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The Effects of 5-methyltetrahydrofolate Supplementation in Patients With Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)

30 juli 2026 bijgewerkt door: Fatemeh Tamjid, Tabriz University of Medical Sciences

The Effect of 5-methyltetrahydrofolate Supplementation on Serum Folate and Homocysteine Level and PPARα and TNFα Gene Expression in Patients With Metabolic Dysfunction-Associated Steatotic Liver Disease: a Double-blind, Parallel Randomized Controlled Trial Study

To determine the effect of MTHF supplementation on serum folate and homocysteine level, metabolic, nutritional status, liver function, and PPARα and TNFα gene expression in patients with MASLD

Studie Overzicht

Toestand

Nog niet aan het werven

Conditie

Interventie / Behandeling

Gedetailleerde beschrijving

Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly termed non-alcoholic fatty liver disease (NAFLD), is diagnosed via liver biopsy or imaging when steatosis is present in the absence of alcohol intake or other hepatic disorders. As the liver manifestation of metabolic syndrome, it commonly coexists with obesity, diabetes, dyslipidemia, hypertension, and related conditions. Global prevalence of MASLD continues to rise.

Evidence from an earlier systematic review and meta-analysis indicated that MASLD patients had significantly lower serum folate and higher homocysteine concentrations. Folate is an essential water-soluble B vitamin that occurs in multiple chemically related forms. Food folates are mainly reduced and polyglutamated, with 5-MTHF predominating in both the diet and systemic circulation. 5-MTHF does not require reduction by DHFR and can enter the bloodstream directly for use. Reduced folates act as methyl donors in one carbon metabolism, supporting cellular proliferation, homocysteine re-methylation to methionine, nucleic acid synthesis and methylation of DNA, RNA, proteins and phospholipids.

Experimental studies have demonstrated that diet-induced hyperhomocysteinemia promotes hepatic steatosis and liver injury and folate as a key regulator of homocysteine concentration, may exert hepatoprotective effects. Evidence suggests that folate may improve hepatic lipid metabolism by activating peroxisome proliferator-activated receptor alpha (PPARα) signaling and modulate the immune response and reduce inflammatory mediators. Nevertheless, no evidence on the effects of folate on PPARα and TNFα gene expression in MASLD patients exist. Moreover, PPARα gene expression is dysregulated in MASLD and related metabolic conditions; PPARα is highly expressed in the liver, skeletal muscle and brown adipose tissue, stimulates β-oxidation and suppresses fatty-acid synthesis. Although the effect of 5-MTHF supplementation on gene expression of PPARα and TNFα in MASLD patients has not been examined, evidence showed that folate can modulate PPARα and TNFα. As folate has been shown to affect lipid metabolism and inflammation, we hypothesized that 5-MTHF supplementation might regulate PPARα and TNFα expression in MASLD patients. This randomized, double-blind, placebo-controlled clinical trial will therefore be undertaken to determine the effects of 5-MTHF supplementation on serum levels of folate and homocysteine, and gene expression of PPARα and TNFα in MASLD patients.

Studietype

Ingrijpend

Inschrijving (Geschat)

44

Fase

  • Niet toepasbaar

Contacten en locaties

In dit gedeelte vindt u de contactgegevens van degenen die het onderzoek uitvoeren en informatie over waar dit onderzoek wordt uitgevoerd.

Studiecontact

Studie Contact Back-up

Studie Locaties

Deelname Criteria

Onderzoekers zoeken naar mensen die aan een bepaalde beschrijving voldoen, de zogenaamde geschiktheidscriteria. Enkele voorbeelden van deze criteria zijn iemands algemene gezondheidstoestand of eerdere behandelingen.

Geschiktheidscriteria

Leeftijden die in aanmerking komen voor studie

  • Volwassen

Accepteert gezonde vrijwilligers

Nee

Beschrijving

Inclusion Criteria:

  • Adult men or women (18-50 years)
  • Diagnosis of MASLD (grade 1 or 2 of steatosis confirmed by ultrasound)
  • Body mass index (BMI) = 25-34.9 kg/m²
  • Providing written informed consent

Exclusion Criteria:

  • Pregnancy, lactation, or plans to get pregnant during the next three months.
  • Liver disease (viral hepatitis, autoimmune liver disease, cirrhosis, drug-induced hepatotoxicity, or alcoholic fatty liver disease), heart or renal failure, kidney stones, any neoplasia, inflammatory disease, hypothyroidism, hypercortisolism, or hypertension
  • Taking drugs affecting glucose or lipid metabolism, folate supplements, anti-obesity medications, weight-loss diets, or dietary supplements
  • Lifestyle factors known to impact folate status (current smoking, alcohol intake, recreational drug use)
  • Pre-existing conditions affecting folate status (malabsorptive or inflammatory bowel diseases, active celiac disease, gastric bypass surgery, atrophic gastritis, epilepsy, advanced liver disease, kidney dialysis, type 1 or 2 diabetes mellitus, or sickle cell trait/anemia)
  • Medications that interfere with B-vitamin metabolism (chloramphenicol, methotrexate, metformin, sulfasalazine, phenobarbital, phenytoin, primidone, triamterene, barbiturates)

Studie plan

Dit gedeelte bevat details van het studieplan, inclusief hoe de studie is opgezet en wat de studie meet.

Hoe is de studie opgezet?

Ontwerpdetails

  • Primair doel: Behandeling
  • Toewijzing: Gerandomiseerd
  • Interventioneel model: Parallelle opdracht
  • Masker: Verviervoudigen

Wapens en interventies

Deelnemersgroep / Arm
Interventie / Behandeling
Placebo-vergelijker: Placebo
Patients in this group will receive placebo for 90 days. The placebo is corn starch/ cellulose and will be consumed once a day. Placebo tablets will be manufactured by Ashbal Chemi Co. (Tehran, Iran).
Experimenteel: Interventie
Patients in this group will receive 5-methyltetrahydrofolate tablets (800 mcg) once a day for 90 days. Tablets will be manufactured by Ashbal Chemi pharmaceutical company (Qfol, Ashbal Chemi Co., Tehran, Iran).

Wat meet het onderzoek?

Primaire uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
Serum folate level
Tijdsspanne: 3 months
Changes in serum folate level pre and post the 3-month intervention period.
3 months
Serum homocysteine level
Tijdsspanne: 3 months
Changes in serum homocysteine level pre and post the 3-month intervention period.
3 months
Expression of PPARα and TNFα genes
Tijdsspanne: 3 months
Changes in expression of PPARα and TNFα genes pre and post the 3-month intervention period.
3 months

Secundaire uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
Liver biochemical parameters (ALT (alanine aminotransferase), AST (aspartate aminotransferase), and GGT (gamma-glutamyl transferase)
Tijdsspanne: 3 months
Changes in ALT, AST, and GGT pre and post the 3-month intervention period.
3 months
The fibrosis-4 (FIB-4) index
Tijdsspanne: 3 months
Changes in FIB-4 index pre and post the 3-month intervention period. The Fibrosis-4 (FIB-4) index will be calculated using the following formula: FIB-4 = (Age [years] × AST [U/L]) / (Platelet count [10⁹/L] × √ALT [U/L]). FIB-4 values >1.3, indicate a greater likelihood of liver fibrosis.
3 months
Quality of life using SF-36 (36-Item Short Form Health Survey) questionnaires
Tijdsspanne: 3 months
Changes in quality-of-life pre and post the 3-month intervention period. Health-related quality of life will be assessed using the validated 36-Item Short Form Health Survey (SF-36). The questionnaire evaluates eight health domains: physical functioning, role limitations due to physical health, bodily pain, general health, vitality, social functioning, role limitations due to emotional problems, and mental health. Scores for each domain will be transformed to a 0-100 scale according to the standard scoring algorithm, with higher scores indicating better health-related quality of life.
3 months
Lipid profile (triglycerides, total cholesterol, LDL-C (low-density lipoprotein cholesterol), HDL-C (high-density lipoprotein cholesterol))
Tijdsspanne: 3 monhs
Changes in lipid profile (triglycerides, total cholesterol, LDL-C, HDL-C) pre and post the 3-month intervention period.
3 monhs
Fasting blood glucose
Tijdsspanne: 3 months
Changes in fasting blood glucose pre and post the 3-month intervention period.
3 months
Fasting serum insulin
Tijdsspanne: 3 months
Changes in fasting serum insulin pre and post the 3-month intervention period.
3 months
QUICKI (quantitative insulin sensitivity check index)
Tijdsspanne: 3 months
Changes in QUICKI pre and post the 3-month intervention period. The quantitative insulin sensitivity check index (QUICKI) will be calculated as 1/[log(fasting insulin [µU/mL]) + log(fasting glucose [mg/dL])], higher values indicating greater insulin sensitivity.
3 months
HOMA-IR (homeostatic model assessment of insulin resistance
Tijdsspanne: 3 months
Changes in HOMA-IR pre and post the 3-month intervention period. Insulin resistance will be assessed using the homeostatic model assessment of insulin resistance (HOMA-IR), calculated as fasting insulin (µU/mL) × fasting glucose (mg/dL) / 405, higher values indicating greater insulin resistance.
3 months
Weight
Tijdsspanne: 3 months
Changes in weight pre and post the 3-month intervention period.
3 months
Body Mass Index (BMI)
Tijdsspanne: 3 months
Changes in BMI pre and post the 3-month intervention period. Body mass index (BMI) will be calculated as weight (kg) divided by the square of height (m²) and expressed as kg/m².
3 months
Waist circumference
Tijdsspanne: 3 months
Changes in waist circumference pre and post the 3-month intervention period.
3 months
Waist-to-hip ratio (WHR)
Tijdsspanne: 3 months
Changes in WHR pre and post the 3-month intervention period. Waist-to-hip ratio (WHR) will be calculated by dividing waist circumference by hip circumference.
3 months
Body composition (fat-free mass)
Tijdsspanne: 3 months
Changes in fat-free mass (%) pre and post the 3-month intervention period. Body composition will be determined using a bioelectrical impedance analyzer.
3 months
Body composition (fat mass)
Tijdsspanne: 3 months
Changes in fat mass (%) pre and post the 3-month intervention period. Body composition will be determined using a bioelectrical impedance analyzer.
3 months

Medewerkers en onderzoekers

Hier vindt u mensen en organisaties die betrokken zijn bij dit onderzoek.

Sponsor

Onderzoekers

  • Hoofdonderzoeker: Bahram Pourghassem Gargari, Tabriz University of Medical Sciences

Studie record data

Deze datums volgen de voortgang van het onderzoeksdossier en de samenvatting van de ingediende resultaten bij ClinicalTrials.gov. Studieverslagen en gerapporteerde resultaten worden beoordeeld door de National Library of Medicine (NLM) om er zeker van te zijn dat ze voldoen aan specifieke kwaliteitscontrolenormen voordat ze op de openbare website worden geplaatst.

Bestudeer belangrijke data

Studie start (Geschat)

30 september 2026

Primaire voltooiing (Geschat)

30 augustus 2027

Studie voltooiing (Geschat)

30 augustus 2027

Studieregistratiedata

Eerst ingediend

22 juli 2026

Eerst ingediend dat voldeed aan de QC-criteria

30 juli 2026

Eerst geplaatst (Werkelijk)

31 juli 2026

Updates van studierecords

Laatste update geplaatst (Werkelijk)

31 juli 2026

Laatste update ingediend die voldeed aan QC-criteria

30 juli 2026

Laatst geverifieerd

1 juli 2026

Meer informatie

Termen gerelateerd aan deze studie

Andere studie-ID-nummers

  • IRCT20100123003140N26

Plan Individuele Deelnemersgegevens (IPD)

Bent u van plan om gegevens van individuele deelnemers (IPD) te delen?

JA

Informatie over medicijnen en apparaten, studiedocumenten

Bestudeert een door de Amerikaanse FDA gereguleerd geneesmiddel

Nee

Bestudeert een door de Amerikaanse FDA gereguleerd apparaatproduct

Nee

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