Norwegian Microbiota Study in Anorexia Nervosa (NORMA)

May 20, 2025 updated by: Siv K Bohn, Norwegian University of Life Sciences

Gut Microbiota Alterations in Anorexia Nervosa - Paving the Way for Personalized Prebiotic Treatment Strategies

Anorexia nervosa (AN) is a serious mental disorder occurring mainly in women. AN is characterized by severely restricted food-intake and subsequent low weight. The disease burden for the individual is high with medical complications and psychiatric comorbidities. Despite decades of research, there are large gaps in the understanding of the biological aspects of AN and lack of effective interventions. Current clinical treatment is associated with gastrointestinal problems, high rates of relapse and poor outcome causing long-term sickness absence and disability. During the COVID19 pandemic the prevalence and severity of AN has spiked. Therefore, there is great need of novel strategies for AN treatment, that can be easily implemented in the clinic without adding complexity to the standard care of treatment. During the resent years it has been proposed that mental disorders might be treated via manipulating the composition and function of the microbes that live in the gut (the microbiota) by adding or restricting fermentable nutrients (prebiotics) in the diet. However, in order to use prebiotics to treat the microbiota in AN patients, more knowledge is needed on how the AN microbiota is affected by the current standard care treatment. Whether prebiotics can be useful for normalizing AN microbiota remains to be established. The overall aim of the "Norwegian study of Microbiota in Anorexia Nervosa" (NORMA) is to join forces of researchers, clinical health care services and voluntary sector in a transdiciplinary approach to improve the understanding of the role of the gut microbiota in AN patients. The current project will include a clinical trial in AN patients and experimental studies to screen novel prebiotics for their ability to modify and normalize AN derived microbiota. The long-term goal of the project is to pave the way for a targeted and clinically feasible individualized treatment for better tolerable weight-restoration and improved health in AN patients.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Recruiting

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Observational

Enrollment (Estimated)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
180

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact

The name and contact information for the person who can answer enrollment questions for a clinical study. Each location where the study is being conducted may also have a specific contact, who may be better able to answer those questions.
  • Name: Siv K Bøhn, PhD
  • Phone Number: +47 67232502
  • Email: sivb@nmbu.no

Study Contact Backup

Study Locations

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

  • Child
  • Adult

Accepts Healthy Volunteers

No

Sampling Method

Non-Probability Sample

Study Population

The female patients with anorexia nervosa (AN) are undergoing specialized nutritional rehabilitation treatment and will be recruited from five Norwegian specialized inpatient treatment units for eating disorders. The standard care treatment consists of a program of psychotherapy and nutritional rehabilitation to achieve normalization of food-intake and weight gain. Although the clinical strategy of AN treatment is standardized, both the psychotherapy and dietary advices are individualized. The dietary advice during standard care treatment is based on clinical experience, as specific guidelines are lacking. Diets are adapted to each individual in aspects of tolerability and preferences, but typically comprise a high-energy diets aiming for a weekly weight gain of 0.5-1.5 kilograms. Often enteral nutrition (i.e., tube feeding) is required. The control group will be aged-matched female subjects with normal weight - mildly overweight.

Description

Inclusion Criteria AN group

  1. Sex: Female
  2. Age: 16-50 years
  3. BMI: <18.5 kg/m2
  4. fulfilling ICD-10 criteria for AN
  5. currently referred to specialized inpatient nutritional treatment for AN
  6. able to understand the Norwegian questionnaires.

Exclusion Criteria AND group:

  1. history of inflammatory bowel disease, celiac disease, or GI tract surgery;
  2. treatment with oral antibiotics the past two months
  3. high intake of probiotic supplements over the past two months.

Inclusion criteria control group

  1. Sex: Female
  2. Age: 16-50 years
  3. BMI: >= 18.5 & < 27
  4. able to understand the Norwegian questionnaires.

Exclusion Criteria AND group:

  1. history of inflammatory bowel disease, celiac disease, or GI tract surgery;
  2. treatment with oral antibiotics the past two months
  3. high intake of probiotic supplements over the past two months.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort

Group / Cohort

A group or subgroup of participants in an observational study that is assessed for biomedical or health outcomes.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Anorexia nervosa (AN) group
Female in-patients with anorexia nervosa, age 16-50 years with BMI below 18.5 kg/m2.
Other: standard care treatment program
The standard care treatment consists of a program of psychotherapy and nutritional rehabilitation to achieve normalization of food-intake and weight gain.
Heathy control (HC) group
Female healthy controls, age 16-50 with normal to mild overweight (18.5 ≤ BMI< 27 kg/m2). .

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Differences in the fecal microbiota composition
Time Frame: Cross-sectional study with only one time point. For AN-group; the baseline sample is delivered during the last week before start of clinical treatment. ]
Comparison of fecal microbial composition between the patients with anorexia nervosa and healthy controls. We will compare different indices of α-diversity - investigating both richness and evenness (e.g. observed number of OTUs, Chao1, Shannon-Wiener, Simpson, and PD whole tree) and different indices of β-diversity (e.g. binary Jaccard, Bray-Curtis, and weighted Unifrac). Also differences in bacterial abundances at various taxonomic levels (phylum, class, order, family, and genus) will be investigated.
Cross-sectional study with only one time point. For AN-group; the baseline sample is delivered during the last week before start of clinical treatment. ]
Change in the fecal microbiota composition in patients with anorexia nervosa during the standard care treatment at the clinics for eating disorder.
Time Frame: One group time-series design. Samples will be taken at baseline (~one week before admission to the clinic) and at ~6 weeks and ~12 weeks.
Mixed model analyses will be performed to assess whether the standard care treatment at the clinics for eating disorder induce changes in the fecal microbiota composition. Both diversity measures ( α-diversity and β-diversity) and bacterial abundances at various taxonomic levels (phylum, class, order, family, and genus) will be investigated.
One group time-series design. Samples will be taken at baseline (~one week before admission to the clinic) and at ~6 weeks and ~12 weeks.
Change in mental scores during standard care treatment at the clinics for eating disorder
Time Frame: One group time-series design. Data will be collected at baseline, at admission to the clinic and at ~6 weeks and ~12 weeks.
Mixed model analyses will be performed to assess whether the standard care treatment at the clinics for eating disorder induce changes in mental scores. Effects of time will be investigated in the AN group only. Mental scores will be assessed using digital questionnaires.
One group time-series design. Data will be collected at baseline, at admission to the clinic and at ~6 weeks and ~12 weeks.
Change in gastrointestinal problems during standard care treatment at the clinics for eating disorder
Time Frame: One group time-series design. Data will be collected at baseline, at admission to the clinic and at ~6 weeks and ~12 weeks.
Mixed model analyses will be performed to assess whether the standard care treatment at the clinics for eating disorder induce changes in gastrointestinal problems. Effects of time will be investigated in the AN group only. Scores for gastrointestinal problems will be assessed using digital questionnaires.
One group time-series design. Data will be collected at baseline, at admission to the clinic and at ~6 weeks and ~12 weeks.

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Associations between microbiota measures (diversity and abundance of specific species), serum biomarkers, dietary charachteristics, gastrointestinal issues and mental issues.
Time Frame: Cross-sectional study with only one time point. For AN-group; the baseline sample is delivered during the last week before start of clinical treatment. ]
Associations between multiple variables will be investigated in both AN group (at baseline, 6 weeks and 12 weeks) and HC group at baseline using unsupervised learning algorithm techniques such as Principal Component Analysis and hireachical clustering techniques. Microbiota is charachterized as described under outcome 1, serum biomarkers include standard clinical biomarkers and biomarkers of inflammation and microbiota relevant biomarkers. Data on dietary charachteristics, gastrointestinal issues and mental issues are obtained by digital questionnaires.
Cross-sectional study with only one time point. For AN-group; the baseline sample is delivered during the last week before start of clinical treatment. ]
Associations between baseline microbiota composition and changes in gastrointestinal complaints during the standard care treatment at the clinics for eating disorder.
Time Frame: One group time-series design. Samples, data will be obtained at baseline (~one week before admission to the clinic) and at ~6 weeks and ~12 weeks.
Associations between microbiota measures at baseline and changes in gastrointestinal complaint sduring the standard care treatment at the clinics for eating disorder will be investigated by unsupervised learning algorithm techniques such as Principal Component Analysis and by applying hireachical clustering techniques on correlation measures. Microbiota will be charachterized as described under outcome 1, serum biomarkers include standard clinical biomarkers and biomarkers of inflammation and microbiota relevant biomarkers. Data on dietary charachteristics, gastrointestinal issues and mental issues are obtained by digital questionnaires.
One group time-series design. Samples, data will be obtained at baseline (~one week before admission to the clinic) and at ~6 weeks and ~12 weeks.
Associations between baseline microbiota composition and changes in mental scores during the standard care treatment at the clinics for eating disorder.
Time Frame: One group time-series design. Samples, data will be obtained at baseline (~one week before admission to the clinic) and at ~6 weeks and ~12 weeks.
Associations between microbiota measures at baseline and changes in mental scores during the standard care treatment at the clinics for eating disorder will be investigated by unsupervised learning algorithm techniques such as Principal Component Analysis and by applying hireachical clustering techniques on correlation measures. Microbiota will be charachterized as described under outcome 1, serum biomarkers include standard clinical biomarkers and biomarkers of inflammation and microbiota relevant biomarkers. Data on dietary charachteristics, gastrointestinal issues and mental issues are obtained by digital questionnaires.
One group time-series design. Samples, data will be obtained at baseline (~one week before admission to the clinic) and at ~6 weeks and ~12 weeks.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Norwegian University of Life Sciences

Collaborators

Collaborators

An organization other than the sponsor that provides support for a clinical study. This support may include activities related to funding, design, implementation, data analysis, or reporting.
Karolinska Institutet
Oslo University Hospital
Haukeland University Hospital
Helse Nord-Trøndelag HF
Nordlandssykehuset HF
Modum Bad
The Eating disorder Association, Norway (SPISFO)
Counseling on eating disorders, Norway (ROS)

Investigators

Investigators

A researcher involved in a clinical study. Related terms include site principal investigator, site sub-investigator, study chair, study director, and study principal investigator.
  • Principal Investigator: Siv K Bøhn, PhD, Norwegian University of Life Sciences

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
September 24, 2023

Primary Completion (Estimated)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
September 1, 2025

Study Completion (Estimated)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
September 1, 2043

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
September 22, 2023

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
November 17, 2023

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
November 22, 2023

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
May 23, 2025

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
May 20, 2025

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
May 1, 2025

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • 336239_KBM_SKB2023

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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