Cardiovascular Risk Factor, Dietary Modification
Conditions
Keywords
TMAO, Gut Flora, Dietary Intervention, Choline, Carnitine
Brief summary
Our group has recently identified the association between gut-flora-mediated carnitine and phosphatidylcholine metabolism, specifically trimethylamine-N-oxide (TMAO), and cardiovascular risk. This study investigates the ability for dietary intervention to modulate TMAO levels.
Detailed description
This is a pilot human study to characterize the relationship between gut flora-associated TMAO generation and dietary intervention. The investigators hypothesize that tailored dietary interventions may help to reduce the ability for gut flora to generate TMAO in individuals with elevated TMAO levels. Specific aims include: 1. To investigate the proportion of subjects with persistently elevated circulating TMAO levels. 2. To compare the amount of TMAO generated from gut flora using stable-isotope-labelled choline, carnitine, and betaine in subjects with elevated versus normal circulating TMAO levels. 3. To evaluate the effect of dietary interventions on the amount of TMAO generated from gut flora using stable-isotope-labelled choline, carnitine, and betaine in subjects with elevated circulating TMAO levels.
Interventions
BEHAVIORALMeLT Dietary intervention
Mediterranean diet containing food with low TMAO content.
BEHAVIORALTLC Dietary intervention
Standard American Heart Association (AHA) recommendations for dietary counseling.
BEHAVIORALMeLT dietary intervention with TMAO
Mediterranean diet containing food with low TMAO content with TMAO levels provided to the subject for guidance.
Sponsors
The Cleveland Clinic
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
Cohort 1 Inclusion criteria: * Men and women age 18 years or above. * Elevated TMAO metabolizers (\>5 µM) based on screening test and/or eGFR \< 60 at most recent measurement. * Willing to remain on aspirin or able to be off aspirin or aspirin products for 1 week prior to starting the study and staying on the same aspirin regimen during the duration of the study. * Willing to sign the consent form and follow the study protocol, which includes a 12-week dietary modification. Cohort 2 Inclusion criteria: * Men and women age 18 years or above. * Willing to remain on aspirin or able to be off aspirin or aspirin products for 1 week prior to starting the study and staying on the same aspirin regimen during the duration of the study. * Willing to sign the consent form and follow the study protocol. * eGFR values ranging from 16-59 Cohort 3 Inclusion criteria: * Men and women age 18 years or above. * Willing to remain on aspirin or able to be off aspirin or aspirin products for 1 week prior to starting the study and staying on the same aspirin regimen during the duration of the study. * Willing to sign the consent form and follow the study protocol.
Exclusion criteria
(all cohorts): * Significant chronic illness or end-organ dysfunction, including known history of uncompensated heart failure, renal failure, pulmonary disease, hematologic diseases. * Active infection or received antibiotics within 2 months of study enrollment * Use of over-the-counter probiotic within past month, or ingestion of yogurt within past 7 days * Having undergone bariatric procedures or surgeries such as gastric banding or bypass. * Pregnancy. * Any condition which, in the judgment of the Investigator, would place a patient at undue risk by being enrolled in the trial, or cause inability to comply with the trial
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in TMAO level | From baseline to 12 weeks follow-up | The change in TMAO concentration measured in blood samples |
Countries
United States
Contacts
CONTACTJennifer Wilcox, BA
CONTACTValesha Province, MA
PRINCIPAL_INVESTIGATORW. H. Wilson Tang, MD
The Cleveland Clinic
PRINCIPAL_INVESTIGATORStanley L. Hazen, MD, PhD
The Cleveland Clinic
Outcome results
None listed