Diet and COVID-19 Vaccination
COVID-19 Vaccination in Subjects With Obesity: Impact of Metabolic Health and the Role of a Ketogenic Diet
Recently, obesity and excess visceral fat were shown to be major risk factors for the development of complications following Covid 19 infection. Recently, KDs have been suggested as possible weapons to tame the cytokine storm being described in those developing complications upon COVID-19 infection, and preclinical evidence strongly supports the hypothesis, with mouse models of COVID-19 infection in the elderly reporting strikingly better outcomes upon consumption of a KD. Short-term interventions that use low-calorie ketogenic diets may be prescribed for selected overweight or obese patients with type 2 diabetes or prediabetes.
No data is available on the impact of a ketogenic diet on immune modulation following vaccination. We herein aim at investigating whether obesity and unhealthy body composition are associated with poor seroconversion following the upcoming COVID-19 vaccine administration, and whether consumption of a KD before and between COVID-19 vaccine doses leads to better immune response in obese subjects. 24 obese patients will be assigned to follow a LCKD regimen for 5 weeks.
Studieoversigt
Status
Betingelser
Intervention / Behandling
Detaljeret beskrivelse
Recently, obesity and excess visceral fat were shown to be major risk factors for the development of complications following Covid 19 infection. Recently, KDs have been suggested as possible weapons to tame the cytokine storm being described in those developing complications upon COVID-19 infection, and preclinical evidence strongly supports the hypothesis, with mouse models of COVID-19 infection in the elderly reporting strikingly better outcomes upon consumption of a KD. Short-term interventions that use low-calorie ketogenic diets may be prescribed for selected overweight or obese patients with type 2 diabetes or prediabetes.
No data is available on the impact of a ketogenic diet on immune modulation following vaccination. We herein aim at investigating whether obesity and unhealthy body composition are associated with poor seroconversion following the upcoming COVID-19 vaccine administration, and whether consumption of a KD before and between COVID-19 vaccine doses leads to better immune response in obese subjects. 24 patients will be assigned to follow a low-calorie ketogenic diet (LCKD). Outcome measures will be antiSARS-CoV-2 antibodies, cell mediated response to SARS CoV-2, anthropometric parameters, vital signs, metabolic profile, and body composition. The patients will be assessed at baseline (T0) and every two weeks (T1, T2) as they receive both SARS Cov-2 vaccination doses up to 1 week after the second dose (T3) when they will be finally evaluated and carbohydrate reintroduction takes place. Patients will be given support and counselling to enhance their compliance. Anthropometric parameters such as body weight, blood pressure (systolic and diastolic), heart rate, waist and hip circumference will be measured at baseline (T0), every two weeks up to the end of the trial (T3).
Blood and urine chemistry Complete Blood Count (CBC), electrolytes (chloride, calcium, potassium, sodium, magnesium), fasting glucose, insulin, lipids (total and fractionated cholesterol and triglycerides) and proteins, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), plasma creatinine, blood urea nitrogen (BUN), alanine transferase (AST), aspartate transaminase (ALT), uric acid, beta hydroxy butyrate and estimated Glomerular Filtration Rate (using the Modification of Diet in Renal Disease study equation MDRD-eGFR) will be determined
AntiSARS-CoV-2 antibodies: antibodies will be quantified by enzyme-linked immunosorbent assay using the appropriate antigen at T3 and T4 in all arms. The cell mediated response to SARS CoV-2 will be analyzed by taking whole blood that will be stimulated with immune ligands.
Data obtained will be expressed as mean values ±Standard Deviation (SD) and finally processed to ascertain whether statistical differences among them can be demonstrated, using appropriate methods. In particular, the analysis of variance (ANOVA) at different times will be used for efficacy and safety data, such as weight reduction, changes in anthropometric measures, and variation of the metabolic parameters. P values <0.05 will be considered statistically significant.
Undersøgelsestype
Tilmelding (Forventet)
Fase
- Ikke anvendelig
Kontakter og lokationer
Studiekontakt
- Navn: Lucio Gnessi, MD PhD
- Telefonnummer: +390649970721
- E-mail: lucio.gnessi@uniroma1.it
Undersøgelse Kontakt Backup
- Navn: Mikiko Watanabe, MD
- Telefonnummer: +393483244207
- E-mail: mikiko.watanabe@uniroma1.it
Studiesteder
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Roma, Italien, 00185
- Rekruttering
- Sapienza University of Rome
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Kontakt:
- Mikiko Watanabe, MD
- Telefonnummer: +393483244207
- E-mail: mikiko.watanabe@uniroma1.it
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Kontakt:
- Lucio Gnessi, MD PhD
- Telefonnummer: +390649960721
- E-mail: lucio.gnessi@uniroma1.it
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Deltagelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
Tager imod sunde frivillige
Køn, der er berettiget til at studere
Beskrivelse
- BMI ≥35.0 kg/m2 with comorbidities or BMI≥40
- Stable body weight (less than 5 kg self-reported change during the previous 3 months)
- Informed consent obtained before any trial-related activity takes place Exclusion criteria
- Stage 3-5 CKD (GFR<60 ml/min)
- Type 1 diabetes
- Uncontrolled type 2 diabetes
- Previous infection with SARS CoV-2
- Immunodeficiency or immunomodulating treatment
- Treatment with anti-obesity medications or other medications potentially affecting body weight or SGLT2 inhibitors
- Pregnancy and lactation
- Previous gout episodes
- Cardio and cerebrovascular accidents in the preceding 12 months
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: N/A
- Interventionel model: Enkelt gruppeopgave
- Maskning: Ingen (Åben etiket)
Våben og indgreb
Deltagergruppe / Arm |
Intervention / Behandling |
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Eksperimentel: Ketogenic Diet-obese
LCKD (1200-1400kcal/day) low in carbohydrates (<50g per day) with a moderate protein intake (1-1.5g/kg of ideal body mass) but otherwise no other dietary restrictions.
The participants will be counselled by a trained nutritionist at baseline and every two weeks, and compliance will be assessed through a 3-day dietary recall at each follow up visit and capillary beta hydroxybutyrate levels as well as urinary acetoacetate levels.
The follow up visits take place at the time of the first vaccine dose, two weeks after the first vaccine dose, one week after the second vaccine dose.
Then, gradual reintroduction of carbohydrates will take place following the second vaccine dose.
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The very low-carbohydrate diet will be hypo caloric and aim to provide less than 50 g of carbohydrates per day.
the participants will be counseled to choose vegetarian and healthy sources of fat and protein and to avoid trans fat.
Then, gradual reintroduction of carbohydrates will take place following the second vaccine dose.
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Hvad måler undersøgelsen?
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
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AntiSARS-CoV-2 antibodies
Tidsramme: 5 weeks
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antibodies will be quantified by enzyme-linked immunosorbent assay at week 0 and 5
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5 weeks
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Cell mediated response to SARS CoV-2
Tidsramme: 5 weeks
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whole blood will be stimulated with immune ligands within 8 h from blood collection.
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5 weeks
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Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
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Body weight
Tidsramme: 5 weeks
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Body weight will be obtained with the subjects wearing very light clothing and no shoes, and with an empty bladder.
The same scale will be used throughout the study.
The scale will be calibrated.
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5 weeks
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Waist Circumference
Tidsramme: 5 weeks
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Waist circumference will be measured on subjects while semi clothed, standing with their feet close together and their weight equally distributed on each leg.
Subjects will be asked to breath normally.
Circumference will be taken at the midpoint between the lower rib margin and the iliac crest.
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5 weeks
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Triglycerides, glucose, insulin, ESR, CRP, ferritin
Tidsramme: 5 weeks
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All biochemical parameters will be measured according to local laboratory standards.
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5 weeks
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Samarbejdspartnere og efterforskere
Sponsor
Efterforskere
- Ledende efterforsker: Lucio Gnessi, MD PhD, University of Roma La Sapienza
Publikationer og nyttige links
Generelle publikationer
- Gardner CD, Trepanowski JF, Del Gobbo LC, Hauser ME, Rigdon J, Ioannidis JPA, Desai M, King AC. Effect of Low-Fat vs Low-Carbohydrate Diet on 12-Month Weight Loss in Overweight Adults and the Association With Genotype Pattern or Insulin Secretion: The DIETFITS Randomized Clinical Trial. JAMA. 2018 Feb 20;319(7):667-679. doi: 10.1001/jama.2018.0245. Erratum In: JAMA. 2018 Apr 3;319(13):1386. JAMA. 2018 Apr 24;319(16):1728.
- Ang QY, Alexander M, Newman JC, Tian Y, Cai J, Upadhyay V, Turnbaugh JA, Verdin E, Hall KD, Leibel RL, Ravussin E, Rosenbaum M, Patterson AD, Turnbaugh PJ. Ketogenic Diets Alter the Gut Microbiome Resulting in Decreased Intestinal Th17 Cells. Cell. 2020 Jun 11;181(6):1263-1275.e16. doi: 10.1016/j.cell.2020.04.027. Epub 2020 May 20.
- Shai I, Schwarzfuchs D, Henkin Y, Shahar DR, Witkow S, Greenberg I, Golan R, Fraser D, Bolotin A, Vardi H, Tangi-Rozental O, Zuk-Ramot R, Sarusi B, Brickner D, Schwartz Z, Sheiner E, Marko R, Katorza E, Thiery J, Fiedler GM, Bluher M, Stumvoll M, Stampfer MJ; Dietary Intervention Randomized Controlled Trial (DIRECT) Group. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med. 2008 Jul 17;359(3):229-41. doi: 10.1056/NEJMoa0708681. Erratum In: N Engl J Med. 2009 Dec 31;361(27):2681.
- Youm YH, Nguyen KY, Grant RW, Goldberg EL, Bodogai M, Kim D, D'Agostino D, Planavsky N, Lupfer C, Kanneganti TD, Kang S, Horvath TL, Fahmy TM, Crawford PA, Biragyn A, Alnemri E, Dixit VD. The ketone metabolite beta-hydroxybutyrate blocks NLRP3 inflammasome-mediated inflammatory disease. Nat Med. 2015 Mar;21(3):263-9. doi: 10.1038/nm.3804. Epub 2015 Feb 16.
- Choi IY, Piccio L, Childress P, Bollman B, Ghosh A, Brandhorst S, Suarez J, Michalsen A, Cross AH, Morgan TE, Wei M, Paul F, Bock M, Longo VD. A Diet Mimicking Fasting Promotes Regeneration and Reduces Autoimmunity and Multiple Sclerosis Symptoms. Cell Rep. 2016 Jun 7;15(10):2136-2146. doi: 10.1016/j.celrep.2016.05.009. Epub 2016 May 26.
- Vandanmagsar B, Youm YH, Ravussin A, Galgani JE, Stadler K, Mynatt RL, Ravussin E, Stephens JM, Dixit VD. The NLRP3 inflammasome instigates obesity-induced inflammation and insulin resistance. Nat Med. 2011 Feb;17(2):179-88. doi: 10.1038/nm.2279. Epub 2011 Jan 9.
- Andersen CJ, Murphy KE, Fernandez ML. Impact of Obesity and Metabolic Syndrome on Immunity. Adv Nutr. 2016 Jan 15;7(1):66-75. doi: 10.3945/an.115.010207. Print 2016 Jan.
- Watanabe M, Risi R, De Giorgi F, Tuccinardi D, Mariani S, Basciani S, Lubrano C, Lenzi A, Gnessi L. Obesity treatment within the Italian national healthcare system tertiary care centers: what can we learn? Eat Weight Disord. 2021 Apr;26(3):771-778. doi: 10.1007/s40519-020-00936-1. Epub 2020 May 25.
- Mariani S, Fiore D, Varone L, Basciani S, Persichetti A, Watanabe M, Saponara M, Spera G, Moretti C, Gnessi L. Obstructive sleep apnea and bone mineral density in obese patients. Diabetes Metab Syndr Obes. 2012;5:395-401. doi: 10.2147/DMSO.S37761. Epub 2012 Nov 7.
- Lonardo A, Mantovani A, Lugari S, Targher G. Epidemiology and pathophysiology of the association between NAFLD and metabolically healthy or metabolically unhealthy obesity. Ann Hepatol. 2020 Jul-Aug;19(4):359-366. doi: 10.1016/j.aohep.2020.03.001. Epub 2020 Mar 21.
- Dwivedi AK, Dubey P, Cistola DP, Reddy SY. Association Between Obesity and Cardiovascular Outcomes: Updated Evidence from Meta-analysis Studies. Curr Cardiol Rep. 2020 Mar 12;22(4):25. doi: 10.1007/s11886-020-1273-y.
- Okamura T, Hashimoto Y, Hamaguchi M, Obora A, Kojima T, Fukui M. Ectopic fat obesity presents the greatest risk for incident type 2 diabetes: a population-based longitudinal study. Int J Obes (Lond). 2019 Jan;43(1):139-148. doi: 10.1038/s41366-018-0076-3. Epub 2018 May 1.
- Palermo A, Tuccinardi D, Defeudis G, Watanabe M, D'Onofrio L, Lauria Pantano A, Napoli N, Pozzilli P, Manfrini S. BMI and BMD: The Potential Interplay between Obesity and Bone Fragility. Int J Environ Res Public Health. 2016 May 28;13(6):544. doi: 10.3390/ijerph13060544.
- Arboleda S, Vargas M, Losada S, Pinto A. Review of obesity and periodontitis: an epidemiological view. Br Dent J. 2019 Aug;227(3):235-239. doi: 10.1038/s41415-019-0611-1.
- Watanabe M, Caruso D, Tuccinardi D, Risi R, Zerunian M, Polici M, Pucciarelli F, Tarallo M, Strigari L, Manfrini S, Mariani S, Basciani S, Lubrano C, Laghi A, Gnessi L. Visceral fat shows the strongest association with the need of intensive care in patients with COVID-19. Metabolism. 2020 Oct;111:154319. doi: 10.1016/j.metabol.2020.154319. Epub 2020 Jul 23.
- Petrilli CM, Jones SA, Yang J, Rajagopalan H, O'Donnell L, Chernyak Y, Tobin KA, Cerfolio RJ, Francois F, Horwitz LI. Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study. BMJ. 2020 May 22;369:m1966. doi: 10.1136/bmj.m1966.
- Watanabe M, Risi R, Tuccinardi D, Baquero CJ, Manfrini S, Gnessi L. Obesity and SARS-CoV-2: A population to safeguard. Diabetes Metab Res Rev. 2020 Apr 21:e3325. doi: 10.1002/dmrr.3325. Online ahead of print.
- McLarnon A. Obesity: influenza immunity impaired in obesity. Nat Rev Endocrinol. 2011 Nov 15;8(1):3. doi: 10.1038/nrendo.2011.199. No abstract available.
- Painter SD, Ovsyannikova IG, Poland GA. The weight of obesity on the human immune response to vaccination. Vaccine. 2015 Aug 26;33(36):4422-9. doi: 10.1016/j.vaccine.2015.06.101. Epub 2015 Jul 8.
- Neidich SD, Green WD, Rebeles J, Karlsson EA, Schultz-Cherry S, Noah TL, Chakladar S, Hudgens MG, Weir SS, Beck MA. Increased risk of influenza among vaccinated adults who are obese. Int J Obes (Lond). 2017 Sep;41(9):1324-1330. doi: 10.1038/ijo.2017.131. Epub 2017 Jun 6.
- Yasuda K, Takeuchi Y, Hirota K. The pathogenicity of Th17 cells in autoimmune diseases. Semin Immunopathol. 2019 May;41(3):283-297. doi: 10.1007/s00281-019-00733-8. Epub 2019 Mar 19. Erratum In: Semin Immunopathol. 2019 Apr 29;:
- Sukkar SG, Bassetti M. Induction of ketosis as a potential therapeutic option to limit hyperglycemia and prevent cytokine storm in COVID-19. Nutrition. 2020 Nov-Dec;79-80:110967. doi: 10.1016/j.nut.2020.110967. Epub 2020 Aug 10.
- Bradshaw PC, Seeds WA, Miller AC, Mahajan VR, Curtis WM. COVID-19: Proposing a Ketone-Based Metabolic Therapy as a Treatment to Blunt the Cytokine Storm. Oxid Med Cell Longev. 2020 Sep 9;2020:6401341. doi: 10.1155/2020/6401341. eCollection 2020.
- Ryu S, Shchukina I, Youm YH, Qing H, Hilliard BK, Dlugos T, Zhang X, Yasumoto Y, Booth CJ, Fernandez-Hernando C, Suarez Y, Khanna KM, Horvath TL, Dietrich MO, Artyomov MN, Wang A, Dixit VD. Ketogenesis restrains aging-induced exacerbation of COVID in a mouse model. bioRxiv. 2020 Sep 12:2020.09.11.294363. doi: 10.1101/2020.09.11.294363. Preprint.
Hjælpsomme links
Datoer for undersøgelser
Studer store datoer
Studiestart (Faktiske)
Primær færdiggørelse (Forventet)
Studieafslutning (Forventet)
Datoer for studieregistrering
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Yderligere relevante MeSH-vilkår
Andre undersøgelses-id-numre
- KDC19090421
Plan for individuelle deltagerdata (IPD)
Planlægger du at dele individuelle deltagerdata (IPD)?
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