital signs - blood pressure [ Time Frame: 6 months after enrollment ]
    Blood pressure will be measured following standard operating procedures (SOP).

  6. Vital signs - heart rate [ Time Frame: 6 months after enrollment ]
    Heart rate will be measured following standard operating procedures (SOP).

  7. Genetic studies [ Time Frame: 6 months after enrollment ]
    Genetic studies will consist of Single Nucleoside Polymorphism (SNP) analysis of genes of the GLP1 receptors and cannabinoid receptor 1 will be performed in the molecular lab. These tests will be run at the endocrine core research Lab in batches at study completion.

  8. Metabolic, inflammatory and appetite hormones in pg/mL [ Time Frame: 6 months after enrollment ]
    Gastric inhibitory polypeptide (GIP), Leptin, Adiponectin, Orexin, IL6. These tests will be run at the endocrine core research Lab in batches at study completion.

  9. Metabolic, inflammatory and appetite hormones in pmol/L [ Time Frame: 6 months after enrollment ]
    Insulin and Ghrelin.These tests will be run at the endocrine core research Lab in batches at study completion.

  10. Metabolic, inflammatory and appetite hormones in ng/mL [ Time Frame: 6 months after enrollment ]
    Irisin and mineral hormones and markers, including Crosslaps, Osteocalcin, GLP1. These tests will be run at the endocrine core research Lab in batches at study completion.

  11. Quality of Life Measurement as assessed by the SF-36 questionnaire [ Time Frame: 6 months after enrollment ]
    SF-36 questionnaire filled by participant


Eligibility Criteria
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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  • Men and premenopausal women with obesity defined as BMI ≥ 30 kg/m2
  • Upon the initiation of Liraglutide (within the first 1-4 weeks) for medical weight management, for clinical purposes, as advised by the primary physician
  • Able to commit for a 6-month trial visits

Exclusion Criteria:

  • Pregnant women
  • Patients who are taking or have taken other weight reducing drug therapies in the previous 6 months
  • Patients who have undergone metabolic weight loss surgery
  • Patients known to have diabetes (HbA1c ≥6.5% at screening)
  • Patients with uncontrolled hypertension
  • Patients with cardiac, pulmonary, renal or liver diseases, active cancer or psychiatric diseases
  • Patients with excessive alcohol intake, defined as ≥ 2 glasses per day
  • Patients known to have uncontrolled/ untreated thyroid disorders.
  • Patients with cushing disease or polycystic ovaries, and those with neuro-endocrine or drug induced obesity (such as anti-psychotic, steroids, hormonal therapy): Such patients are resistant to weight loss, and they need treatment of their primary disease and/or cessation of the culprit medication to lose weight
  • Patients with untreated gout
  • Patients who have undergone bariatric surgery
Contacts and Locations
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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): NCT04990024


Contacts
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Contact: Marlene Chakhtoura, MD, MSc +9611350000 ext 7411 mc39@aub.edu.lb
Contact: Rachelle El Haber, BSc +9611350000 ext 8314 re136@aub.edu.lb

Locations
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Lebanon
American University of Beirut - Medical Center Recruiting
Beirut, Riad El Solh, Lebanon, 1107 2020
Contact: AUBMC    +961350000    aubmc@aub.edu.lb   
Principal Investigator: Marlene Chakhtoura, MD, MSc         
Sponsors and Collaborators
American University of Beirut Medical Center
Investigators
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Principal Investigator: Marlene Chakhtoura, MD, MSc American University of Beirut Medical Center
More Information
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Responsible Party: Marlene Chakhtoura, Assistant Professor of Medicine, American University of Beirut Medical Center
ClinicalTrials.gov Identifier: NCT04990024    
Other Study ID Numbers: BIO-2020-0136
First Posted: August 4, 2021    Key Record Dates
Last Update Posted: July 20, 2022
Last Verified: July 2022

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Additional relevant MeSH terms:
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Weight Loss
Body Weight Changes
Body Weight