Crohn Disease
Conditions
Brief summary
Diet is a determinant of gut microbial diversity and composition and is recognized as a potential environmental trigger for IBD; for example, high-fat diets are associated with increased risk of CD in pre-clinical models, with effects mediated through dysbiosis and altered gut permeability. Diet is also a potential non-pharmacological therapy for weight loss and for reducing the occurrence of disease flares and the reliance on dose escalation of biologic agents. Indeed, there is accumulating evidence for the role of diet in the treatment of CD, and diet-induced improvement of microbial dysbiosis is associated with induction of remission in pediatric patients with active CD. Intermittent Fasting (IF) is a dietary intervention that involves periodic intervals of no or very limited energy intake. We want to determine the efficacy and feasibility of a 12-week IF(Intermittent Fasting) intervention to induce weight loss (by 1 BMI unit reduction), decrease biomarker inflammation and increase microbial functional diversity compared to standard medical management (SM) in a pilot study of individuals with overweight or obesity and CD in clinical remission with elevated biomarkers of inflammation, indicated by fecal calprotectin (FCP) \> 250 µg/g or C-reactive protein (CRP) \> 5 mg/L).
Detailed description
Objectives: To determine if a 12-week IF intervention compared to SM: 1. Induces weight loss of at least 1 BMI unit. 2. Reduces intestinal and systemic inflammation. 3. Alters gut microbial community structure (beta-diversity) from baseline. 4. Alters the adipokines and myokines leptin, adiponectin, IL-6, or irisin. 5. Alters zonulin and serum levels of gastrointestinal hormones ghrehlin, glucagon-like peptide 1 (GLP-1), and glucagon-like peptide 2 (GLP-2). 6. Alters body composition and whether changes in body composition have an effect on biomarkers of inflammation. 7. Is a feasible and sustainable intervention for patients with CD. Hypotheses: We hypothesize that, compared to SM, IF will: 1. Induce at least a 1-unit decrease in BMI over the course of the intervention. 2. Improve inflammatory markers of CD, demonstrated by a decrease in FCP by ≥ 50%, normalization of FCP to ≤ 100 µg/g, or a decrease in CRP to ≤ 5 mg/L. 3. Alter gut microbial community structure (beta-diversity ) and lead to enrichment of bacterial species typically depleted in CD, such as Faecalibacterium prausnitzii and Roseburia hominus with concomitant decreases in Escherichia coli and overall Proteobacteria phylum abundance. 4. Alter adipokines and myokines (leptin, adiponectin, IL-6, and irisin), zonulin and serum levels of gastrointestinal hormones (ghrehlin, GLP-1, and GLP-2). 5. Alter body composition by decreasing VAT. 6. Be a feasible and sustainable treatment option for patients with CD Methods Study Design: The study is a 12-week pilot randomized controlled trial (RCT). Eligible participants (N=42) will be randomized 1:1 to either the IF or the SM control group. Patients from the University of Calgary IBD clinic will be enrolled in the RCT. Screening: The study RD will assess participants for malnutrition using the abridged patient-generated subjective global assessment (PG-SGA), a validated tool to determine malnutrition status in patients with chronic disease. The Nine Item Avoidant/Restrictive Food Intake Disorder screen33 will be completed to rule out avoidant and restrictive food behaviours that may increase the malnutrition risk of an IF intervention. Inclusion criteria: 1\) ≥ 18 to ≤ 75 years of age; 2) ileocolonic or colonic CD in clinical remission diagnosed through conventional definitions with a Harvey Bradshaw Index (HBI) \< 5 within 3 months of recruitment; 3) presence of inflammation using an FCP ≥ 250 µg/g or a CRP ≥ 5 mg/L; 4) stable dosing of biologic agents and/or immunomodulators and/or oral or rectal 5-ASA, and no changes to medical management (including corticosteroid exposure) for at least 3 months prior to recruitment; and 5) presence of overweight or obesity with BMI \> 25 and a PG-SGA of class A. Exclusion criteria: 1\) upper gastrointestinal involvement CD, fistulizing disease; 2) documented strictures based on sonographic findings or colonoscopy within the last year; 3) \> 1 small bowel resection; 4) colectomy; 5) presence of an ostomy; 6) antibiotic use in past 3-months; 7) pregnancy; and 8) corticosteroids in the last 3 months.
Interventions
OTHERIntermittent Fasting
Intermittent Fasting (IF) is a dietary intervention that involves periodic intervals of no or very limited energy intake. Fasting and feeding intervals vary and the practice of IF commonly consists of either a daily fast for 16 hours, a 24-hour fast on alternate days, or a fast two days per week on non-consecutive days. For the study, the IF group will be asked to fast for 16 consecutive hours, 6 days per week. This means they will have an 8-hour eating window (e.g., eat from 10 a.m. to 6 p.m.) each day. They will be asked to eat the same types of food and the same amounts as usual, but only during the 8-hour eating window.
Sponsors
Crohn's and Colitis Foundation
University of Calgary
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
1. ≥ 18 to ≤ 75 years of age; 2. ileocolonic or colonic CD in clinical remission diagnosed through conventional definitions with a Harvey Bradshaw Index (HBI) \< 5 within 3 months of recruitment; 3. presence of inflammation using an FCP ≥ 250 µg/g or a CRP ≥ 5 mg/L; 4. stable dosing of biologic agents and/or immunomodulators and/or oral or rectal 5-ASA, and no changes to medical management (including corticosteroid exposure) for at least 3 months prior to recruitment 5. presence of overweight or obesity with BMI \> 25 and a PG-SGA of class A.
Exclusion criteria
1. upper gastrointestinal involvement CD, fistulizing disease; 2. documented strictures based on sonographic findings or colonoscopy within the last year; 3. \> 1 small bowel resection; 4. colectomy; 5. presence of an ostomy; 6. antibiotic use in past 3-months; 7. pregnancy; 8. corticosteroids in the last 3 months.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| BMI-A decrease in BMI of at least 1 BMI unit over the course of the intervention: Change is being assessed | Baseline and Week 12 | A measure of body fat based on height and weight |
| Fecal Calprotectin: Change is being assessed | Baseline and Week 12 | FCP is a test used to detect inflammation in the colon and is associated with disease |
| C Reactive Protien: Change is being assessed | Baseline and Week 12 | A protein the liver produces in the presence of inflammatory disease |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Body Composition: Change is being assessed | Baseline and week 12 | Lean muscle mass, total fat mass, subcutaneous fat mass, and visceral fat mass will be assessed using DEXA, a gold standard test to determine body composition, differentiate proportion of lean muscle compared to fat mass, and distinguish between subcutaneous and VAT |
| 24 hour ASA food recalls: Change is being assessed. | Baseline and week 12 | Assess diet quality |
| Fecal microbiome: Change is being assessed | Baseline and Week 12 | Determined using shotgun metagenomic sequencing (Illumina NovaSeq 6000 platform at the UoC Centre for Health Genomics and Informatics) to provide in-depth coverage of the microbial metagenome. Sequences will be analyzed for species level abundances, beta diversity metrics, and functional capacity based on gene content. |
| Serum and fecal metabolomics: Change is being assessed | Baseline and Week 12 | Metabolomics analysis provides a snapshot of an organism's current metabolite profile |
| Serum markers: Change is being assessed | Baseline and week 12 | Leptin, adiponectin, IL-6, irisin, zonulin, ghrehlin, GLP-1, and GLP-2 |
Countries
Canada
Contacts
Primary ContactMaitreyi Raman, MD
Backup ContactLorian Taylor, PhD, RD
Outcome results
None listed