The Effect of Curcumin on Liver Fat Content in Obese Subjects
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|ClinicalTrials.gov Identifier: NCT03864783|
Recruitment Status : Recruiting
First Posted : March 6, 2019
Last Update Posted : September 24, 2019
|First Submitted Date ICMJE||February 26, 2019|
|First Posted Date ICMJE||March 6, 2019|
|Last Update Posted Date||September 24, 2019|
|Actual Study Start Date ICMJE||March 5, 2019|
|Estimated Primary Completion Date||September 2020 (Final data collection date for primary outcome measure)|
|Current Primary Outcome Measures ICMJE
||Curcumin's effect on steatosis [ Time Frame: 42 days +/- 3 days ]
Percentage of fat in the liver tissue measured by magnetic resonance spectroscopy
|Original Primary Outcome Measures ICMJE||Same as current|
|Change History||Complete list of historical versions of study NCT03864783 on ClinicalTrials.gov Archive Site|
|Current Secondary Outcome Measures ICMJE
|Original Secondary Outcome Measures ICMJE
|Current Other Pre-specified Outcome Measures||Not Provided|
|Original Other Pre-specified Outcome Measures||Not Provided|
|Brief Title ICMJE||The Effect of Curcumin on Liver Fat Content in Obese Subjects|
|Official Title ICMJE||The Effect of Curcumin on Liver Fat Content in Obese Subjects|
The majority of obese have non-alcoholic fatty liver disease (NALFD). Currently, no pharmacological agents are licenced for the prevention or treatment of NAFLD, and weight loss, notoriously difficult to obtain (and specially to maintain), remains the only treatment option. Interestingly, curcumin, a phenolic compound extracted from the turmeric root, has from in vitro and animal studies shown promising effects in preventing and treating NAFLD, and the sparse available human data point in the same direction; but solid human data are missing. This study will delineate the effects of curcumin when treating NAFLD in humans.
The primary aim of this study is to investigate the effect of 6 weeks of curcumin on liver fat content (assessed by magnetic resonance spectroscopy (MRS)) in obese subject with NAFLD. Additionally, a range of secondary endpoints have been chosen in order to delineate the role of NAFLD in the newly discovered liver-alpha cell axis governing circulating levels of the glucose-mobilising pancreatic alpha cell hormone glucagon and, thus, to elucidate the link between liver fat content and the risk of developing reduced glucose tolerance and type 2 diabetes (T2D). Also, the anti-inflammatory effect of curcumin will be elucidated, as inflammatory markers will be measured before and after intervention. Furthermore, the effect of curcumin will be measured by measuring the following parameters before and after intervention: Transient elastography, anthropometric measurements, body weight, appetite, food-consumption, calory balance, resting energy expenditure, gut microbiota, bioimpedance measures, visceral- and subcutaneous fat, glucose tolerance, lipids, blood pressure, pulse, liver parameters (blood-tests) and adipokines. During the oral glucose tolerance test before and after intervention, incretin hormones, glucagon, amino acids, insulin, c-peptide and urea will be measured.
The prevalence of obesity is increasing worldwide. Obesity and its associated complications represent an enormous burden for obese individuals, their families, healthcare systems and societies. Non-alcoholic fatty liver disease (NAFLD) has emerged as a frequent and serious complication of obesity. Steatosis, the benign and potentially reversible form of NAFLD, may progress to a more severe form, non-alcoholic steatohepatitis (NASH), which can result in fibrosis and ultimately liver cirrhosis, and rarely hepatocellular carcinoma. The majority of obese have NAFLD. Currently, no pharmacological agents are licenced for the prevention or treatment of NAFLD, and weight loss, notoriously difficult to obtain (and specially to maintain), remains the only treatment option. Interestingly, curcumin, a phenolic compound extracted from the turmeric root, has from in vitro and animal studies shown promising effects in preventing and treating NAFLD, and the sparse available human data point in the same direction; but solid human data are missing. This study seeks to investigate the effects of curcumin on treating NAFLD in humans by looking at the effects of ingestion of curcumin for 6 weeks in obese subject with NAFLD on lipid, glucose and protein metabolism.
In this randomised, double-blinded, placebo-controlled trial, eligible participants will undergo baseline assessments before being randomised to receive two capsules of placebo twice daily or two capsules of curcumin (corresponding to 200 mg) twice daily for 6 weeks. In the end of the 6-week intervention periods, end-of-trial assessments (similar to baseline assessments) will be performed.
Prior to any protocol-related procedures, an information meeting at Clinical Metabolic Physiology, Steno Diabetes Center Copenhagen will be arranged, and subjects will be informed of the possibility of bringing a person of own choice to the visit. During this meeting, a member of the research group will explain the purpose, procedures and possible risks of the study in undisturbed and confidential surroundings. The subject will be informed that if extra time to evaluate participation is needed, a minimum of 24 hours from oral information is given until the consent and sign the informed consent form should be given is acceptable. After obtaining the informed consent, time of screening is planned. The subject will be informed that it is possible to withdraw the written consent at any time prior to or during the study.
If a person agrees to participate in the study following the information meeting, and oral and written informed consent has been obtained, a screening visit will be planned. The subject will be instructed in a 10 hour overnight fast before screening (including medicine, but water may be consumed until 2 hours before screening). After this fast the subject will meet in the department in the morning. Height and body weight will be measured, medication and medical history will be recorded, blood will be sampled for assessment of plasma/serum concentrations of thyroid-stimulating hormone, creatinine, electrolytes, aspartate aminotransferase (ASAT), alanine aminotransferase (ALAT), lactate dehydrogenase, alkaline phosphatase, albumin, bilirubin, gamma-glutamyltransferase, viral hepatitis markers, platelet count, ferritin and haemoglobin, and albumin-creatinine ratio in the urine will be measured. A Fibro Scan will be performed. A physical examination will be made including evaluation of blood pressure and pulse rate. Alcohol habits will be evaluated based on The Alcohol Use Disorder Identification Test (AUDIT) questionnaire76,77 and quantification of the weekly amount of alcohol. A magnetic resonance (MR) safety checklist will be completed and a MR information sheet will be given. If all inclusion criteria and none of the exclusion criteria are met, dates for baseline assessments and randomisation visit will be planned within 6 weeks from the screening visit. The subject will be instructed in not to consume curcumin-containing food on a daily basis from screening until end of trial.
Baseline assessments and randomisation visit:
Included subjects will undergo an MRS, which will be scheduled within one week prior to the randomisation visit. The subject will meet at the Department of Radiology at Herlev Hospital and be placed in a horizontal position during the scan. During the MRS, a spectroscopy of the liver will be assessed, and an estimation of visceral adipose tissue and subcutaneous adipose tissue will be done. The subject will be placed in a horizontal position during the scan (duration: approximately 30 minutes).
Food and physical activity diary and standardised food intake period: Starting five days before the randomization visit and the end-of-trial visit, each subject will fill out a three days food and physical activity dairy followed by two days standardized food intake. The food and physical activity diary will be registered manually by participants, using a questionnaire. The standardized food intake should be high in carbohydrates, to get the most valid oral glucose tolerance test (OGTT) response, and the subject will be thoroughly instructed in this.
During the last week before randomisation, the subject is kindly asked to collect a stool sample for the determination of gut bacteria count and subtype. The participant will receive sample kits consisting of cooler bag, freezer packs and stool sample tubes. Stool samples will be collected by the participant at home: Prior to defecation a disposable collector will be placed in the toilet from where stool will be transferred to a tube that immediately is transferred to a transport container and placed at -20°C in the patient's freezer. Prior to transport to Gentofte Hospital, the transport container is transferred to the cooler bag and at arrival at Gentofte Hospital the transport container (with the sample tube) is immediately stored in at -80°C for later analysis. This entails DNA extraction, library preparation, MiSeq 16S rRNA sequencing and microbiota analysis (relative abundance, alpha/beta diversity, link to phenotype of interest).
On the randomisation visit, the subject will meet in the laboratory around 8 a.m. after 10 hours of fast (including medication) and refrainment from tobacco or nicotine supplements use. The subject is allowed to drink water until 8 hours before meeting in department. Furthermore, the subject will be requested to avoid heavy alcohol intake and strenuous exercise two days prior to the visit and instructed to use non-strenuous methods of transportation to the research facility. The following procedures will be conducted:
The interventional period:
The intervention will start the day after randomisation but can be postponed up to three days for logistic reasons if necessary. During the entire intervention period, each subject will fill out a dairy to keep track of any new concomitant medication, compliance and possible adverse events. Each subject will take either two capsules of Meriva® or two placebo capsules each morning and each evening for 42 days (±3 days) with a small glass of water, preferably in relation to a meal. Should the subject forget/miss to take a dose, it can be ingested until 6 hours before the next planned dose. If the subject forgets/misses a dose, and the next planned dose is within the next 6 hours, the dose should be passed, and the subject must note the incident in the diary. The subject is kindly asked to keep the alcohol and smoking habits they might have had before screening and, thus, not to consume more than 21 units of alcohol per week. Furthermore, it is not allowed to consume more than 5 units in one night or to consume curcumin-containing food on a daily basis until end of trial. Mid-way through the intervention period, the subject will receive a phone call from the investigator or other delegated site staff, checking on adverse events, concomitant medication and compliance, and to answer any questions from the subject.
Starting five days prior to end-of-trial visit, the subject must once more fill out the food and physical activity diary followed by two days of standardized food intake.
End-of-trial assessments and visit:
The end-of-trial visit will be scheduled 42±3 days after the randomisation visit and within one week prior to the end-of-trial visit, stool sample collection and MRS will be scheduled and performed as described above under "Baseline assessments and randomisation visit". Procedures during the end-of-trial visit are similar to the ones described above under "Baseline assessments and randomisation visit". Also, during this day, to check for any effect of curcumin intervention, physical examination will be performed by a physician from the research team and additional blood samples (identical with the samples at the screening visit, except viral hepatitis markers) will be collected (which adds another 5 ml blood samples compared to randomisation visit) and albumin-creatinine ratio in the urine will be measured.
|Study Type ICMJE||Interventional|
|Study Phase ICMJE||Not Applicable|
|Study Design ICMJE||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
|Study Arms ICMJE||
|Publications *||Not Provided|
* Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
|Recruitment Status ICMJE||Recruiting|
|Estimated Enrollment ICMJE
|Original Estimated Enrollment ICMJE||Same as current|
|Estimated Study Completion Date ICMJE||October 2020|
|Estimated Primary Completion Date||September 2020 (Final data collection date for primary outcome measure)|
|Eligibility Criteria ICMJE||
Two of the following four parameters:
|Ages ICMJE||20 Years and older (Adult, Older Adult)|
|Accepts Healthy Volunteers ICMJE||No|
|Listed Location Countries ICMJE||Denmark|
|Removed Location Countries|
|NCT Number ICMJE||NCT03864783|
|Other Study ID Numbers ICMJE||H-18045227|
|Has Data Monitoring Committee||Yes|
|U.S. FDA-regulated Product||
|IPD Sharing Statement ICMJE||
|Responsible Party||Steno Diabetes Center Copenhagen|
|Study Sponsor ICMJE||Steno Diabetes Center Copenhagen|
|PRS Account||Steno Diabetes Center Copenhagen|
|Verification Date||February 2019|
ICMJE Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP