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Mars Flavanol Exercise and Cognitive Function Study

Study of the Impact of a Flavanol Containing Food Product and Exercise on Cognitive Function and Brain Structure

Status
Completed
Phases
NA
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT01180127
Enrollment
41
Registered
2010-08-11
Start date
2009-12-31
Completion date
2013-10-31
Last updated
2018-12-05

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Cognitive Function

Keywords

flavonol, exercise, dentate gyrus, cerebral blood volume, dentate gyrus CBV

Brief summary

This is a randomized controlled trial to test the impact of a flavonol containing food product and aerobic exercise on cognitive function and brain structure.

Detailed description

I. Background and Significance A. The epidemiology of cognitive aging. Encompassing multiple cognitive domains, higher order thinking includes memory, language, abstract reasoning, and visuospatial ability. A range of studies have established that memory is a cognitive domain differentially targeted by the normal aging process. With an increase in lifespan and a decrease in co-morbid diseases, aging individuals expect to lead cognitively-challenging lives. Even mild forgetfulness, therefore, is no longer considered 'benign'. Indeed, with the exponential growth of the aging population, and since memory decline will occur in all of us as we age, age-related memory decline has emerged as a major societal problem. B. The anatomy of cognitive aging. A range of studies in humans, non-human primates and rodents have established that the hippocampal formation, a brain circuit vital for memory, is targeted by the aging process. Age-related hippocampal dysfunction is therefore a major contributor to age-related memory decline. The hippocampal formation is organized as a circuit, made up of separate but interconnected regions, including the entorhinal cortex, the dentate gyrus, the CA subfields, and the subiculum. Because of hippocampal circuit properties, dysfunction in one subregion will affect the function of neighboring subregions and the hippocampal circuit as a whole. Thus, when confronted with any process that causes the hippocampal circuit to malfunction, pinpointing the subregion that is most effected becomes an important goal. In the case of age-related memory decline, a range of studies in humans, non-human primates, and rodents, have suggested that normal aging causes hippocampal dysfunction by differentially targeting the dentate gyrus. C. Imaging cognitive aging. The anatomical organization of the hippocampal circuit and the differential vulnerability of the dentate gyrus to cognitive aging imposes specific requirements on brain imaging techniques. Specifically, an imaging technique must be able to assess the functional integrity of the multiple hippocampal subregions, in particular the dentate gyrus. With this in mind, our lab has been dedicated to optimizing a functional brain imaging approach applicable to both the human and rodent hippocampal formation. We have recently achieved this goal, and have been applying our cross-species imaging capabilities to investigate a range of process that affect hippocampal function. D. Flavanols, exercise, and cognitive aging. Previous studies have established that physical exercise improved hippocampal function. We have recently exploited our cross-species imaging techniques to show, that within the hippocampal circuit, exercise has a selective effect on dentate gyrus function, in humans and in mice. Independently, a recent study has shown that the flavanol epichatechin improves hippocampal function, and importantly, within the hippocampal circuit, epichatechin was found to differentially target the dentate gyrus. Moreover, this study showed that epichatechin coupled with exercise had its greatest effect on dentate gyrus function. E. Summary. Starting at around 30 years of age, all of us will begin experiencing the insidious cognitive slide of age-related memory decline. With the expansion of aging, age-related memory decline is swelling to epidemic proportions, and ameliorating age-related memory decline has emerged as major societal goal. This proposal is designed to test the following hypothesis: That flavanols with or without physical exercise will ameliorate age-related memory decline. This hypothesis is informed by two sets of interleaving findings: First, a range of studies have pinpointed dysfunction in the dentate gyrus as a specific brain region contributing to age-related memory decline; and second, flavanol consumption with or without physical exercise enhances memory performance by improving dentate gyrus function. In order to experimentally test this hypothesis an imaging technique is required that can assess the functional integrity of the dentate gyrus, techniques that are now available. Importantly, these imaging techniques have been developed so that can they can be applied not only to humans but also to animal models, generating the same 'imaging readout'. Cross-species imaging is particularly important for translational studies.

Interventions

DIETARY_SUPPLEMENTFlavanol containing food product

12 weeks, 2X/day, 20g serving

BEHAVIORALAerobic training

4X/week, 1 hour/session at 75% maximum HR

DIETARY_SUPPLEMENTFood product lacking flavanol

20 g serving, 2X/day, food additive lacking flavonol

12 week wait list control condition during which participants abstain from aerobic exercise

Sponsors

Mars, Inc.
CollaboratorINDUSTRY
New York State Psychiatric Institute
Lead SponsorOTHER

Study design

Allocation
RANDOMIZED
Intervention model
FACTORIAL
Primary purpose
BASIC_SCIENCE
Masking
SINGLE (Investigator)

Eligibility

Sex/Gender
ALL
Age
50 Years to 75 Years
Healthy volunteers
Yes

Inclusion criteria

1. Age 50-75 2. English-speaking 3. Ambulatory 4. BMI \< 32 5. Post-menopausal (women only), no estrogen replacement therapy 6. VO2max \< 36 and 33 ml/kg/min for men age 50-59 and 60-69 respectively; \< 29 and 27 ml/kg/min for women age 50-59 and 60-75 respectively. 7. Baecke Physical Activity Sports Score ≤ 2 8. Medical clearance to participate in the study (normal serum electrolyte, BUN, creatinine levels, normal blood pressure and resting cardiogram)

Exclusion criteria

1. Use of psychotropic medications 2. Current psychiatric disorder 3. Any condition for which aerobic training is counter-indicated 4. Habitual consumers of dietary or herbal supplements, including Gingko, flavonoid, and dietary herbal or plant extracts 5. Lactose Intolerance 6. Individuals who report directly to any of the study investigators 7. Diabetes

Design outcomes

Primary

MeasureTime frameDescription
CBV-fMRI (Cerebral Blood Volume-functional Magnetic Resonance Imaging)Up to 12 weeks after exercise/dietary intervention exposureIn steady state conditions, CBV is an indirect measure of basal metabolism in the brain. CBV-fMRI is a technique that generates maps of basal metabolism across different brain regions
ModBent (Modified Benton Visual Retention Test)Up to 12 weeks after exercise/dietary intervention exposureThis is an object recognition task. Participants view a complex stimulus, then are asked to select which one of two objects was identical to the studied stimulus. After a series of these matching trials, during the subsequent recognition trials participants are shown serially individual complex objects and asked to indicate whether the object was identical to any of the target stimuli viewed during the matching trials. Their reaction time for correct responses, measured in milliseconds, is the unit of measurement.

Secondary

MeasureTime frameDescription
Modified Rey Auditory Verbal Learning TestUp to 12 weeks after exercise/dietary intervention exposureParticipants are read a list of words over three learning trials and the subject is asked to free recall as many words as possible after each trial. These 3 trials are followed by 1 learning trial of a distracter list and then a short delayed free recall trial of the initial list. After approximately 60-minutes, subjects are asked to freely recall words from the initial list, then to recall words form the distracter list, and then complete a forced-choice recognition trial. A source memory trial is administered in which subjects are read each presented word and then asked to identify whether they were initially presented during the 3 learning trials or during the distracter trial. Measured as a retention score (ratio) for which the number of words recalled after the short delay is divided by the number of words recalled on the third learning trial.
VO2maxUp to 12 weeks after exercise/dietary intervention exposuremeasured at randomization, i.e., before exposure to the intervention, and then again after completion of the 12-week intervention

Participant flow

Participants by arm

ArmCount
Exercise, Dietary Intervention
aerobic training and flavanol containing food product Flavanol containing food product: 12 weeks, 2X/day, 20g serving Aerobic training: 4X/week, 1 hour/session at 75% maximum HR
10
no Exercise, Dietary Intervention
wait list control plus flavanol containing food product for 12 weeks Flavanol containing food product: 12 weeks, 2X/day, 20g serving Wait list control: 12 week wait list control condition during which participant abstain from aerobic exercise
11
Exercise, Food Additive Lacking Flavonol
aerobic training plus food additive without flavanol Aerobic training: 4X/week, 1 hour/session at 75% maximum HR Placebo food additive: 20 g serving, 2X/day, food additive lacking flavanol
10
Wait List Control Food Additive Without Flavonol
12 weeks of wait list control status plus food additive without the flavanol containing food product Placebo food additive: 20 g serving, 2X/day, food additive lacking flavanol Wait list control: 12 week wait list control condition during which participant abstain from aerobic exercise
10
Total41

Baseline characteristics

CharacteristicExercise, Dietary InterventionTotalWait List Control Food Additive Without FlavonolExercise, Food Additive Lacking Flavonolno Exercise, Dietary Intervention
Age, Continuous58.4 years
STANDARD_DEVIATION 4.9
57.5 years
STANDARD_DEVIATION 4.89
56.6 years
STANDARD_DEVIATION 3.7
56.6 years
STANDARD_DEVIATION 5.56
57.5 years
STANDARD_DEVIATION 5.34
Ethnicity (NIH/OMB)
Hispanic or Latino
1 Participants10 Participants4 Participants3 Participants2 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
9 Participants31 Participants6 Participants7 Participants9 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
0 Participants0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
Asian
1 Participants2 Participants1 Participants0 Participants0 Participants
Race (NIH/OMB)
Black or African American
1 Participants7 Participants2 Participants2 Participants2 Participants
Race (NIH/OMB)
More than one race
0 Participants0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
Unknown or Not Reported
1 Participants9 Participants3 Participants2 Participants3 Participants
Race (NIH/OMB)
White
7 Participants23 Participants4 Participants6 Participants6 Participants
Region of Enrollment
United States
10 participants41 participants10 participants10 participants11 participants
Sex: Female, Male
Female
8 Participants29 Participants7 Participants7 Participants7 Participants
Sex: Female, Male
Male
2 Participants12 Participants3 Participants3 Participants4 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
EG003
affected / at risk
deaths
Total, all-cause mortality
— / —— / —— / —— / —
other
Total, other adverse events
0 / 100 / 110 / 100 / 10
serious
Total, serious adverse events
0 / 100 / 110 / 100 / 10

Outcome results

Primary

CBV-fMRI (Cerebral Blood Volume-functional Magnetic Resonance Imaging)

In steady state conditions, CBV is an indirect measure of basal metabolism in the brain. CBV-fMRI is a technique that generates maps of basal metabolism across different brain regions

Time frame: Up to 12 weeks after exercise/dietary intervention exposure

Population: One subject in the exercise, food additive lacking flavanol arm, and one subject in the wait list control food additive without flavanol arm had non useable data for this outcome which is why there are only 8 subjects analyzed in those two arms rather than 9.

ArmMeasureGroupValue (MEAN)Dispersion
Exercise, Dietary InterventionCBV-fMRI (Cerebral Blood Volume-functional Magnetic Resonance Imaging)Baseline3.43 percent CBV in a brain regionStandard Deviation 1.43
Exercise, Dietary InterventionCBV-fMRI (Cerebral Blood Volume-functional Magnetic Resonance Imaging)12 weeks4.58 percent CBV in a brain regionStandard Deviation 1.66
no Exercise, Dietary InterventionCBV-fMRI (Cerebral Blood Volume-functional Magnetic Resonance Imaging)12 weeks4.48 percent CBV in a brain regionStandard Deviation 1.31
no Exercise, Dietary InterventionCBV-fMRI (Cerebral Blood Volume-functional Magnetic Resonance Imaging)Baseline2.55 percent CBV in a brain regionStandard Deviation 0.45
Exercise, Food Additive Lacking FlavanolCBV-fMRI (Cerebral Blood Volume-functional Magnetic Resonance Imaging)12 weeks2.91 percent CBV in a brain regionStandard Deviation 0.81
Exercise, Food Additive Lacking FlavanolCBV-fMRI (Cerebral Blood Volume-functional Magnetic Resonance Imaging)Baseline2.89 percent CBV in a brain regionStandard Deviation 0.7
Wait List Control Food Additive Without FlavanolCBV-fMRI (Cerebral Blood Volume-functional Magnetic Resonance Imaging)12 weeks2.60 percent CBV in a brain regionStandard Deviation 0.59
Wait List Control Food Additive Without FlavanolCBV-fMRI (Cerebral Blood Volume-functional Magnetic Resonance Imaging)Baseline3.38 percent CBV in a brain regionStandard Deviation 0.52
Comparison: Repeated measures ANOVA for the interaction of time (baseline vs 12 week) and flavanol group.p-value: 0.0001Repeated measures ANOVA
Primary

ModBent (Modified Benton Visual Retention Test)

This is an object recognition task. Participants view a complex stimulus, then are asked to select which one of two objects was identical to the studied stimulus. After a series of these matching trials, during the subsequent recognition trials participants are shown serially individual complex objects and asked to indicate whether the object was identical to any of the target stimuli viewed during the matching trials. Their reaction time for correct responses, measured in milliseconds, is the unit of measurement.

Time frame: Up to 12 weeks after exercise/dietary intervention exposure

Population: One subject in the exercise, dietary intervention and one subject in the no exercise, dietary intervention group had outlying (larger than 3 standard deviation from mean) ModBent values that were deleted and hence those groups have 7 and 10 subjects analyzed rather than 8 and 11 respectively.

ArmMeasureGroupValue (MEAN)Dispersion
Exercise, Dietary InterventionModBent (Modified Benton Visual Retention Test)Baseline1945 millisecondsStandard Deviation 584
Exercise, Dietary InterventionModBent (Modified Benton Visual Retention Test)12 weeks1867 millisecondsStandard Deviation 478
no Exercise, Dietary InterventionModBent (Modified Benton Visual Retention Test)12 weeks2009 millisecondsStandard Deviation 815
no Exercise, Dietary InterventionModBent (Modified Benton Visual Retention Test)Baseline2296 millisecondsStandard Deviation 1056
Exercise, Food Additive Lacking FlavanolModBent (Modified Benton Visual Retention Test)Baseline2291 millisecondsStandard Deviation 515
Exercise, Food Additive Lacking FlavanolModBent (Modified Benton Visual Retention Test)12 weeks2560 millisecondsStandard Deviation 1086
Wait List Control Food Additive Without FlavanolModBent (Modified Benton Visual Retention Test)Baseline2347 millisecondsStandard Deviation 919
Wait List Control Food Additive Without FlavanolModBent (Modified Benton Visual Retention Test)12 weeks2794 millisecondsStandard Deviation 1298
Comparison: ANCOVA used to test main effect of flavanolp-value: 0.038ANCOVA
Comparison: ANCOVA used to test main effect of exercisep-value: 0.815ANCOVA
Secondary

Modified Rey Auditory Verbal Learning Test

Participants are read a list of words over three learning trials and the subject is asked to free recall as many words as possible after each trial. These 3 trials are followed by 1 learning trial of a distracter list and then a short delayed free recall trial of the initial list. After approximately 60-minutes, subjects are asked to freely recall words from the initial list, then to recall words form the distracter list, and then complete a forced-choice recognition trial. A source memory trial is administered in which subjects are read each presented word and then asked to identify whether they were initially presented during the 3 learning trials or during the distracter trial. Measured as a retention score (ratio) for which the number of words recalled after the short delay is divided by the number of words recalled on the third learning trial.

Time frame: Up to 12 weeks after exercise/dietary intervention exposure

Population: There were 4 subjects (1 in exercise, dietary intervention; 2 in no exercise, dietary intervention, and 1 in exercise, food additive lacking flavanol) who did not have useable data and are thus not included in analyses.

ArmMeasureGroupValue (MEAN)Dispersion
Exercise, Dietary InterventionModified Rey Auditory Verbal Learning TestBaseline0.76 ratioStandard Deviation 0.21
Exercise, Dietary InterventionModified Rey Auditory Verbal Learning Test12 weeks0.83 ratioStandard Deviation 0.08
no Exercise, Dietary InterventionModified Rey Auditory Verbal Learning Test12 weeks0.65 ratioStandard Deviation 0.25
no Exercise, Dietary InterventionModified Rey Auditory Verbal Learning TestBaseline0.69 ratioStandard Deviation 0.19
Exercise, Food Additive Lacking FlavanolModified Rey Auditory Verbal Learning TestBaseline0.80 ratioStandard Deviation 0.19
Exercise, Food Additive Lacking FlavanolModified Rey Auditory Verbal Learning Test12 weeks0.76 ratioStandard Deviation 0.23
Wait List Control Food Additive Without FlavanolModified Rey Auditory Verbal Learning TestBaseline0.89 ratioStandard Deviation 0.11
Wait List Control Food Additive Without FlavanolModified Rey Auditory Verbal Learning Test12 weeks0.87 ratioStandard Deviation 0.21
Comparison: ANCOVA for testing main effect of flavanolp-value: 0.853ANCOVA
Comparison: ANCOVA for testing main effect of exercisep-value: 0.581ANCOVA
Secondary

VO2max

measured at randomization, i.e., before exposure to the intervention, and then again after completion of the 12-week intervention

Time frame: Up to 12 weeks after exercise/dietary intervention exposure

Population: One subject in the exercise, dietary intervention and one subject in the exercise, food additive lacking flavanol group had unusable data for this outcome and thus are not included in these analyses.

ArmMeasureGroupValue (MEAN)Dispersion
Exercise, Dietary InterventionVO2maxBaseline25.6 mL/(kg·min)Standard Deviation 3.77
Exercise, Dietary InterventionVO2max12 weeks27.8 mL/(kg·min)Standard Deviation 4.33
no Exercise, Dietary InterventionVO2max12 weeks25.36 mL/(kg·min)Standard Deviation 3.66
no Exercise, Dietary InterventionVO2maxBaseline26.26 mL/(kg·min)Standard Deviation 4.62
Exercise, Food Additive Lacking FlavanolVO2maxBaseline25.1 mL/(kg·min)Standard Deviation 4.36
Exercise, Food Additive Lacking FlavanolVO2max12 weeks25.98 mL/(kg·min)Standard Deviation 6.57
Wait List Control Food Additive Without FlavanolVO2maxBaseline23.94 mL/(kg·min)Standard Deviation 3.81
Wait List Control Food Additive Without FlavanolVO2max12 weeks25.44 mL/(kg·min)Standard Deviation 5.51
Comparison: ANCOVA was used to test for an exercise effect.p-value: 0.237ANCOVA

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026