Effects of Green-MED Diet Via the Gut-fat-brain Axis (DIRECT-PLUS)
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ClinicalTrials.gov Identifier: NCT03020186 |
Recruitment Status :
Completed
First Posted : January 13, 2017
Last Update Posted : July 15, 2019
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Condition or disease | Intervention/treatment | Phase |
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Abdominal Obesity Metabolic Syndrome | Other: Physical activity Other: Physical activity+ MED diet Other: Physical activity+green MED diet | Not Applicable |
Study Type : | Interventional (Clinical Trial) |
Actual Enrollment : | 294 participants |
Allocation: | Randomized |
Intervention Model: | Parallel Assignment |
Masking: | None (Open Label) |
Primary Purpose: | Prevention |
Official Title: | Effects of Green-MED Diet Via the Gut-fat-brain Axis; DIRECT-PLUS |
Actual Study Start Date : | January 2017 |
Actual Primary Completion Date : | March 2019 |
Actual Study Completion Date : | March 2019 |

Arm | Intervention/treatment |
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Placebo Comparator: Physical activity
Physical activity (PA) group will receive free gym memberships and the instruction necessary to engage in moderate-intensity physical activity, ~80% of which will have an aerobic component. The participants will get basic health promoting guideline for healthy diet .
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Other: Physical activity |
Experimental: Physical activity+ MED diet
On top of the PA intervention described in Arm 1, the participants will be guided for moderate weight loss with a traditional Mediterranean (MED) diet, low in simple carbohydrates. The diet will include 1oz/day of walnuts that will be provided free of charge.
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Other: Physical activity+ MED diet |
Experimental: Physical activity+ green-MED diet
On top of the PA intervention described in Arm 1, the participants will guided for moderate weight loss with a MED diet, low in simple carbohydrates that will be rich in plants and polyphenols and low in processed meat. The diet will include 1oz/day of walnuts, 3-4 cups/day of green tea and ~500cc green shake/dinner based on specific strain of duckweed [Wolffia globose, "Mankai"], an aquatic plant, which might serve as a plant protein source. All the above will be provided free of charge.
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Other: Physical activity+green MED diet
****Sub-study from all 3 main arms: Autologous fecal microbiota supplement intervention derived from the time of maximal weight loss: At the 6-month time period, the time of anticipated greatest weight reduction, participants's feces samples will be processed to capsulized inocula. Samples will be frozen within 2 hours and will be kept at -80c pending analysis. Participants will be randomized to receive either research capsules or identical placebo capsules between 8 and 14 months time period. Placebo capsules will consist of a combination of powdered cocoa and vegetable gelatin in normal saline/glycerol and will be identical in appearance to research capsules. |
- Abdominal fat [ Time Frame: 18 months ]Changes in visceral fat (MRI)
- Hepatic fat [ Time Frame: 18 months ]Changes in hepatic fat (MRI)
- Obesity [ Time Frame: 6, 14, 18 months ]Changes in body weight and waist circumference
- Brain anatomy [ Time Frame: 18 months ]Changes in hippocampus volume, diffusion Tensor Imaging (MRI)
- Cognitive function-MRI [ Time Frame: 18 months ]Changes in resting state connectivity (MRI, sub-study)
- Cognitive function [ Time Frame: 18 months ]cognitive tests
- Cardiac state [ Time Frame: 18 months ]Changes in cardiac anatomy (MRI, substudy)
- Cardiac state [ Time Frame: 18 months ]Changes in cardiac function (MRI, substudy)
- Endothelial dysfunction [ Time Frame: 18 months ]Changes endothelial function (ECG)
- Lipid profile [ Time Frame: 6 , 14 and 18 months ]Changes in lipid biomarkers (blood draw)
- Glycemic control [ Time Frame: 6 , 14 and 18 months ]Changes in glycemic biomarkers (blood draw)
- Inflammatory state [ Time Frame: 6 , 14 and 18 months ]Changes in inflammatory biomarkers (blood draw)
- Metabolomic [ Time Frame: 18 months ]Changes in sub-lipids (blood draw)
- Metabolomic [ Time Frame: 18 months ]Changes in sub-proteins ( blood draw)
- Liver function (blood biomarkers) [ Time Frame: 6 and 18 months ]Changes in liver function biomarkers (blood draw)
- Genetic signature [ Time Frame: baseline ]SNPs associated with fat distribution and visceral fat
- Epigenetics [ Time Frame: 18 months ]changes in mRNAs
- Epigenetics [ Time Frame: 18 months ]changes in genes' methylation
- Well being [ Time Frame: 18 months ]assessed by questionnaire
- Fecal microbiota profile [ Time Frame: 6, 14, 18 months ]Diversity Index as a key measure
- 24h- continuous glucose levels [ Time Frame: 2 weeks ]24h dynamics of glucose using continuous glucose monitor. substudy

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Ages Eligible for Study: | 30 Years and older (Adult, Older Adult) |
Sexes Eligible for Study: | All |
Accepts Healthy Volunteers: | Yes |
Inclusion Criteria:
age >30 years with abdominal adiposity (waist circumference: men > 102 cm, women > 88 cm) or dyslipidemia (TG>150mg/dl and HDL-c <40mg/dL for men and <50mg/dL for women)
Exclusion Criteria:
Individuals who may not be able to partake in PA in the gym; TGs>400 mg/dL; serum creatinine>2 mg/dL; disturbed liver function; major illness that might require hospitalization; pregnant or lactating women; presence of active cancer, is receiving or received chemotherapy in the last three years; participation in another trial; participants who are treated with Coumadin (warfarin) - given its interaction with vitamin K and high level of this vitamin in "Mankai" green shake; pacemaker or platinum implant, because of the impossibility of MRI screening.

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): NCT03020186
Israel | |
Nuclear research center Negev | |
Dimona, Israel |
Principal Investigator: | Iris Shai, PhD | Ben-Gurion University of the Negev |
Responsible Party: | Iris Shai, Principle investigator, Ben-Gurion University of the Negev |
ClinicalTrials.gov Identifier: | NCT03020186 |
Other Study ID Numbers: |
BGU |
First Posted: | January 13, 2017 Key Record Dates |
Last Update Posted: | July 15, 2019 |
Last Verified: | January 2017 |
Individual Participant Data (IPD) Sharing Statement: | |
Plan to Share IPD: | No |
Metabolic Syndrome Obesity, Abdominal Insulin Resistance Hyperinsulinism Glucose Metabolism Disorders Metabolic Diseases |
Obesity Overweight Overnutrition Nutrition Disorders Body Weight |