Effects of Intermittent Caloric Restriction in Youth With Cardiometabolic Risk

March 7, 2022 updated by: Weili Yan, Children's Hospital of Fudan University

Effects of Intermittent Caloric Restriction in Youth With Cardiometabolic Risk: a Randomized Controlled Pilot Study

This is a randomized controlled pilot study to evaluate the effects of intermittent caloric restriction compared with low carbohydrate diet in youth with cardiometabolic risk.

Study Overview

Detailed Description

The National China Health and Nutrition Survey revealed that 42% of overweight children had at least one cardiovascular metabolic risk, such as hyperglycaemia, dyslipidemia or hypertension. Non-pharmaceutical life style modifications are the recommended intervention to these subjects, including caloric restriction and increased physical activity. However, the problems of poor compliance and metabolic adaptation are well known. Evidences from a number studies in rodent models and human indicated that intermittent caloric restriction (ICR) may stimulate series reactions in human body, including improvement of insulin sensitivity, blood pressure, oxidative stress and inflammation, and may be easier to follow. Evidence from larger human studies is strongly encouraged, while the effects, safety and adherence in chidren and youth need to be studied.

This study is a randomized controlled trial of intermittent caloric restriction versus low carbohydrate diet in youth with cardiometabolic risk over one month period. The intervention is based on the 5:2 diet, which involves caloric restriction for 2 days (consecutive or nonconsecutive, 600kcal/d for male and 500kcal/d for female) per week and unrestricted eating during the other 5 days of the week. For control group, the subjects receive 7 days (consecutive or nonconsecutive) of low carbohydrate diet intervention during the 14-day intervention period,. Carbohydrate intake of low-carbohydrate diet should be controlled as ≤ 50g per day. Total trial duration is one month consisting of a 14-day intervention phase and a 14-day self-maintenance phase. During the maintenance phase, two follow-up electronic questionnaires were conducted.

The study aim to explore effects of the dietary interventions on cardiometabolic markers, inflammatory reaction, oxidative stress and gut microbiome in youth with cardiometabolic risk.

Study Type

Interventional

Enrollment (Actual)

34

Phase

  • Not Applicable

Contacts and Locations

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

Study Locations

      • Shanghai, China
        • Children's Hospital of Fudan University

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

Ages Eligible for Study

9 years to 30 years (Child, Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

Have at least one of the following cardiometabolic abnormalities:

  1. Overweight or obesity (central obesity or general obesity)
  2. Prediabetes: impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT)
  3. Dyslipidemia
  4. Elevated blood pressure

Criteria for cardiometabolic abnormalities:

  1. Overweight or obesity

    For subjects (9 ≤ age ≤ 18 years) :

    • General obesity: Body mass index higher than the 85th percentile for overweight and the 90th percentile for obesity, based on the references for screening overweight and obesity in Chinese children and adolescents.

    • Central obesity: Waist circumference higher than the 90th percentile of the age and gender-specific reference for screening cardiovascular risk factors in Chinese children and adolescents.

    For subjects ( 19 ≤ age ≤ 30 years) :

    • General obesity: Body mass index between 24.0 and 27.9 kg/m2 for overweight and ≥28 kg/m2 for obesity.

    • Central obesity: Waist circumference ≥85cm for men and ≥80cm for female. Based on recommendation of overweight and obesity in Chinese adults.

  2. Prediabetes:

    With IFG and/or IGT. IFG: fasting glucose from 5.6 to 6.9 mmol/L; IGT: 2-h glucose in the 75g oral glucose tolerance test from 7.8 to 11.0 mmol/L.

    Based on recommendation of American Diabetes Association.

  3. Dyslipidemia:

    For subjects (9 ≤ age ≤ 18 years) :

    Triglycerides of ≥1.70 mmol/L or total cholesterol of ≥5.18 mmol/L or lowdensity lipoprotein cholesterol ≥3.37 mmol/L or highdensity lipoprotein cholesterol of ≤1.04 mmol/L. Based on recommendation in Chinese children and adolescents.

    For subjects ( 19 ≤ age ≤ 30 years) :

    Triglycerides of ≥1.7 mmol/L or total cholesterol of ≥5.2 mmol/L or lowdensity lipoprotein cholesterol ≥3.4 mmol/L or highdensity lipoprotein cholesterol of ≤1.0 mmol/L. Based on guideline for the management of dyslipidemia in Chinese adults.

  4. Elevated blood pressure:

For subjects (9 ≤ age ≤ 18 years) :

Blood pressure higher than the 90th percentile of blood pressure age and gender-specific reference standards for Chinese children and adolescents, or blood pressure >120/80 mmHg.

For subjects ( 19 ≤ age ≤ 30 years) :

Systolic blood pressure≥120 mmHg and/or diastolic blood pressure ≥80 mmHg. Based on Chinese guidelines for the management of hypertension.

Exclusion Criteria:

  1. Diagnosis of severe diseases such as cardiac insufficiency, severe malnutrition or immunodeficiency.
  2. History of bariatric surgery.
  3. Use of antiobesity drugs or supplements.

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

  • Primary Purpose: Prevention
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Low carbohydrate diet
Health education is conducted once a week during 14-day dietary intervention for all subjects. Health education including the understanding of cardiovascular disease, how to determine the cardiometabolic risk level, and the lifestyle intervention as caloric restriction and increased physical activity to promote health.

During the 14-day intervention period, the subjects receive 7 days (consecutive or nonconsecutive) of low carbohydrate diet intervention. Carbohydrate intake of low-carbohydrate diet should be controlled as ≤ 50g per day.

Total trial duration is one month consisting of a 14-day intervention phase and a 14-day self-maintenance phase. During the maintenance phase, two follow-up electronic questionnaires were conducted.

Experimental: Intermittent caloric restriction

The intervention is based on the 5:2 diet, which involves caloric restriction for 2 days (consecutive or nonconsecutive, 600kcal/d for male and 500kcal/d for female) per week and unrestricted eating during the other 5 days of the week.

Total trial duration is one month consisting of a 14-day intervention phase and a 14-day self-maintenance phase. During the maintenance phase, two follow-up electronic questionnaires were conducted.

Other Names:
  • Intermittent fasting
Health education is conducted once a week during 14-day dietary intervention for all subjects. Health education including the understanding of cardiovascular disease, how to determine the cardiometabolic risk level, and the lifestyle intervention as caloric restriction and increased physical activity to promote health.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Reversal of cardiometabolic abnormalities
Time Frame: From the baseline (the first day of the intervention phase) to the 14th day of the intervention phase.

The primary outcome is a composite outcome that will be measured by combining multiple reverse outcomes of the following cardiometabolic abnormalities: (1) overweight or obesity, (2) prediabetes, (3) hyperlipidemia and (4) elevated blood pressure. It is defined as occurring if any cardiometabolic abnormality has a reversal outcome at the 14th day of dietary intervention phase.

Reversal of cardiometabolic abnormalities is defined as:

At the 14th day of dietary intervention phase, at least one of the following indicators changed from abnormal at baseline to normal: overweight, obesity, prediabetes, hyperlipidemia and elevated blood pressure.

(The reversal of overweight or obesity is defined according to reference[1, 2]: For subject with general obesity at baseline: weight loss of 1.5 kg after intervention; For subject with central obesity at baseline: waist circumference reduction of 1.5 cm after intervention.)

From the baseline (the first day of the intervention phase) to the 14th day of the intervention phase.

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in insulin
Time Frame: From the baseline (the first day of the intervention phase) to the 14th day of the intervention phase.
Serum from fasting blood sample is used for measurement of insulin.
From the baseline (the first day of the intervention phase) to the 14th day of the intervention phase.
Change in insulin-like growth factor-1
Time Frame: From the baseline (the first day of the intervention phase) to the 14th day of the intervention phase.
Fasting blood sample for measurement of insulin-like growth factor-1.
From the baseline (the first day of the intervention phase) to the 14th day of the intervention phase.
Change in mean blood glucose
Time Frame: From the baseline (the first day of the intervention phase) to the 14th day of the intervention phase.
Measured by a blood glucose monitor for 24-hour glucose monitoring during the 14-day intervention phase.
From the baseline (the first day of the intervention phase) to the 14th day of the intervention phase.
Change in gut microbial compositions
Time Frame: From the baseline (the first day of the intervention phase) to the 14th day of the intervention phase.
Stool sample of subject is used for measurement of gut microbial compositions.
From the baseline (the first day of the intervention phase) to the 14th day of the intervention phase.
Change in body weight
Time Frame: From the baseline (the first day of the intervention phase) to the 14th day of the intervention phase.
Body weight is measured according to the Physical Fitness and Health Surveillance of Chinese School Students by trained, certified study staff. It is measured to the nearest 0.1 kg.
From the baseline (the first day of the intervention phase) to the 14th day of the intervention phase.
Change in body weight
Time Frame: From the baseline (the first day of the intervention phase) to the 14th day of the self-maintenance phase.
Body weight is measured by subject and reported by electronic questionnaire. It is measured to the nearest 0.1 kg.
From the baseline (the first day of the intervention phase) to the 14th day of the self-maintenance phase.
Change in waist circumference
Time Frame: From the baseline (the first day of the intervention phase) to the 14th day of the intervention phase.
Waist circumference is measured to the nearest 0.1 cm using a constant tension tape around the waist at 1 cm below the navel as the subject exhaled. It is calculated as the average value of two measurements.
From the baseline (the first day of the intervention phase) to the 14th day of the intervention phase.
Change in waist circumference
Time Frame: From the baseline (the first day of the intervention phase) to the 14th day of the self-maintenance phase.
Waist circumference is measured by subject and reported by electronic questionnaire. It is measured to the nearest 0.1 cm using a constant tension tape around the waist at 1 cm below the navel as the subject exhaled. It is calculated as the average value of two measurements.
From the baseline (the first day of the intervention phase) to the 14th day of the self-maintenance phase.
Dietary energy intake
Time Frame: From the baseline (the first day of the intervention phase) to the 14th day of the intervention phase.
Daily dietary energy intake (kcals/day) is calculated by researchers using food weighing photos of the subject.
From the baseline (the first day of the intervention phase) to the 14th day of the intervention phase.
Self-reported dietary adherence
Time Frame: At the 14th day of the self-maintenance phase.
Adherence to diet will be assessed with a electronic questionnaire in the self-maintenance phase.
At the 14th day of the self-maintenance phase.
Change in monocyte chemoattractant protein-1 (MCP-1)
Time Frame: From the baseline (the first day of the intervention phase) to the 14th day of the intervention phase.
MCP-1 will be measured by enzyme-linked immunosorbent assays (R&D Systems, Inc. USA), using fasting serum samples at baseline and 14 days after intervention.
From the baseline (the first day of the intervention phase) to the 14th day of the intervention phase.
Change in free fatty acid (FFA)
Time Frame: From the baseline (the first day of the intervention phase) to the 14th day of the intervention phase.
FFA will be measured by enzyme-linked immunosorbent assays (R&D Systems, Inc. USA), using fasting serum samples at baseline and 14 days after intervention.
From the baseline (the first day of the intervention phase) to the 14th day of the intervention phase.
Change in fibroblast growth factor 21 (FGF-21)
Time Frame: From the baseline (the first day of the intervention phase) to the 14th day of the intervention phase.
FGF-21 will be measured by enzyme-linked immunosorbent assays (R&D Systems, Inc. USA), using fasting serum samples at baseline and 14 days after intervention.
From the baseline (the first day of the intervention phase) to the 14th day of the intervention phase.

Collaborators and Investigators

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

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

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)

July 12, 2018

Primary Completion (Actual)

November 16, 2021

Study Completion (Actual)

December 1, 2021

Study Registration Dates

First Submitted

July 4, 2019

First Submitted That Met QC Criteria

July 4, 2019

First Posted (Actual)

July 9, 2019

Study Record Updates

Last Update Posted (Actual)

March 22, 2022

Last Update Submitted That Met QC Criteria

March 7, 2022

Last Verified

March 1, 2022

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • ICR_2019_2.0

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

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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