Skip to content

Investigation of the Gut Microbiota in Regulating Nutrient Absorption in Humans

Investigation of the Gut Microbiota in Regulating Nutrient Absorption in Humans

Status
Completed
Phases
Phase 2
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT02037295
Enrollment
27
Registered
2014-01-15
Start date
2014-01-14
Completion date
2019-03-29
Last updated
2020-07-31

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

Conditions

Obesity

Keywords

Gut Microbiota, Obesity, Absorption, Overfeeding

Brief summary

We propose to study both stool and urine energy loss in 24 individuals on two experimental diets (50% increased and 50% reduced nutrient load relative to body size) in a random cross-over design. Following this over/underfeeding, volunteers will also be randomly assigned to a placebo versus oral antibiotic medication arm. This study will extend our previous findings by investigating whether 1) nutrient absorption changes upon similar increases/decreases in relative nutrient load and 2) whether manipulation of gut microbial communities with antibiotics alters nutrient absorption and 3) how these changes may affect glucose tolerance and fat storage.

Detailed description

The prevalence of obesity has risen to epidemic proportions in the world, resulting from both excessive energy intake and low levels of energy expenditure. The effect of nutrient absorption on energy balance, that is, the relative amount of nutrients consumed vs. the amount excreted in stool, has been reported only in small studies in which energy waste in feces and urine between lean and obese individuals was not found to be different. New studies have shown that bacteria in the gut may play an important role in calorie absorption. We have recently shown that leaner individuals absorbed more calories when overfed compared to when they were given a diet with just enough calories to maintain their own weight. Our studies have also found that overfeeding also changes the kinds of bacteria found in the gut. In lean individuals, these changes in gut bacterial communities with overfeeding were associated with changes in how many calories were absorbed. Our results are similar to those seen in other studies in animals and humans that suggest a role for gut bacteria in weight gain and obesity. To try to better understand the role of gut bacteria in absorbing food, we propose to investigate 1) whether energy loss (as measured in stool and urine) changes following over- and underfeeding relative to body size and 2) whether changes in the gut bacteria, induced by an antibiotic medication, affect nutrient absorption and glucose tolerance. We plan to study 24 healthy non-smoking volunteers age 18 45 years old, not taking any medications (including medications for weight loss, antibiotics or probiotics) for the examination. All participants will be admitted to the Clinical Research Unit for 31 days. During their stay, subjects will be fed a weight maintaining diet for 3 days, followed by two experimental diets (150% and 50% of weight maintaining calories) in a random order. After this, volunteers will be randomly assigned to one of two groups: group 1 will take oral antibiotic medication; group 2 will receive pills that look the same but will not contain any active medication (placebos). Feces (stool) will be collected throughout the study. Additionally, twenty four-hour urine collections will take place each day of the experimental diet period and when stool is collected on the antibiotics. The energy content of these waste products as well as that of the diet (using duplicate plate analysis) will be measured by bomb calorimetry. Bacterial components in feces will be extracted by repeated fractional centrifugation to obtain bacterial mass and by using 16S rDNA-based oligonucleotide probes to obtain data on gut bacteria. Primary results will examine how many calories remain in stool during relative over- and underfeeding and whether changes in gut bacteria, induced by an antibiotic medication, affect nutrient absorption and glucose tolerance.

Interventions

DRUGVancomycin

Vancomycin 125mg orally four times per day for 12 days

DRUGPlacebo oral tablet

Placebo pills orally four times per day for 12 days

OTHEROverfeeding diet (OF)

Diet in which the calories are 150% of their weight maintaining energy requirements

OTHERUnderfeeding diet (UF)

Diet in which the calories are 50% of their weight maintaining energy requirements

Sponsors

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Lead SponsorNIH

Study design

Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
PREVENTION
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)

Eligibility

Sex/Gender
ALL
Age
18 Years to 45 Years
Healthy volunteers
No

Inclusion criteria

* INCLUSION CRITERIA: Free of acute and chronic diseases (especially GI disorders) as determined by medical history, physical examination and laboratory tests. Individuals may be taking laxative drugs but they must be discontinued 3 or more weeks before admission. Age 18-45 y (in order to minimize the affect of aging on nutrient absorption).

Exclusion criteria

Because it is unclear how chronic illnesses or substance abuse could affect nutrient absorption we will exclude volunteers with chronic diseases or current substance abuse. This is especially important because the limited number of study subjects in this study will make it hard to control for these confounders. We will therefore exclude subjects with a history or clinical manifestation of: * Current smoking * Type 2 diabetes (according to the World Health Organization diagnostic criteria) * Endocrine disorders, such as Cushing s disease, pituitary disorders, and hypo- and hyperthyroidism * HIV infection (self-report), due to effects on weight and body composition of HIV and medications used to treat HIV * Active tuberculosis (self-report) * Asthma on active daily treatment with medications * Pulmonary disorders including physician diagnosed chronic obstructive pulmonary diseases and obstructive sleep apnea syndrome * Cardiovascular diseases, including coronary heart disease, heart failure, arrhythmias, and peripheral artery disease * Hypertension (according to the World Health Organization diagnostic criteria), treated or uncontrolled * Gastrointestinal disease, including inflammatory bowel diseases (e.g. Crohn s disease and ulcerative colitis), malabsorption syndromes (e.g. celiac disease), gastric ulcer (active) and irritable bowel syndrome. * Lactose intolerance * Anemia (defined as hemoglobin \< 11 mg/dl), leucopenia (defined as white blood cell count \< 4,000/microL) or thrombocytopenia (defined as platelet count \< 150,000/microL) * Liver disease, including non-alcoholic fatty liver disease or current elevated liver enzymes over 1.5 times the normal range for AST, ALT or GGT or a history and physical exam that indicates a potential liver disease as describe by Giannini et al * Evidence of chronic renal disease as defined by estimated glomerular filtration rate of \< 60 ml/min or evidence of overt proteinuria on urine dipstick. * Central nervous system disease, including previous history of cerebrovascular accidents, dementia, and neurodegenerative disorders * Cancer requiring treatment in the past five years, except for non-melanoma skin cancers or cancers that have clearly been cured or in the opinion of the investigator carry an excellent prognosis * Behavioral or psychiatric conditions that would be incompatible with a safe and successful participation in the study (such as major depression, schizophrenia and presence of psychotic symptoms) * Eating disorders such as anorexia nervosa, bulimia or binge eating syndrome * Taking weight loss drugs * Weight change of more than 5% of total body weight in the 3 months before admission * Use of any antibiotic or probiotic agents within 6 months prior to minimize the potential effects of these substances on the gut microbiota. * Use of antacids (Proton pump inhibitors, H2 antagonists or aluminum/magnesium hydroxide) 3 months prior to the study assessed by self-report because a modified gastric pH might affect the gut microbiota as well * Evidence of alcohol and/or drug abuse (more than 3 drinks per day and use of drugs, such as amphetamines, cocaine, heroin, or marijuana) The following

Design outcomes

Primary

MeasureTime frameDescription
Stool Calories During OF and UFDays 5-7 and 11-13Calculated as stool calories (kcal/day) x 100/ingested calories (kcal/day)
Stool Calories During Vancomycin and PlaceboDays 23-25Calculated as stool calories (kcal/day) x 100/ingested calories (kcal/day), vancomycin compared to placebo

Secondary

MeasureTime frameDescription
Change in 2 Hour Glucose Tolerance From Day 16 to Day 28 During Vancomycin and PlaceboDay 16 and day 28A 75-g 2 hour oral glucose tolerance test (OGTT) was performed on days 16 and 28, before and after treatment with vancomycin or placebo.
Urine Calories During OF and UFDays 5-7 and 11-13Calculated as urine calories (kcal/day) x 100/ingested calories (kcal/day)
Overall Gut Microbial Colonization During Vancomycin and PlaceboDays 23-25qPCR-based quantification of 16S rRNA gene copies per gram wet weight (log10)
Overall Gut Microbial Colonization During OF and UFDays 5-7 and 11-13qPCR-based quantification of 16S rRNA gene copies per gram wet weight (log10)
Urine Calories During Vancomycin and PlaceboDays 23-25Calculated as urine calories (kcal/day) x 100/ingested calories (kcal/day), vancomycin compared to placebo

Countries

United States

Participant flow

Participants by arm

ArmCount
OF_UF Vancomycin
Healthy volunteers assigned overfeeding diet, underfeeding diet, and then vancomycin Vancomycin: Vancomycin 125mg orally four times per day for 12 days Overfeeding diet (OF): Diet in which the calories are 150% of their weight maintaining energy requirements Underfeeding diet (UF): Diet in which the calories are 50% of their weight maintaining energy requirements
9
OF_UF Placebo
Healthy volunteers assigned overfeeding diet, underfeeding diet, and then placebo Placebo oral tablet: Placebo pills orally four times per day for 12 days Overfeeding diet (OF): Diet in which the calories are 150% of their weight maintaining energy requirements Underfeeding diet (UF): Diet in which the calories are 50% of their weight maintaining energy requirements
7
UF_OF Vancomycin
Healthy volunteers assigned underfeeding diet, overfeeding diet, and then vancomycin Vancomycin: Vancomycin 125mg orally four times per day for 12 days Overfeeding diet (OF): Diet in which the calories are 150% of their weight maintaining energy requirements Underfeeding diet (UF): Diet in which the calories are 50% of their weight maintaining energy requirements
4
UF_OF Placebo
Healthy volunteers assigned underfeeding diet, overfeeding diet, and then placebo Placebo oral tablet: Placebo pills orally four times per day for 12 days Overfeeding diet (OF): Diet in which the calories are 150% of their weight maintaining energy requirements Underfeeding diet (UF): Diet in which the calories are 50% of their weight maintaining energy requirements
7
Total27

Withdrawals & dropouts

PeriodReasonFG000FG001FG002FG003
Phase 2: Vancomycin and PlaceboWithdrawal by Subject1001

Baseline characteristics

CharacteristicOF_UF VancomycinOF_UF PlaceboUF_OF VancomycinUF_OF PlaceboTotal
Age, Continuous31.7 years
STANDARD_DEVIATION 13.3
34.9 years
STANDARD_DEVIATION 7.2
29.7 years
STANDARD_DEVIATION 4.4
38.4 years
STANDARD_DEVIATION 3.6
35.1 years
STANDARD_DEVIATION 7.2
Ethnicity (NIH/OMB)
Hispanic or Latino
1 Participants2 Participants0 Participants0 Participants3 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
8 Participants5 Participants4 Participants7 Participants24 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
0 Participants0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
American Indian or Alaska Native
5 Participants3 Participants3 Participants2 Participants13 Participants
Race (NIH/OMB)
Asian
0 Participants0 Participants0 Participants0 Participants0 Participants
Race (NIH/OMB)
Black or African American
2 Participants1 Participants1 Participants1 Participants5 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 Participants2 Participants0 Participants0 Participants3 Participants
Race (NIH/OMB)
White
1 Participants1 Participants0 Participants4 Participants6 Participants
Sex: Female, Male
Female
3 Participants2 Participants2 Participants3 Participants10 Participants
Sex: Female, Male
Male
6 Participants5 Participants2 Participants4 Participants17 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
0 / 270 / 270 / 130 / 14
other
Total, other adverse events
0 / 270 / 270 / 130 / 14
serious
Total, serious adverse events
0 / 270 / 270 / 130 / 14

Outcome results

Primary

Stool Calories During OF and UF

Calculated as stool calories (kcal/day) x 100/ingested calories (kcal/day)

Time frame: Days 5-7 and 11-13

Population: 4 subjects were excluded from the analysis because the delineation of the diet periods using two dye markers was not clear

ArmMeasureValue (MEAN)Dispersion
OverfeedingStool Calories During OF and UF5.8 percentage of calorie intakeStandard Deviation 1.9
UnderfeedingStool Calories During OF and UF8.9 percentage of calorie intakeStandard Deviation 3.7
Primary

Stool Calories During Vancomycin and Placebo

Calculated as stool calories (kcal/day) x 100/ingested calories (kcal/day), vancomycin compared to placebo

Time frame: Days 23-25

Population: Phase 2: Of the 27 participants enrolled, 2 participants dropped out and 1 had missing stool data

ArmMeasureValue (MEAN)Dispersion
OverfeedingStool Calories During Vancomycin and Placebo8.4 percentage of calorie intakeStandard Deviation 1.9
UnderfeedingStool Calories During Vancomycin and Placebo5.6 percentage of calorie intakeStandard Deviation 2.5
Secondary

Change in 2 Hour Glucose Tolerance From Day 16 to Day 28 During Vancomycin and Placebo

A 75-g 2 hour oral glucose tolerance test (OGTT) was performed on days 16 and 28, before and after treatment with vancomycin or placebo.

Time frame: Day 16 and day 28

Population: Phase 2: Of the 27 participants enrolled, 2 participants dropped out and 1 had a missing OGTT.

ArmMeasureValue (MEAN)Dispersion
OverfeedingChange in 2 Hour Glucose Tolerance From Day 16 to Day 28 During Vancomycin and Placebo1.3 mg/dLStandard Deviation 16.8
UnderfeedingChange in 2 Hour Glucose Tolerance From Day 16 to Day 28 During Vancomycin and Placebo-1.9 mg/dLStandard Deviation 21.2
Secondary

Overall Gut Microbial Colonization During OF and UF

qPCR-based quantification of 16S rRNA gene copies per gram wet weight (log10)

Time frame: Days 5-7 and 11-13

Population: Data were available during both diets for only 15 subjects

ArmMeasureValue (MEDIAN)
OverfeedingOverall Gut Microbial Colonization During OF and UF9.39 log 10 copies per gram weight
UnderfeedingOverall Gut Microbial Colonization During OF and UF9.73 log 10 copies per gram weight
Secondary

Overall Gut Microbial Colonization During Vancomycin and Placebo

qPCR-based quantification of 16S rRNA gene copies per gram wet weight (log10)

Time frame: Days 23-25

Population: Data were available for only 23 subjects

ArmMeasureValue (MEDIAN)
OverfeedingOverall Gut Microbial Colonization During Vancomycin and Placebo9.92 log 10 copies per gram weight
UnderfeedingOverall Gut Microbial Colonization During Vancomycin and Placebo9.42 log 10 copies per gram weight
Secondary

Urine Calories During OF and UF

Calculated as urine calories (kcal/day) x 100/ingested calories (kcal/day)

Time frame: Days 5-7 and 11-13

Population: 4 subjects were excluded from the analysis because the delineation of the diet periods using two dye markers was not clear

ArmMeasureValue (MEAN)Dispersion
OverfeedingUrine Calories During OF and UF1.1 percentage of calorie intakeStandard Deviation 0.2
UnderfeedingUrine Calories During OF and UF2.3 percentage of calorie intakeStandard Deviation 0.5
Secondary

Urine Calories During Vancomycin and Placebo

Calculated as urine calories (kcal/day) x 100/ingested calories (kcal/day), vancomycin compared to placebo

Time frame: Days 23-25

Population: Phase 2: Of the 27 participants enrolled, 2 participants dropped out and 1 had missing stool data

ArmMeasureValue (MEAN)Dispersion
OverfeedingUrine Calories During Vancomycin and Placebo1.3 percentage of calorie intakeStandard Deviation 0.3
UnderfeedingUrine Calories During Vancomycin and Placebo1.3 percentage of calorie intakeStandard Deviation 0.2

Source: ClinicalTrials.gov · Data processed: Feb 28, 2026