Weight Management in Nonalcoholic Steatohepatitis
12 janvier 2010 mis à jour par: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Weight Management in Nonalcoholic Steatohepatitis (NASH)
Nonalcoholic steatohepatitis (NASH) is one of the most common chronic liver diseases.
The cause of NASH is not completely understood and currently there is no effective treatment for this disease.
An effective approach to treatment is needed since without treatment this disease may progress to fibrosis and cirrhosis.
Obesity is one of the most important risk factors for NASH and weight reduction is generally recommended as an initial step in its management.
However, there are very limited data on the efficacy of weight reduction as a treatment for NASH.
Data from uncontrolled trials using poorly defined primary outcome measures and patient populations and nonstandardized weight loss interventions suggest that modest weight loss may improve fatty liver disease.
The objective of this project is to conduct a randomized controlled trial of weight reduction in the management of NASH using a combination of diet, exercise, and behavior modification.
Aperçu de l'étude
Statut
Complété
Les conditions
Intervention / Traitement
Description détaillée
Nonalcoholic steatohepatitis (NASH) is one of the most common chronic liver diseases.
The cause of NASH is not completely understood and currently there is no effective treatment for this disease.
An effective approach to treatment is needed since without treatment this disease may progress to fibrosis and cirrhosis.
Obesity is one of the most important risk factors for NASH and weight reduction is generally recommended as an initial step in its management.
However, there has never been a randomized controlled trial evaluating the efficacy of weight reduction as a treatment for NASH.
Data from uncontrolled trials using poorly defined primary outcome measures and patient populations and nonstandardized weight loss interventions suggest that modest weight loss may improve liver histology.
The objective of this project is to conduct a pilot study in preparation for a randomized controlled trial of weight reduction in the management of NASH.
In this study, 30 overweight or obese individuals with biopsy-proven NASH will be enrolled.
Twenty patients will be randomized to receive 48 weeks of intensive weight management using a combination of diet, exercise and behavior modification with a goal of 7-10% weight reduction.
This weight loss program is similar to programs used successfully in other overweight populations and to the intensive lifestyle program of the Diabetes Prevention Program and Look AHEAD.
The other 10 patients will be randomized to a control group where they will receive standard medical care and general counseling on healthy eating and exercise.
At the end of the 48-week study, patients will have a repeat liver biopsy that will be compared to their baseline biopsy.
The pilot study will establish the feasibility of recruiting and retaining, producing sustained weight loss and performing repeat liver biopsies in this population.
Based on the outcomes of this preliminary trial, this program will be further refined and readied for a larger-scale clinical trial.
Type d'étude
Interventionnel
Inscription (Anticipé)
30
Phase
- Phase 2
Contacts et emplacements
Cette section fournit les coordonnées de ceux qui mènent l'étude et des informations sur le lieu où cette étude est menée.
Lieux d'étude
-
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Rhode Island
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Providence, Rhode Island, États-Unis, 02903
- Rhode Island Hospital
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-
Critères de participation
Les chercheurs recherchent des personnes qui correspondent à une certaine description, appelée critères d'éligibilité. Certains exemples de ces critères sont l'état de santé général d'une personne ou des traitements antérieurs.
Critère d'éligibilité
Âges éligibles pour étudier
18 ans et plus (Adulte, Adulte plus âgé)
Accepte les volontaires sains
Non
Sexes éligibles pour l'étude
Tout
La description
Inclusion Criteria:
- Evidence of chronic steatohepatitis on liver biopsy.
- Elevated alanine or aspartate aminotransferase values (ALT > 41 or AST > 34) within 3 months of enrollment
- Absence of another form of liver disease
- Body mass index between 25-50 kg/m2.
- At least 18 years of age
- Absence of significant alcohol consumption (more than one standard drink per day).
- Able to walk 2 blocks or a quarter of a mile without stopping
- Willing to complete a two-week run-in period with successful completion of self-monitoring records.
Exclusion Criteria:
- < 18 years of age
- Significant alcohol consumption (> 1 standard drink per day)
- Contraindications to obtaining a liver biopsy
- Unable to walk 2 blocks or a quarter of a mile without stopping
- Currently pregnant or pregnant in the previous six months
- Currently engaged in an active weight-loss program or taking weight-loss medication
- Report conditions that, in the judgment of the investigators, render potential participants unlikely to follow the protocol for 12 months, including illness likely to be terminal within 2 years, plans to move, substance abuse, or other significant psychiatric problems
Plan d'étude
Cette section fournit des détails sur le plan d'étude, y compris la façon dont l'étude est conçue et ce que l'étude mesure.
Comment l'étude est-elle conçue ?
Détails de conception
- Objectif principal: Traitement
- Répartition: Randomisé
- Modèle interventionnel: Affectation parallèle
- Masquage: Aucun (étiquette ouverte)
Que mesure l'étude ?
Principaux critères de jugement
Mesure des résultats |
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Liver histology score (NASH-Clinical Research Network [CRN] scoring system) at 48 weeks
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Weight reduction at 48 weeks
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Mesures de résultats secondaires
Mesure des résultats |
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Insulin sensitivity at 48 weeks
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Liver function test at 48 weeks
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Inflammatory markers and adipokine levels at 48 weeks
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Quality of life at 48 weeks
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Collaborateurs et enquêteurs
C'est ici que vous trouverez les personnes et les organisations impliquées dans cette étude.
Les enquêteurs
- Chercheur principal: Kittichai Promrat, M.D., Rhode Island Hospital/Brown University
Publications et liens utiles
La personne responsable de la saisie des informations sur l'étude fournit volontairement ces publications. Il peut s'agir de tout ce qui concerne l'étude.
Publications générales
- Kleiner DE, Brunt EM, Van Natta M, Behling C, Contos MJ, Cummings OW, Ferrell LD, Liu YC, Torbenson MS, Unalp-Arida A, Yeh M, McCullough AJ, Sanyal AJ; Nonalcoholic Steatohepatitis Clinical Research Network. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology. 2005 Jun;41(6):1313-21. doi: 10.1002/hep.20701.
- Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002 Feb 7;346(6):393-403. doi: 10.1056/NEJMoa012512.
- Bacon BR, Farahvash MJ, Janney CG, Neuschwander-Tetri BA. Nonalcoholic steatohepatitis: an expanded clinical entity. Gastroenterology. 1994 Oct;107(4):1103-9. doi: 10.1016/0016-5085(94)90235-6.
- Ludwig J, Viggiano TR, McGill DB, Oh BJ. Nonalcoholic steatohepatitis: Mayo Clinic experiences with a hitherto unnamed disease. Mayo Clin Proc. 1980 Jul;55(7):434-8.
- Ueno T, Sugawara H, Sujaku K, Hashimoto O, Tsuji R, Tamaki S, Torimura T, Inuzuka S, Sata M, Tanikawa K. Therapeutic effects of restricted diet and exercise in obese patients with fatty liver. J Hepatol. 1997 Jul;27(1):103-7. doi: 10.1016/s0168-8278(97)80287-5.
Dates d'enregistrement des études
Ces dates suivent la progression des dossiers d'étude et des soumissions de résultats sommaires à ClinicalTrials.gov. Les dossiers d'étude et les résultats rapportés sont examinés par la Bibliothèque nationale de médecine (NLM) pour s'assurer qu'ils répondent à des normes de contrôle de qualité spécifiques avant d'être publiés sur le site Web public.
Dates principales de l'étude
Début de l'étude
1 janvier 2005
Achèvement de l'étude (Réel)
1 décembre 2007
Dates d'inscription aux études
Première soumission
14 décembre 2005
Première soumission répondant aux critères de contrôle qualité
14 décembre 2005
Première publication (Estimation)
15 décembre 2005
Mises à jour des dossiers d'étude
Dernière mise à jour publiée (Estimation)
13 janvier 2010
Dernière mise à jour soumise répondant aux critères de contrôle qualité
12 janvier 2010
Dernière vérification
1 janvier 2010
Plus d'information
Termes liés à cette étude
Mots clés
Termes MeSH pertinents supplémentaires
Autres numéros d'identification d'étude
- DK67363 (completed)
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