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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
Sponsor:
Collaborators:
University of Copenhagen
University of Aarhus
Herlev and Gentofte Hospital
Information provided by (Responsible Party):
Steno Diabetes Center Copenhagen

Brief Summary:

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.


Condition or disease Intervention/treatment Phase
Non-Alcoholic Fatty Liver Disease Insulin Resistance Glucose Tolerance Impaired Obesity, Abdominal Dietary Supplement: Curcumin (Meriva®) Drug: Placebo Oral Tablet Not Applicable

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Detailed Description:

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.

Information meeting:

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.

Screening visit:

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:

  1. A fasting urine sample will be collected, and the participant is kindly asked to empty the bladder completely. Urine volume will be measured.
  2. Measurement of bioimpedance.
  3. Fasting blood samples will be collected (biomarkers of NASH and fibrosis, fibroblast growths factors, triglycerides, cholesterols, liver parameters, haemoglobin A1c, inflammatory markers, adipokines, haemoglobin, creatinine) amounting 22 ml.
  4. FibroScan: The subject will be lying in a supine position for approximately 10 minutes during which a probe using shear-waves and ultrasound is applied in the right side of the body below the ribs
  5. Measurement of blood pressure, pulse rate, body weight and hip and waist circumference
  6. One cannula will be inserted in the cubital vein for collection of blood samples; the forearm from which blood samples are drawn will be wrapped in a heating blanket (42°C) throughout the experiment (for arterialisation of venous blood)
  7. Blood samples will be collected according to Table 1 below (total amino acids, gut hormones, glucose, glucagon, insulin, c-peptide, urea, free fatty acids)
  8. At time 0 min, the subject will ingest 75 g of water-free glucose dissolved in 300 ml water over a period of 5 minutes
  9. At time 0, 30, 60, 90, 120, 150, 180, 210, 240 and 280 min, hunger, satiety, fullness and prospective food consumption will be measured by visual analogue scales (VASs). (see enclosure 5 "VAS")
  10. During the last hour (~180min - ~240 min), resting energy expenditure (REE) will be measured in a supine position by indirect calorimetry to determine oxygen consumption (V02) and carbon dioxide production (VC02). A flow-through canopy gas analyser will be used.
  11. At time ~240 min the subject will be asked to provide a new urine sample for measurement of urea concentration. The participant is kindly asked to empty the bladder completely. Urine volume will be measured.
  12. At time 250 min, the subject will ingest a standardised ad libitum meal consisting of minced meat, pasta, corn, carrots, peppers, cream, salt and pepper (50 energy (E) % carbohydrate, 37 E% fat, 13 E% protein); the subject will be instructed to eat as much as possible until feeling comfortable satiated; the meal should be consumed within a maximum of 30 minutes and by the end of the meal, time spent eating, weight of the meal and the total amount of energy consumed will be noted

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.


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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 40 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: The Effect of Curcumin on Liver Fat Content in Obese Subjects
Actual Study Start Date : March 5, 2019
Estimated Primary Completion Date : September 2020
Estimated Study Completion Date : October 2020

Resource links provided by the National Library of Medicine

Drug Information available for: Curcumin

Arm Intervention/treatment
Experimental: Curcumin (Meriva®)
Meriva® 500 mg tablet (contains 100 mg curcumin) Dosage: 2 tablets twice daily for 42 days (+/- 3 days)
Dietary Supplement: Curcumin (Meriva®)

Experimental drug:

Meriva® 500 mg tablet (contains 1 mg curcumin)


Placebo Comparator: Placebo
Placebo. Dosage: 2 tablets twice daily to mimic Meriva® tablets.
Drug: Placebo Oral Tablet

Placebo:

Contains same ingredients as Meriva®, apart from curcumin. Similar in appearance to Meriva®.





Primary Outcome Measures :
  1. Curcumin's effect on steatosis [ Time Frame: 42 days +/- 3 days ]
    Percentage of fat in the liver tissue measured by magnetic resonance spectroscopy


Secondary Outcome Measures :
  1. Curcumin's effect on concentration of total amino acids in plasma [ Time Frame: 42 days +/- 3 days ]
  2. Curcumin's effect on plasma concentration of urea [ Time Frame: 42 days +/- 3 days ]
  3. Curcumin's effect on urin concentration of urea [ Time Frame: 42 days +/- 3 days ]
  4. Curcumin's effect on serum concentration of inflammatory marker interleukin (IL)-1b [ Time Frame: 42 days +/- 3 days ]
  5. Curcumin's effect on serum concentration of inflammatory marker IL-2 [ Time Frame: 42 days +/- 3 days ]
  6. Curcumin's effect on serum concentration of inflammatory marker IL-6 [ Time Frame: 42 days +/- 3 days ]
  7. Curcumin's effect on serum concentration of inflammatory marker IL-10 [ Time Frame: 42 days +/- 3 days ]
  8. Curcumin's effect on serumconcentration of inflammatory marker tumor necrosis factor (TNF)-alpha [ Time Frame: 42 days +/- 3 days ]
  9. Curcumin's effect on plasma concentration of adipokines [ Time Frame: 42 days +/- 3 days ]
  10. Curcumin's effect on plasma concentration of glucagon [ Time Frame: 42 days +/- 3 days ]
  11. Curcumin's effect on plasma concentration of glucagon-like peptide 1 [ Time Frame: 42 days +/- 3 days ]
  12. Curcumin's effect on plasma concentration of glucose-dependent insulinotropic peptide [ Time Frame: 42 days +/- 3 days ]
  13. Curcumin's effect on glucose plasma values during an oral glucose tolerance test for 4 hours [ Time Frame: 42 days +/- 3 days ]
  14. Curcumin's effect on serum c-peptide levels [ Time Frame: 42 days +/- 3 days ]
  15. Curcumin's effect on serum insulin concentration [ Time Frame: 42 days +/- 3 days ]
  16. Curcumin's effect on serum concentration of free fatty acids [ Time Frame: 42 days +/- 3 days ]
  17. Curcumin's effect on liver insulin resistance [ Time Frame: 42 days +/- 3 days ]
  18. Curcumin's effect on body weight in kilograms [ Time Frame: 42 days +/- 3 days ]
  19. Curcumin's effect on BMI (kg/m^2) [ Time Frame: 42 days +/- 3 days ]
  20. Curcumin's effect on waist circumference (cm) [ Time Frame: 42 days +/- 3 days ]
  21. Curcumin's effect on waist-hip ratio [ Time Frame: 42 days +/- 3 days ]
  22. Curcumin's effect on systolic blood pressure (mmHg) [ Time Frame: 42 days +/- 3 days ]
  23. Curcumin's effect on diastolic blood pressure (mmHg) [ Time Frame: 42 days +/- 3 days ]
  24. Curcumin's effect on transient elastography liver stiffness measurements (kPa) [ Time Frame: 42 days +/- 3 days ]
    Evaluated with FibroScan

  25. Curcumin's effect on transient elastography controlled attenuation parameter (CAP) value (dB/m) [ Time Frame: 42 days +/- 3 days ]
    Evaluated with FibroScan

  26. Curcumin's effect on gut microbiota (relative abundance) [ Time Frame: 42 days +/- 3 days ]
  27. Curcumin's effect on gut microbiota (alpha/beta diversity) [ Time Frame: 42 days +/- 3 days ]
  28. Curcumin's effect on gut microbiota (link to phenotype of interest) [ Time Frame: 42 days +/- 3 days ]
  29. Curcumin's effect on visceral fat (cm) [ Time Frame: 42 days +/- 3 days ]
    Evaluated by MR-spectroscopy

  30. Curcumin's effect on subcutaneous fat (cm) [ Time Frame: 42 days +/- 3 days ]
    Evaluated by MR-spectroscopy

  31. Curcumin's effect on muscle percentage [ Time Frame: 42 days +/- 3 days ]
    Evaluated by bioimpedance measurement

  32. Curcumin's effect on fatt mass [ Time Frame: 42 days +/- 3 days ]
    Evaluated by bioimpedance measurement

  33. Curcumin's effect on fat percentage [ Time Frame: 42 days +/- 3 days ]
    Evaluated by bioimpedance measurement

  34. Curcumin's effect on fat-free mass [ Time Frame: 42 days +/- 3 days ]
    Evaluated by bioimpedance measurement

  35. Curcumin's effect on fat-free mass percentage [ Time Frame: 42 days +/- 3 days ]
    Evaluated by bioimpedance measurement

  36. Curcumin's effect on total body water [ Time Frame: 42 days +/- 3 days ]
    Evaluated by bioimpedance measurement

  37. Curcumin's effect on body water percentage [ Time Frame: 42 days +/- 3 days ]
    Evaluated by bioimpedance measurement

  38. Curcumin's effect on prospective food consumption [ Time Frame: 42 days +/- 3 days ]
    Evaluated by questionnaires during the OGTT on the experimental days

  39. Curcumin's effect on food consumption [ Time Frame: 42 days +/- 3 days ]
    Evaluated by how many grams of standardised meal the subject eats at an ad libitum meal

  40. Curcumin's effect on calory balance [ Time Frame: 42 days +/- 3 days ]
    Evaluated by a questionnaire participants fill out on 3 consecutive days

  41. Curcumin's effect on plasma concentration of cholesterol [ Time Frame: 42 days +/- 3 days ]
  42. Curcumin's effect on plasma concentration of alanine aminotransferase [ Time Frame: 42 days +/- 3 days ]
  43. Curcumin's effect on plasma concentration of aspartate aminotransferase [ Time Frame: 42 days +/- 3 days ]


Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.


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Ages Eligible for Study:   20 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   Male
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • BMI >30.0 kg/m2
  • Haemoglobin ≥7.5 mmol/l
  • Written informed consent
  • If the subject is known with diet treated diabetes, HbA1c has to be < 48 mmol/mol.
  • If the subject is not known diabetes, HbA1c can be <53 mmol/mol

Two of the following four parameters:

  • Steatosis on Fibro scan with M-probe or XL-probe (S>=1)
  • Waist circumference >94 cm
  • HbA1c>48 mmol/mol
  • FLI score >60% (see enclosure 2 "FLI score")

Exclusion Criteria:

  • Use of glucose-lowering drugs, lipid-lowering drugs, warfarin, clopidogrel or non-vitamin K oral anticoagulants
  • Treatment with drugs with potential steatogenic side-effects within three months prior to inclusion (e.g. tetracycline, valproic acid, systemic glucocorticoids, amiodarone, tamoxifen and methotrexate)
  • Known viral, inherited or alcoholic liver disease, or any other condition known to affect the liver (e.g. coeliac disease, Wilsons disease, cystic fibrosis, alpha-1 anti-trypsin deficiency)
  • Positive result of blood test for viral hepatitis markers
  • Intake of more than 21 units of alcohol per week, or earlier alcohol abuse
  • Frequent use of anti-inflammatory drugs
  • Nephropathy (eGFR < 60 ml/min/1.73 m² and/or urine albumin > 20 mg/L)
  • In a weight management program, or planning to change life style, alcohol habits or eating habits during the study
  • Known allergy to curcumin/turmeric
  • Claustrophobia
  • Implanted metal objects contraindicative of MRS
  • Any condition(s) or clinical or biochemical signs that the investigator think would interfere with trial participation or with the safety of the subject
  • Any regular drug treatment that cannot be discontinued for minimum 18 hours

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): NCT03864783


Contacts
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Contact: Pernille H Hellmann, MD +45 20911792 pernille.hoegh.hellmann@regionh.dk
Contact: Filip K Knop, MD, PhD +45 26830161 filip.krag.knop.01@regionh.dk

Locations
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Denmark
Center for Clinical Metabolic Research Recruiting
Hellerup, Denmark, 2900
Contact: Pernille H Hellmann, MD    +45 20911792    pernille.hoegh.hellmann@regionh.dk   
Sponsors and Collaborators
Steno Diabetes Center Copenhagen
University of Copenhagen
University of Aarhus
Herlev and Gentofte Hospital
Investigators
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Principal Investigator: Pernille H Hellmann, MD Center for Clinical Metabolic Research, Gentofte Hospital

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Responsible Party: Steno Diabetes Center Copenhagen
ClinicalTrials.gov Identifier: NCT03864783     History of Changes
Other Study ID Numbers: H-18045227
First Posted: March 6, 2019    Key Record Dates
Last Update Posted: September 24, 2019
Last Verified: February 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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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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Liver Diseases
Fatty Liver
Non-alcoholic Fatty Liver Disease
Insulin Resistance
Obesity, Abdominal
Glucose Intolerance
Hyperinsulinism
Glucose Metabolism Disorders
Metabolic Diseases
Digestive System Diseases
Obesity
Overnutrition
Nutrition Disorders
Hyperglycemia
Curcumin
Anti-Inflammatory Agents, Non-Steroidal
Analgesics, Non-Narcotic
Analgesics
Sensory System Agents
Peripheral Nervous System Agents
Physiological Effects of Drugs
Anti-Inflammatory Agents
Antirheumatic Agents
Antineoplastic Agents
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action