Effects of Green-MED Diet Via the Gut-fat-brain Axis (DIRECT-PLUS)
Effects of Green-MED Diet Via the Gut-fat-brain Axis; DIRECT-PLUS
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
Study Type
Study Type
Enrollment (Actual)
Enrollment
Phase
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Dimona, Israel
- nuclear research center Negev
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Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
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.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / 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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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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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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****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.
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What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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Abdominal fat
Time Frame: 18 months
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Changes in visceral fat (MRI)
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18 months
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Hepatic fat
Time Frame: 18 months
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Changes in hepatic fat (MRI)
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18 months
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Obesity
Time Frame: 6, 14, 18 months
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Changes in body weight and waist circumference
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6, 14, 18 months
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Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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Brain anatomy
Time Frame: 18 months
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Changes in hippocampus volume, diffusion Tensor Imaging (MRI)
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18 months
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Cognitive function-MRI
Time Frame: 18 months
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Changes in resting state connectivity (MRI, sub-study)
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18 months
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Cognitive function
Time Frame: 18 months
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cognitive tests
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18 months
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Cardiac state
Time Frame: 18 months
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Changes in cardiac anatomy (MRI, substudy)
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18 months
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Cardiac state
Time Frame: 18 months
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Changes in cardiac function (MRI, substudy)
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18 months
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Endothelial dysfunction
Time Frame: 18 months
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Changes endothelial function (ECG)
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18 months
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Lipid profile
Time Frame: 6 , 14 and 18 months
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Changes in lipid biomarkers (blood draw)
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6 , 14 and 18 months
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Glycemic control
Time Frame: 6 , 14 and 18 months
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Changes in glycemic biomarkers (blood draw)
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6 , 14 and 18 months
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Inflammatory state
Time Frame: 6 , 14 and 18 months
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Changes in inflammatory biomarkers (blood draw)
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6 , 14 and 18 months
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Metabolomic
Time Frame: 18 months
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Changes in sub-lipids (blood draw)
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18 months
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Metabolomic
Time Frame: 18 months
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Changes in sub-proteins ( blood draw)
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18 months
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Liver function (blood biomarkers)
Time Frame: 6 and 18 months
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Changes in liver function biomarkers (blood draw)
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6 and 18 months
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Genetic signature
Time Frame: baseline
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SNPs associated with fat distribution and visceral fat
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baseline
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Epigenetics
Time Frame: 18 months
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changes in mRNAs
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18 months
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Epigenetics
Time Frame: 18 months
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changes in genes' methylation
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18 months
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Well being
Time Frame: 18 months
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assessed by questionnaire
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18 months
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Fecal microbiota profile
Time Frame: 6, 14, 18 months
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Diversity Index as a key measure
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6, 14, 18 months
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24h- continuous glucose levels
Time Frame: 2 weeks
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24h dynamics of glucose using continuous glucose monitor.
substudy
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2 weeks
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Collaborators and Investigators
Sponsor
Sponsor
Collaborators
Collaborators
Investigators
Investigators
- Principal Investigator: Iris Shai, PhD, Ben-Gurion University of the Negev
Publications and helpful links
General Publications
- Zelicha H, Kloting N, Kaplan A, Yaskolka Meir A, Rinott E, Tsaban G, Chassidim Y, Bluher M, Ceglarek U, Isermann B, Stumvoll M, Quayson RN, von Bergen M, Engelmann B, Rolle-Kampczyk UE, Haange SB, Tuohy KM, Diotallevi C, Shelef I, Hu FB, Stampfer MJ, Shai I. The effect of high-polyphenol Mediterranean diet on visceral adiposity: the DIRECT PLUS randomized controlled trial. BMC Med. 2022 Sep 30;20(1):327. doi: 10.1186/s12916-022-02525-8.
- Rinott E, Meir AY, Tsaban G, Zelicha H, Kaplan A, Knights D, Tuohy K, Scholz MU, Koren O, Stampfer MJ, Wang DD, Shai I, Youngster I. The effects of the Green-Mediterranean diet on cardiometabolic health are linked to gut microbiome modifications: a randomized controlled trial. Genome Med. 2022 Mar 10;14(1):29. doi: 10.1186/s13073-022-01015-z.
- Kaplan A, Zelicha H, Yaskolka Meir A, Rinott E, Tsaban G, Levakov G, Prager O, Salti M, Yovell Y, Ofer J, Huhn S, Beyer F, Witte V, Villringer A, Meiran N, B Emesh T, Kovacs P, von Bergen M, Ceglarek U, Bluher M, Stumvoll M, Hu FB, Stampfer MJ, Friedman A, Shelef I, Avidan G, Shai I. The effect of a high-polyphenol Mediterranean diet (Green-MED) combined with physical activity on age-related brain atrophy: the Dietary Intervention Randomized Controlled Trial Polyphenols Unprocessed Study (DIRECT PLUS). Am J Clin Nutr. 2022 May 1;115(5):1270-1281. doi: 10.1093/ajcn/nqac001.
- Tsaban G, Yaskolka Meir A, Zelicha H, Rinott E, Kaplan A, Shalev A, Katz A, Brikner D, Bluher M, Ceglarek U, Stumvoll M, Stampfer MJ, Shai I. Diet-induced Fasting Ghrelin Elevation Reflects the Recovery of Insulin Sensitivity and Visceral Adiposity Regression. J Clin Endocrinol Metab. 2022 Jan 18;107(2):336-345. doi: 10.1210/clinem/dgab681.
- Yaskolka Meir A, Rinott E, Tsaban G, Zelicha H, Kaplan A, Rosen P, Shelef I, Youngster I, Shalev A, Bluher M, Ceglarek U, Stumvoll M, Tuohy K, Diotallevi C, Vrhovsek U, Hu F, Stampfer M, Shai I. Effect of green-Mediterranean diet on intrahepatic fat: the DIRECT PLUS randomised controlled trial. Gut. 2021 Nov;70(11):2085-2095. doi: 10.1136/gutjnl-2020-323106. Epub 2021 Jan 18.
- Tsaban G, Yaskolka Meir A, Rinott E, Zelicha H, Kaplan A, Shalev A, Katz A, Rudich A, Tirosh A, Shelef I, Youngster I, Lebovitz S, Israeli N, Shabat M, Brikner D, Pupkin E, Stumvoll M, Thiery J, Ceglarek U, Heiker JT, Korner A, Landgraf K, von Bergen M, Bluher M, Stampfer MJ, Shai I. The effect of green Mediterranean diet on cardiometabolic risk; a randomised controlled trial. Heart. 2020 Nov 23:heartjnl-2020-317802. doi: 10.1136/heartjnl-2020-317802. Online ahead of print.
- Rinott E, Youngster I, Yaskolka Meir A, Tsaban G, Zelicha H, Kaplan A, Knights D, Tuohy K, Fava F, Scholz MU, Ziv O, Reuven E, Tirosh A, Rudich A, Bluher M, Stumvoll M, Ceglarek U, Clement K, Koren O, Wang DD, Hu FB, Stampfer MJ, Shai I. Effects of Diet-Modulated Autologous Fecal Microbiota Transplantation on Weight Regain. Gastroenterology. 2021 Jan;160(1):158-173.e10. doi: 10.1053/j.gastro.2020.08.041. Epub 2020 Aug 26.
- Yaskolka Meir A, Tsaban G, Zelicha H, Rinott E, Kaplan A, Youngster I, Rudich A, Shelef I, Tirosh A, Brikner D, Pupkin E, Sarusi B, Bluher M, Stumvoll M, Thiery J, Ceglarek U, Stampfer MJ, Shai I. A Green-Mediterranean Diet, Supplemented with Mankai Duckweed, Preserves Iron-Homeostasis in Humans and Is Efficient in Reversal of Anemia in Rats. J Nutr. 2019 Jun 1;149(6):1004-1011. doi: 10.1093/jn/nxy321.
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Actual)
Primary Completion
Study Completion (Actual)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Estimate)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
Other Study ID Numbers
- BGU
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
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