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Beneficial Impact of Orange Juice Consumption on Risk Factors Associated With Cardiovascular Diseases (CITRUS)

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ClinicalTrials.gov Identifier: NCT02479568
Recruitment Status : Unknown
Verified June 2016 by Technological Centre of Nutrition and Health, Spain.
Recruitment status was:  Recruiting
First Posted : June 24, 2015
Last Update Posted : June 6, 2016
Sponsor:
Collaborators:
Florida Department of Citrus
Technological Centre of Nutrition and Health
Hospital Universitari Sant Joan de Reus
University Rovira i Virgili
Information provided by (Responsible Party):
Technological Centre of Nutrition and Health, Spain

Brief Summary:
The primary aim is to examine both the acute and chronic effects of hesperidin consumption from 100% Florida orange juice in various doses on functional and systemic markers associated with cardiovascular disease (CVD) risks.

Condition or disease Intervention/treatment Phase
Cardiovascular Risk Factors Dietary Supplement: Control Dietary Supplement: 100% Florida OJ Dietary Supplement: 100% Florida OJ-enriched Phase 3

Detailed Description:

The aim of this study is to compare the effect of different doses of hesperidin in 100% Florida orange juice (OJ) when regularly or postprandially consumed on cardiovascular risk markers; in addition, the plausible role and mechanism of the hesperidin will be investigated.

The sample size was calculated using a previously available bibliography using systolic blood pressure (SBP) as the primary outcome measure. A total of 84 subjects per study product group were needed, assuming variance components of approximately 20.0, to detect differences between the three groups (control, orange juice and hesperidin-enriched orange juice (10 mm Hg)) with a bilateral significance level of α=0.05 and a power of 80 %.

The sample size was computed to be sufficient to detect differences between treatment groups regarding the evolution in time of SBP levels. Justification of chosen sample size is based on the clinically meaningful difference assigned to δ=10.0 mm Hg, which is equivalent to a difference of approximately 7.4 % in patients with baseline SBP levels of approximately 135 mm Hg. Thus, a sample of 252 participants can be used for the chronic three arm parallel trial design (84 subjects/arm) and will allow us to detect small but clinically relevant differences between the three groups with statistical robustness and direct interpretation in terms of the chronic treatment effect.

To the acute postprandial tests, the investigators have chosen n=20 subjects per arm according to the most studies that have addressed the metabolic effects of a postprandial intervention have been performed using a very similar number of subjects with statistically good quality results.

The statistical analysis will follow the principles specified in the guidelines of the ICHE9 and CPMP/EWP/908/99 ICHE9 Points to Consider on Multiplicity Issues in Clinical Trials.

The continuous efficacy variables will be analyzed by an ANCOVA (analysis of covariance) with the baseline value as a covariate.

The efficacy outcomes will be determined using the absolute values and absolute differences from the baseline. The efficacy analysis will be performed using the Available Data Only approach. In addition, the analysis of the primary efficacy variable will be performed with the Baseline Observation Carried Forward approach.

A suitable hypothesis test will be applied to the rest of the variables according to the nature of each variable, such as the Fisher exact test for categorical variables, Student's T-test for continuous variables and Mann-Whitney U test for ordinal scale variables.

The statistical tests will be applied with an α=0.05 two-sided significance level. Post-hoc analyses and comparisons between pairs of groups will be done as for exploratory purposes.

In addition, the statistical plan will be transferred to the application form of the electronic data collection report (e-CDR), which allows the improvement of data management, diminishes human errors (according threshold values of each outcome) and, overall, guarantees the maximum exploitation of human data in the context of statistical analysis.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 252 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Prevention
Official Title: Randomized, Parallel and Double Blind Placebo-controlled Study for the Evaluation of Both Acute and Chronic Role of Hesperidin Consumption in 100% Orange Juice
Study Start Date : September 2015
Estimated Primary Completion Date : May 2017
Estimated Study Completion Date : January 2018

Arm Intervention/treatment
Active Comparator: Control
Control drink (placebo)
Dietary Supplement: Control
500 mL (250 mL; 2 times/day) of placebo drink for 12 weeks

Experimental: Natural Florida orange juice
100% Florida orange juice (OJ) (natural content of hesperidin)
Dietary Supplement: 100% Florida OJ
500 mL (250 mL; 2 times/day) of 100% Florida OJ for 12 weeks

Experimental: Enriched Florida orange juice
100% Florida orange juice (OJ) (enriched hesperidin content)
Dietary Supplement: 100% Florida OJ-enriched
500 mL (250 mL; 2 times/day) of 100% Florida OJ-enriched for 12 weeks




Primary Outcome Measures :
  1. Systolic Blood Pressure [ Time Frame: Every 2 weeks for a total of 12 weeks. ]
    During each visit, SBP will be measured after 5 min in a seated position in a comfortable room by the physician. The measurement will be taken in duplicate at 1-min intervals using an automatic sphygmomanometer (OMRON HEM-907; Peroxfarma, Barcelona, Spain), and the average of the two measurements will be calculated.


Secondary Outcome Measures :
  1. Diastolic Blood Pressure [ Time Frame: Every 2 weeks for a total of 12 weeks. ]
    During each visit, diastolic BP will be measured after 5 min in a seated position in a comfortable room by the physician. The measurement will be taken in duplicate at 1-min intervals using an automatic sphygmomanometer (OMRON HEM-907; Peroxfarma, Barcelona, Spain), and the average of the two measurements will be calculated.

  2. Ischemic reactive hyperemia (IRH) [ Time Frame: Every 4 weeks for a total of 12 weeks ]
    The endothelial-dependent vasomotor functions will be measured as IRH by a Laser-Doppler linear Periflux 5000 flowmeter (Perimed AB, Järfälla, Stockholm, Sweden)

  3. Platelet aggregation [ Time Frame: Every 4 weeks for a total of 12 weeks ]
    Multiplate analyzer, Roche

  4. Homocysteine [ Time Frame: Every 4 weeks for a total of 12 weeks ]
    Homocysteine concentrations will be measured by liquid chromatography-mass spectrometry (LC-MS/MS)

  5. C-reactive protein (inflammatory marker) [ Time Frame: Every 4 weeks for a total of 12 weeks ]
    High sensitivity C-reactive protein (hsCRP) by standardized methods in a Cobas Mira Plus autoanalyzer (Roche Diagnostics Systems, Madrid, Spain)

  6. oxidized LDL (as oxidative stress biomarker) [ Time Frame: Every 4 weeks for a total of 12 weeks ]
    Mercodia Oxidized LDL ELISA kit will be used to measure the oxidized LDL (mU/L).


Other Outcome Measures:
  1. Transcriptomics [ Time Frame: At week 0 (V1) and 12 week (V7). ]
    Plasma collected at 0 h (V1 and V7) of 20 samples each arm (volunteers in the postprandial study). These cells will be used to perform transcriptomics analysis to detect whole gene expression changes due to the chronic consumption of two doses of hesperidin in 100% Florida orange juice.

  2. Non-targeted Metabolomics [ Time Frame: At week 0 (V1) and 12 week (V7). ]
    Plasma collected at 0 h (V1 and V7) of 20 samples each arm (volunteers in the postprandial study) will be used to perform non-targeted metabolomics by Nuclear Magnetic Response Spectroscopy (NMR) to detect metabolomic profile changes due to the chronic consumption of two doses of hesperidin in 100% Florida orange juice



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Ages Eligible for Study:   18 Years to 65 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion criteria

  • Men or women 18-65 years old
  • No evidence of chronic disease
  • No familial CVD history
  • Written informed consent provided before the initial screening visit.
  • Blood pressure (with no drug intervention) >120 mm Hg systolic blood pressure ≤ 159 mmHg

Exclusion criteria

  • Body mass index (BMI) ≥ 35 kg/m2
  • Glucose >125 mg/dl
  • Systolic blood pressure ≥ 160 mm Hg and diastolic blood pressure >100 mm Hg or taking antihypertensive medications
  • Total cholesterol >240 mg/dl
  • LDL-cholesterol >160 md/dl
  • TAG >350
  • Smoking
  • Pregnant or intending to become pregnant
  • Use of medications, antioxidants, or vitamin supplements
  • Chronic alcoholism
  • Intense physical activity (5h/week)
  • Intestinal disorders
  • Following of a vegetarian diet
  • Anemia (hemoglobin ≤13 g/dL in men and ≤12 g/dL in women)
  • Current or past participation in a clinical trial or consumption of a research product in the 30 days prior to inclusion in the study
  • Failure to follow the study guidelines.

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): NCT02479568


Contacts
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Contact: Rosa Maria Valls, PhD +34 636 944 723 estudis@ctns.cat
Contact: Anna Pedret, PhD +34 977 75 93 77 estudis@ctns.cat

Locations
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Spain
Technological Centre of Nutrition and Health (CTNS) Recruiting
Reus, Tarragona, Spain, 43204
Contact: Rosa Maria Valls, PhD    +34 636 944 723    estudis@ctns.cat   
Contact: Ignasi Papell, BSc    +34 977 300 431    estudis@ctns.cat   
Sponsors and Collaborators
Technological Centre of Nutrition and Health, Spain
Florida Department of Citrus
Technological Centre of Nutrition and Health
Hospital Universitari Sant Joan de Reus
University Rovira i Virgili
Investigators
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Principal Investigator: Rosa Solà Alberich, Prof, MD • University Rovira i Virgili / Hospital Universitari Sant Joan de Reus
Additional Information:
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Responsible Party: Technological Centre of Nutrition and Health, Spain
ClinicalTrials.gov Identifier: NCT02479568    
Other Study ID Numbers: CITRUS 14-12
First Posted: June 24, 2015    Key Record Dates
Last Update Posted: June 6, 2016
Last Verified: June 2016
Keywords provided by Technological Centre of Nutrition and Health, Spain:
Cardiovascular disease
biomarkers
transcriptomics
orange juice
hesperidin
systolic blood pressure
metabolomics
cardiovascular risk factor
Additional relevant MeSH terms:
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Cardiovascular Diseases