Effets d'un régime à faible IG sur la stéatose hépatique non alcoolique (LGI-NAFLD)
Effets d'un régime iso-énergétique à faible indice glycémique (IG) sur l'accumulation de graisse hépatique et la composition du microbiote intestinal chez les patients atteints de stéatose hépatique non alcoolique (NAFLD)
A 2 x 2 cross-over dietary intervention trial designed to investigate the effects of low glycemic index (LGI) versus high glycemic index (HGI) diet on hepatic fat accumulation and gut microbiota composition in participants with NAFLD.
Participants will be allocated randomly to a 2-week either high GI (HGI) or low GI (LGI) diet followed by a 4-week wash-out period and then the LGI or HGI diet, opposite to the first 2-weeks (N= 16).
Aperçu de l'étude
Statut
Les conditions
Intervention / Traitement
Description détaillée
Following the screening phase and standardisation week, each participant will experience two, 2-week intervention phases, with a 4-week washout period between interventions. Before and after each intervention period they will attend the Imaging Centre (Sir Peter Mansfield Imaging Centre) for MRI scan measurements and then will attend the Biomedical Research Centre for FibroScan, and blood and stool samples collection. During each intervention phase each participant will be required to consume all the food that has been provided, fill in dietary compliance sheets and complete Visual Analogue Scales (VAS) relating to subjective appetite ratings.
Design of the dietary interventions Energy expenditure will be estimated for each participant using the individual's basal metabolic rate calculated from Henry-modified Schofield formula and multiplied by an activity factor based on the IPAQ score physical activity levels. A menu, consisting of meals for 3 days personalised for energy requirement, will be devised (these meals are repeated over 2 weeks) by adjusting a template according to their estimated energy requirement in order to minimise weight change during the intervention phase. The diet consists of normal food closely resembling that described by Bawden et al study. A diet template of 2000 kcal/day with energy proportions distributed as 55% from carbohydrates, 15% from protein and 30% from fat are designed and food quantities will be modified to supply the energy requirements for each participant. Three-day cycle menu plans are designed for each diet (LGI/ HGI). Table 1 shows example template menus for both HGI (a) and LGI (b) diets.
The GI values of commercial food items are generated from that reported by Henry et al, as well as Nutritics software databases (Nutritics). The dietary GI of the menu is calculated from GI proportional contribution to total carbohydrate using the equation: GI=∑(Cfood/Ctotal) × GIfood; where Cfood is the amount of carbohydrate contained in each digested food (g), Ctotal is the total carbohydrate in the meal and is the reported GI of the food. The GL of the diet is calculated based on the dietary GI and the amount of carbohydrate provided (the same in both diets) using the following equation: GL=(GIfood × Cfood)/100; where GI is the GI of each digested food and food is the amount of carbohydrate in the food. Food composition analysis and evaluation were performed using Nutritics software (Nutritics, Dublin, Ireland, 2018).
Participants will be provided with the food at the start of each 2-week diet period and will be clearly instructed on safe food storage and reheating. They will be required to complete dietary compliance sheet on a daily basis. Instructions on dietary compliance will be given at each study period and the dietary compliance records will be reviewed regularly during the intervention to assess their compliance. For the first 1 week prior to the intervention (1-week standardisation), and during the 4-week wash-out period, participants will be asked to avoid eating probiotics, yoghurt and cultured milk drink; if any, to standardise their gut microbiota and avoid any carry-over effects as shown in previous studies.Meal-timing will be standardised among all participants as much as possible during the intervention as well as during the standardisation period.
Type d'étude
Inscription (Réel)
Phase
- N'est pas applicable
Contacts et emplacements
Lieux d'étude
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Nottinghamshire
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Nottingham, Nottinghamshire, Royaume-Uni, NG7 2UH
- NIHR Nottingham Clinical Research Facility Nottingham Digestive Diseases Centre
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Critères de participation
Critère d'éligibilité
Âges éligibles pour étudier
Accepte les volontaires sains
Sexes éligibles pour l'étude
La description
Inclusion Criteria:
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• Adult males and females aged from 18 to 65 years (balanced number).
- Detected NAFLD by CAP-FibroScan™ >288dB/m or by MRI-PDFF) > 5% fat of liver weight.
- Body mass index ≥ 25 kg/m2
- Have current moderate to high GI diet intake of ≥ 60 (Assessed from a completed 7-day food diary).
- Abdominal obesity (Waist circumference > 102 cm for males and > 88 cm for females)
- Able to give informed consent.
- Able to undergo MRI/S and CAP-FibroScan™.
Exclusion Criteria:
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• Current smokers and excessive alcohol drinkers (> 14 units/week).
- Perimenopausal (irregular periods) women.
- Participants with other liver abnormalities.
- Participants with history of gastrointestinal surgeries, depression, eating disorders or difficulties.
- Participants using pharmacologic agents for obesity or NAFLD.
- Participants with type 1 diabetes.
- Participants with type 2 diabetes on second line medications (eg GLP-1 analogues, sulfonylureas).
- Participation in any other trial in the last 3 months.
- Participants on any special diets (e.g. vegetarians).
- Intolerance to foods included in the diet plan.
Plan d'étude
Comment l'étude est-elle conçue ?
Détails de conception
- Objectif principal: Autre
- Répartition: Randomisé
- Modèle interventionnel: Affectation croisée
- Masquage: Quadruple
Armes et Interventions
Groupe de participants / Bras |
Intervention / Traitement |
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Expérimental: LGI Diet
low glycemic index diet |
• Three-day cycle menu of LGI diet will be designed and supplied to each participant in an amount designed to meet their estimated energy requirements. The percentage energy from protein, fat and carbohydrate will be the same in the two diets. Each diet period of the trial will last for two weeks.
Autres noms:
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Autre: HGI Diet
High glycemic index diet |
Three-day cycle menu of HGI diet will be designed and supplied to each participant in an amount designed to meet their estimated energy requirements. The percentage energy from protein, fat and carbohydrate will be the same in the two diets. Each diet period of the trial will last for two weeks.
Autres noms:
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Que mesure l'étude ?
Principaux critères de jugement
Mesure des résultats |
Description de la mesure |
Délai |
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Change in Liver Fat Content From Baseline to End of Each 2-Week Dietary Intervention
Délai: Baseline and end of each 2-week dietary intervention period
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Change in liver fat content (%) from baseline to the end of each 2-week dietary intervention period (LGI diet and HGI diet) in participants with NAFLD. Liver fat content was measured using magnetic resonance spectroscopy. Values represent liver fat content at 2 weeks minus liver fat content at baseline. Lower values indicate lower liver fat content and may reflect improvement in hepatic steatosis. Show more lines |
Baseline and end of each 2-week dietary intervention period
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Mesures de résultats secondaires
Mesure des résultats |
Description de la mesure |
Délai |
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Change in Gut Microbiome Alpha Diversity After 2 Weeks of LGI and HGI Diets
Délai: Baseline and end of each 2-week dietary intervention period
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Change in gut microbiome alpha diversity from baseline to the end of each 2-week dietary intervention period (LGI diet and HGI diet), assessed by 16S rRNA gene sequencing in participants with NAFLD. Higher values indicate greater microbial alpha diversity. Values represent the change from baseline to the end of the intervention period. |
Baseline and end of each 2-week dietary intervention period
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Change in Gut Microbiome Beta Diversity From Baseline to End of Each 2-Week Dietary Intervention
Délai: Baseline and end of each 2-week dietary intervention period
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Change in gut microbiome beta diversity from baseline to the end of each 2-week dietary intervention period (LGI diet and HGI diet), assessed by 16S rRNA gene sequencing using UniFrac distance. Beta diversity measures differences in microbial community composition between samples. Lower UniFrac distance values indicate greater similarity between microbial communities, whereas higher values indicate greater dissimilarity. UniFrac distance ranges from 0 to 1, where 0 indicates identical communities and 1 indicates completely distinct communities. Values represent the change from baseline to the end of each intervention period. |
Baseline and end of each 2-week dietary intervention period
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Change in Blood Glucose Level From Baseline to End of 2-Week Dietary Intervention
Délai: Baseline and end of each 2-week dietary intervention period
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Change in fasting blood glucose concentration from baseline to the end of each 2-week dietary intervention period (LGI diet and HGI diet), measured using a Horiba automated analyser. Values represent blood glucose at 2 weeks minus blood glucose at baseline. Higher values indicate an increase in blood glucose concentration, whereas lower or negative values indicate a decrease in blood glucose concentration. |
Baseline and end of each 2-week dietary intervention period
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Blood Insulin Change in Fasting Insulin Concentration From Baseline to End of Each 2-Week Dietary Intervention
Délai: Baseline and end of each 2-week dietary intervention period
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Change in fasting insulin concentration from baseline to the end of each 2-week dietary intervention period (LGI diet and HGI diet). Values represent insulin concentration at 2 weeks minus insulin concentration at baseline. Lower values indicate lower circulating insulin concentrations. |
Baseline and end of each 2-week dietary intervention period
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Change in Liver Function Biomarkers From Baseline to End of Each 2-Week Dietary Intervention
Délai: 2 Baseline and end of each 2-week dietary intervention period Show more lines
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Change in liver function biomarkers from baseline to the end of each 2-week dietary intervention period. Values represent the biomarker concentration at 2 weeks minus the concentration at baseline The blood liver function tests (LFTs) to be assessed are GGT(Gamma-Glutamyl Transferase), ALP(Alkaline Phosphatase), AST(Aspartate Amino Transferase), and ALT(Alanine Amino Transferase) |
2 Baseline and end of each 2-week dietary intervention period Show more lines
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Change in Blood Lipids Concentration From Baseline to End of Each 2-Week Dietary Intervention Show More Lines
Délai: Baseline and end of each 2-week dietary intervention period
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Change in fasting blood lipids concentration from baseline to the end of each 2-week dietary intervention period. Values represent triglyceride concentration at 2 weeks minus triglyceride concentration at baseline. The blood lipids biomarkers to be assessed are Total Cholesterol, High-density lipoprotein, low-density lipoprotein, Triglycerides. |
Baseline and end of each 2-week dietary intervention period
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Change in Gut Hormones Concentration From Baseline to End of Each 2-Week Dietary Intervention
Délai: Baseline and end of each 2-week dietary intervention period
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Change in gut hormones concentration from baseline to the end of each 2-week dietary intervention period. Values represent GLP-1 concentration at 2 weeks minus GLP-1 concentration at baseline.using radioimmunoassay (RIA) or Sandwich ELISA methods. The blood gut hormones to be assessed were Leptin, Ghrelin,, GLP-1 (Glucagon-like peptide 1). |
Baseline and end of each 2-week dietary intervention period
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Change in Plasma Short-Chain Fatty Acid Concentrations From Baseline to End of Each 2-Week Dietary Intervention
Délai: Baseline and end of each 2-week dietary intervention period
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Change in plasma short-chain fatty acid (SCFA) concentrations from baseline to the end of each 2-week dietary intervention period (LGI diet and HGI diet) in participants with NAFLD. Plasma SCFAs (including acetic acid, butyric acid, and valeric acid) were measured in fasting blood samples. Values represent the concentration at the end of the intervention period minus the concentration at baseline. Higher values indicate higher circulating SCFA concentrations. |
Baseline and end of each 2-week dietary intervention period
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Change in Body Weight From Baseline to End of Each 2-Week Dietary Intervention
Délai: Baseline and end of each 2-week dietary intervention period
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Change in body weight from baseline to the end of each 2-week dietary intervention period (LGI diet and HGI diet) in participants with NAFLD. Body weight was measured in kilograms using calibrated scales. Values represent body weight at the end of the intervention period minus body weight at baseline. Negative values indicate weight loss, whereas positive values indicate weight gain. |
Baseline and end of each 2-week dietary intervention period
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Change in Composite Appetite Sensations (CAS) Score From Baseline to End of Each 2-Week Dietary Intervention
Délai: Baseline and end of each 2-week dietary intervention period
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Composite Appetite Sensations (CAS) score was derived from Visual Analogue Scale (VAS) assessments of appetite. Participants rated hunger, satisfaction, fullness, desire to eat, and prospective food consumption on 10-cm (0-100 mm) visual analogue scales. The CAS score was calculated as: 2 3 [Hunger + (100 - Satisfaction) + (100 - Fullness) + Desire to Eat + Prospective Food Consumption] / 5 4 5 CAS scores range from 0 to 100 mm, with higher scores indicating greater overall appetite and lower scores indicating lower appetite. Values represent the change from baseline to the end of each 2-week dietary intervention period. |
Baseline and end of each 2-week dietary intervention period
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Collaborateurs et enquêteurs
Parrainer
Les enquêteurs
- Chercheur principal: Guru Aithal, PhD, University of Nottingham
Publications et liens utiles
Publications générales
- Al-Awadi A, Grove J, Taylor M, Valdes A, Vijay A, Bawden S, Gowland P, Aithal G. Effects of an isoenergetic low Glycaemic Index (GI) diet on liver fat accumulation and gut microbiota composition in patients with non-alcoholic fatty liver disease (NAFLD): a study protocol of an efficacy mechanism evaluation. BMJ Open. 2021 Oct 7;11(10):e045802. doi: 10.1136/bmjopen-2020-045802.
- Al-Awadi AA, Grove JI, Bawden S, Vijay A, Valdes AM, Gowland P, Taylor MA, Aithal GP. The effect of a two-week low glycaemic index, higher fibre diet versus high glycaemic index diet on body composition, ectopic lipids, inflammatory biomarkers, gastrointestinal hormones and gut microbiota in metabolic dysfunction-associated steatotic liver disease (MASLD): A pilot randomized cross-over study. Clin Nutr ESPEN. 2026 Jun;73:103306. doi: 10.1016/j.clnesp.2026.103306. Epub 2026 Apr 25.
Dates d'enregistrement des études
Dates principales de l'étude
Début de l'étude (Réel)
Achèvement primaire (Réel)
Achèvement de l'étude (Réel)
Dates d'inscription aux études
Première soumission
Première soumission répondant aux critères de contrôle qualité
Première publication (Réel)
Mises à jour des dossiers d'étude
Dernière mise à jour publiée (Réel)
Dernière mise à jour soumise répondant aux critères de contrôle qualité
Dernière vérification
Plus d'information
Termes liés à cette étude
Termes MeSH pertinents supplémentaires
Autres numéros d'identification d'étude
- 19042
- 262245 (Autre identifiant: IRAS)
- 19/EM/0291 (Autre identifiant: REC)
Plan pour les données individuelles des participants (IPD)
Prévoyez-vous de partager les données individuelles des participants (DPI) ?
Description du régime IPD
Within a five-year timeframe, the final anonymized trial data will be uploaded to the https://rdmc.nottingham.ac.uk public repository after consistency and quality have been verified by the project team and publication of the results. Data from this trial are intended to be presented at local and international conferences including those attended by clinicians and dietitians and will also be used as part of a Philosophy Doctorate thesis. Publications will be in peer reviewed journals. No participant will be identified in any of these publications.
Délai de partage IPD
within five years time-frame
Critères d'accès au partage IPD
Public repository. presented at local and international conferences. part of a Philosophy Doctorate thesis
Type d'informations de prise en charge du partage d'IPD
- PROTOCOLE D'ÉTUDE
- SÈVE
- CIF
Informations sur les médicaments et les dispositifs, documents d'étude
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