2-5 Intermittent Caloric Restriction in HIV

2-5 Intermittent Caloric Restriction for Weight Loss and Insulin Resistance in HIV-Infected Adults With Features of the Metabolic Syndrome

Status

Terminated

Phases

Study type

Interventional

Source

ClinicalTrials.gov

Registry ID

NCT03489109

Acronym

2-5toWIN

Enrollment

Registered

2018-04-05

Start date

2018-05-09

Completion date

2021-12-17

Last updated

2022-10-21

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

Conditions

Human Immunodeficiency Virus, Metabolic Syndrome

Keywords

Fasting

Brief summary

Background: Weight gain can lead to obesity and diabetes even in people living with human immunodeficiency virus (HIV). Researchers want to see if the technique intermittent calorie restriction can help overweight people with HIV as an alternative to traditional diets. Objective: To see if intermittent calorie restriction leads to weight loss and improved blood sugar in obese people with HIV. Eligibility: Adults ages 18-65 with HIV who are obese and do not have diabetes Design: Participants will be screened with a medical history, physical exam, and blood and urine tests. Before starting treatment, participants will: * Have a nutritional consultation * Get a pedometer to record daily steps * Test a restricted diet for 1 day * Have a body x-ray At the baseline visit, participants will have: * Blood drawn after they drink a sugar drink * Questions about their health and eating * A nutritional consultation * Resting energy expenditure measured. Participants will fast overnight. Then they will lie down while a plastic bubble goes over the head and a plastic sheet covers the upper body. Oxygen flows into the bubble. * Liver stiffness test. A wand on the stomach releases sound waves like an ultrasound. For 12 weeks, some participants will be on a standard diet. Others will restrict how much food they eat 2 days a week. On those days they will eat about 25% of their recommended calories. Participants will keep a diary of their diet and steps. Participants will have 4 visits during the 12-week diet and 1 visit 12 weeks after the diet ends. They will repeat previous tests.

Detailed description

The high prevalence of obesity coupled with chronic inflammation and immune activation places human immunodeficiency virus (HIV)-infected individuals at increased risk for metabolic complications emphasizing the need for more aggressive management of obesity and related co-morbidities in the aging HIV-infected population. The most effective treatment for obesity and metabolic syndrome is lifestyle modification, usually with a combination of caloric restriction and increased exercise. Intermittent caloric restriction (ICR) or intermittent fasting simplifies caloric restriction by severely limiting calories only a few days per week and allowing ad lib diet on the other days. Weight loss benefits are similar to those seen with conventional diets, however, data suggests possible added health benefits from intermittent fasting. We propose to study the benefits of a 2-5 ICR strategy on weight, insulin resistance, and cardiovascular disease markers in obese HIV-infected adults with features of the metabolic syndrome. In a prospective pilot study, 50 HIVinfected adults will be randomized 1:1 to ICR or standard-of-care instruction of healthy diet and lifestyle for a 12-week intervention period. We hypothesize that ICR (2 days per week) will be an effective and acceptable diet strategy that will result in significant weight reduction, improvements in insulin sensitivity, and related metabolic parameters.

Interventions

BEHAVIORALIntermittent fasting

Subject will consume approximately 25% of their daily calories for 2 days per week. The other 5 days they will eat their normal diet

OTHERStandard of Care

Subject will receive standard of care recommendations for healthy diet and lifestyle

Study design

Allocation

RANDOMIZED

Intervention model

PARALLEL

Primary purpose

TREATMENT

Masking

NONE

Eligibility

Sex/Gender

ALL

Age

18 Years to 65 Years

Healthy volunteers

Inclusion criteria

-INCLUSION CRITERIA: 1. Aged 18 to 65 years 2. HIV RNA level less than or equal to 200 copies/mL for greater than or equal to1 year (1 measure greater than or equal to 200 allowed if also \<500 and preceded and followed by one or more undetectable values) 3. Cluster of differentiation 4 (CD4) \>200 cells/mL and no active opportunistic infection or malignancy 4. BMI greater than or equal to 30 kg/m\^2 5. One or more components of the metabolic syndrome as defined below. * Risk Factor: Waist circumference * Men: Defining Level: \>102 cm * Women: Defining Level: \>88 cm * Risk Factor: Triglycerides, greater than or equal to 150 mg/dL * Risk Factor: High density lipoprotein (HDL) cholesterol * Men: Defining Level: \<40 mg/dL * Women: Defining Level: \<50 mg/dL * Risk Factor: Blood pressure, greater than or equal to 130 / greater than or equal to 85 mmHg * Risk Factor: Fasting glucose, greater than or equal to 110 mg/dL 6. Fasting blood glucose \>60 mg/dL at screening 7. Willingness to allow sample storage for future research 8. Able to provide informed consent

Exclusion criteria

1. Established diagnosis of diabetes mellitus use of anti-diabetes medications, or a hemoglobin A1C (HgbA1C) of \>7.0% 2. History of eating disorder, uncontrolled mood or thought disorder, significant gastrointestinal disorder or malabsorption, or significant hepatic or renal impairment 3. Current use of medical therapy for overweight/obesity including phentermine, orlistat, lorcaserin, naltrexone/bupropion, and liraglutide or history of weight loss surgery. Concomitant use of medications with side effects known to potentially influence appetite are allowed if on a stable dose for at least 12 months 4. History of symptomatic hypoglycemia. 5. Use of systemic glucocorticoids (stable dose daily inhaled corticosteroid allowed) 6. Chronic viral hepatitis C; subjects with a history of hepatitis C successfully treated can enroll \>12 months after sustained virologic response 7. Alcohol or substance use disorder in the past year as defined by Diagnostic and Statistical Manual (DSM)-V or positive urine drug screen 8. Current pregnancy, actively seeking to become pregnant or breastfeeding 9. Any serious health or other condition which, in the opinion of the PI or their designee, could potentially interfere with the ability of a subject to comply with the procedures and assessments of the protocol or to safely participate and complete the study.

Design outcomes

Primary

Measure	Time frame	Description
Change in Weight	Assessed before 12-week intervention (baseline) and at week 12	The effect of intermittent fasting was measured by change in weight between baseline and at week 12
Change in Insulin Sensitivity	Assessed before 12-week intervention (baseline) and at week 12	The effect of intermittent fasting on insulin sensitivity was measured by change in homeostatic model assessment of insulin resistance (HOMA-IR) between baseline and week 12. Homeostasis model assessment of insulin resistance (HOMA-IR) is a method to measure insulin sensitivity. Optimal insulin sensitivity is a HOMA-IR ratio less than 1. Levels above 1.9 signal early insulin resistance, while levels above 2.9 signal significant insulin resistance.

Secondary

Measure	Time frame	Description
Change in Lipid Panel Levels	Assessed before 12-week intervention (baseline) and at week 12	The effect of Intermittent fasting was measured by change in lipid profile levels between baseline and week 12. Lipid profile levels assessed include serum triglyceride, HDL cholesterol, LDL cholesterol, and total cholesterol levels.
Change in C-reactive Protein (CRP) Levels	Assessed before 12-week intervention (baseline) and at week 12	The effect of Intermittent fasting on biomarker of inflammation was measured by C-reactive protein (CRP) levels between baseline and week 12
Change in Controlled Attenuation Parameter (CAP) Score	Assessed before 12-week intervention (baseline) and at week 12	The effect of Intermittent fasting on body composition was evaluated using Controlled Attenuation Parameter (CAP) score from Fibroscan. Measurement of controlled attenuation parameter (CAP) is a non-invasive quantitative and qualitative assessment of liver steatosis. CAP measures ultrasonic attenuation (in dB/m) at a frequency of 3.5 MHz (on a go-and-return path). Values range from 100 to 400 dB/m. Higher levels indicate increased hepatic fat.
Self-reported Compliance Rate With Assigned Diet	Compliance reported at Week 12	Compliance with assigned diet was assessed by participant self-reported rating. Participants used a self rating score of 0-100% with 0% = noncompliant and 100% = completely compliant with assigned diet. Compliance rate per participant was calculated using average of all daily reported scores. The overall compliance rate was averaged over all participants to get the mean compliance.
Change in Beck Depression Inventory (BDI) Score	Assessed before 12-week intervention (baseline) and at week 12	The effect of Intermittent fasting on mood was evaluated by change in the Beck Depression Inventory (BDI) score between baseline and week 12. The Beck Depression Inventory (BDI) is a 21-item measure of depression with each question on a 4-point scale ranging from 0=minimal to 3 = more severe (full list score values = 0,1,2,3). Total scores are a sum of individual items. Minimal depression = 0-13, mild depression = 14-19, moderate depression = 20-28, and severe depression = 29-63. The maximum score is 63 and the minimum possible score is zero.
Change in Visceral Adipose Tissue	Assessed before 12-week intervention (baseline) and at week 12	The effect of intermittent fasting was evaluated by change in visceral adiposity using total body dual energy x-ray absorptiometry (DEXA) between baseline and at week 12.

Countries

United States

Participant flow

Recruitment details

Of the 35 subjects who were consented to protocol, four subjects withdrew prior to start of study, one subject was screen failure and 30 subjects started the study.

Participants by arm

Arm	Count
Intermittent Fasting Diet HIV positive subjects with body mass index ≥30 kg/m2 (obese) consume approximately 25% of their daily calories for 2 non-consecutive days per week, normal diet for the other 5 days, and receive healthy lifestyle counseling for 12 weeks.	14
Standard of Care Diet HIV positive subjects with body mass index ≥30 kg/m2 (obese) receive nutritional and healthy lifestyle counseling for 12 weeks.	16
Total	30

Withdrawals & dropouts

Period	Reason	FG000	FG001
Overall Study	Lost to Follow-up	1	2

Baseline characteristics

Characteristic	Intermittent Fasting Diet	Standard of Care Diet	Total
Age, Categorical <=18 years	0 Participants	0 Participants	0 Participants
Age, Categorical >=65 years	0 Participants	0 Participants	0 Participants
Age, Categorical Between 18 and 65 years	14 Participants	16 Participants	30 Participants
Ethnicity (NIH/OMB) Hispanic or Latino	3 Participants	2 Participants	5 Participants
Ethnicity (NIH/OMB) Not Hispanic or Latino	10 Participants	14 Participants	24 Participants
Ethnicity (NIH/OMB) Unknown or Not Reported	1 Participants	0 Participants	1 Participants
Race (NIH/OMB) American Indian or Alaska Native	1 Participants	0 Participants	1 Participants
Race (NIH/OMB) Asian	0 Participants	0 Participants	0 Participants
Race (NIH/OMB) Black or African American	10 Participants	11 Participants	21 Participants
Race (NIH/OMB) More than one race	1 Participants	1 Participants	2 Participants
Race (NIH/OMB) Native Hawaiian or Other Pacific Islander	0 Participants	0 Participants	0 Participants
Race (NIH/OMB) Unknown or Not Reported	0 Participants	1 Participants	1 Participants
Race (NIH/OMB) White	2 Participants	3 Participants	5 Participants
Sex: Female, Male Female	8 Participants	8 Participants	16 Participants
Sex: Female, Male Male	6 Participants	8 Participants	14 Participants
Weight	112.1 kilograms STANDARD_DEVIATION 18.4	109.6 kilograms STANDARD_DEVIATION 14.9	110.8 kilograms STANDARD_DEVIATION 16.4

Adverse events

Event type	EG000 affected / at risk	EG001 affected / at risk
deaths Total, all-cause mortality	0 / 14	0 / 16
other Total, other adverse events	9 / 14	7 / 16
serious Total, serious adverse events	0 / 14	0 / 16

Outcome results

Primary

Change in Insulin Sensitivity

The effect of intermittent fasting on insulin sensitivity was measured by change in homeostatic model assessment of insulin resistance (HOMA-IR) between baseline and week 12. Homeostasis model assessment of insulin resistance (HOMA-IR) is a method to measure insulin sensitivity. Optimal insulin sensitivity is a HOMA-IR ratio less than 1. Levels above 1.9 signal early insulin resistance, while levels above 2.9 signal significant insulin resistance.