Predicting Weight Gain and Weight Loss Associated With Overeating or Fasting - Full Text View

Sponsored by:	National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Information provided by:	National Institutes of Health Clinical Center (CC)
ClinicalTrials.gov Identifier:	NCT00687115

Purpose

This study will investigate how to better predict why some individuals gain or lose weight more easily than others. It will examine whether the increase in the amount of energy a body burns in 24 hours with overeating or the decrease over 24 hours with fasting can help determine how easily someone gains or loses weight.

Healthy people between 18 and 60 years of age who have a body mass index (BMI) between 18.5 kg/m(2) and 24 kg/m(2) (for overfeeding study) or a BMI greater than 27 kg/m(2) with a body weight less than 350 pounds (weight loss study) may be eligible for this study. The study requires a 10-week admission to the NIH Clinical Center (2-week baseline, 6-week overfeeding/weight loss, 2-week post-weight change).

Participants undergo the following tests and procedures during the hospital admission:

Medical history, physical examination and laboratory studies
Questionnaires to assess eating behavior, food preferences, body composition, and activity level
Body composition assessment (height, weight, waist circumference, and fat mass and muscle content through DXA and MRI scans)
Oral glucose tolerance test
Meal test to measure the response of certain hormones to food
Activity monitors to determine activity level
Metabolic chamber study to measure calories burned over 24 hours and monitor body temperature
Free-living energy use study to measure calories burned under normal home conditions over 7 days
Fat and muscle biopsies
Dietary intervention: Measurements of food intake and energy loss over a 6-week overfeeding (1.5 times the subject's normal food intake) or weight loss (one-half the subject's normal food intake) program

Followup procedures after the inpatient stay:

Height and weight measurements at 6 months (overfeeding study participants) and monthly for the first year, at 3-month intervals for the second year, and then yearly for 3 more years (weight loss study participants)
Yearly visits (2-night inpatient stay) for all participants for repeat meal test, DXA, oral glucose tolerance test, behavioral questionnaires and, in women who can become pregnant, pregnancy test

Condition	Intervention	Phase
Obesity Diet Therapy Weight Loss Weight Gain Nutrition Therapy	Behavioral: Nutrition Therapy Behavioral: Overfeeding Behavioral: Underfeeding	Phase II

MedlinePlus related topics: Nutritional Support Obesity Weight Control

U.S. FDA Resources

Study Type:	Interventional
Study Design:	Treatment, Randomized, Open Label, Uncontrolled, Parallel Assignment, Efficacy Study
Official Title:	Predicting Adaptive Thermogenesis

Further study details as provided by National Institutes of Health Clinical Center (CC):

Primary Outcome Measures:

Effect of protein content on weight gain.

Secondary Outcome Measures:

Bioavailability of food; energy content of human muscle and fat tissue.

Estimated Enrollment:	105
Study Start Date:	May 2008

Intervention Details:

N/A

Detailed Description:

For obese individuals, losing weight and keeping it off are extremely difficult, whereas some other individuals are thin and report trouble gaining weight. In most weight loss and overfeeding studies there is a large variation in the amount of weight lost or gained, and it is not clear whether an individual's response to an intervention can be predicted. Measurement of the amount of energy an individual uses over 24 hours (24 hour energy expenditure or 24-EE) and the response of 24-EE to overfeeding and fasting may help predict which individuals will have the greatest changes in weight with changes in energy balance. In previous work, 24-EE responses to overfeeding and fasting were related such that individuals with the greatest increase in 24-EE upon overfeeding tended to have the smallest decrease in 24-EE upon fasting ( spendthrift phenotype) and those individuals with less increase in 24-EE during overfeeding had a greater decrease in 24-EE with fasting ( thrifty phenotype). Those with the spendthrift phenotype who had a greater increase in 24-EE in response to overfeeding gained less weight over time. Furthermore, studies have shown that diets with very low protein content may magnify the variability in response to overfeeding.

The aim of this study is to determine if a phenotype defined by 24-EE responses to overfeeding and underfeeding is related to weight loss or gain in 3 different under- and overfeeding settings: an inpatient weight loss group for obese individuals who will be administered a diet based on a 50% reduction of their daily energy needs for six weeks (6 week weight reduction, 10 week stay, n=35), and two overfeeding groups for lean, weight gain resistant individuals: a low-protein overfeeding group at 150% of daily energy needs for 6 weeks overfeeding (6% protein, 64% carbohydrate, 30% fat; 10 week stay, n=35), and a normal protein overfeeding group at 150% of daily energy needs for 6 weeks overfeeding (20% protein, 50% carbohydrate, 30% fat; 10 week stay, n=35). We will also examine additional metabolic and behavioral measurements to determine how they relate to weight change and changes in 24-EE. These include sympathetic nervous system activity, behavior, adipose and muscle tissue energy content, and abdominal adipocyte size. The study will evaluate the relationship between the percent increase in 24-EE in response to overfeeding/underfeeding and the amount of weight change over time in each subject. These findings may provide important information for predicting and adapting specific individualized interventions for obesity.

Eligibility

Ages Eligible for Study:	18 Years to 60 Years
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	Yes

Criteria

INCLUSION CRITERIA:
BMI greater than or equal to 27 kg/m(2) for the weight loss protocol but body weight less than 350 pounds to accommodate the DXA scanner.
BMI less than or equal to 24 kg/m(2) (and BMI greater than or equal to 18.5 kg/m(2) for the overfeeding protocols, with no first degree relatives with BMI greater than or equal to 25 kg/m(2) and no family history of diabetes. A history of low BMI and difficulty gaining weight.
Age 18-60 years, to minimize potential co-morbid conditions which may indirectly affect EE. Minors under the age of 18 will be excluded because growth and pubertal issues are significant parameters that could affect our outcomes and also because the time requirements of the study are such that they would interfere with school schedules. Women who are post-menopausal will be excluded from the study as changes in their metabolism could affect the baseline measurements which are hypothesized to predict weight change.
Healthy, as determined by medical history, physical examination, and laboratory tests

EXCLUSION CRITERIA:

Current smoking
Type 2 diabetes (according to the World Health Organization diagnostic criteria)
Endocrine disorders (Cushing's Disease, pituitary disorders, and hypo- and hyperthyroidism)
Chronic pulmonary disorders, including chronic obstructive pulmonary disease that would limit ability to follow the protocol (investigator judgment) and obstructive sleep apnea syndrome; only subjects with mild or exercise-induced asthma on no medications or on beta-adrenergic agonists only (such as albuterol) will be allowed to enter the study (provided use of these agents is not required for one week before study entry).
Cardiovascular diseases (coronary heart disease, heart failure, arrhythmias, and peripheral artery disease)
Hypertension (blood pressure measurement higher than 140/90 mm Hg on two or more occasions or use of anti-hypertensive medications)
Diagnosed gastrointestinal diseases, including inflammatory bowel diseases (e.g., Crohn's disease and ulcerative colitis), malabsorption syndromes (e.g., celiac disease), gastric ulcer (active); only subjects with gastro-esophageal reflux will be allowed to enter the study
Presence of a pacemaker or other implantable devices
Liver disease (cirrhosis, active hepatitis B or C, and AST or ALT greater than or equal to 1.5 times normal)
Renal disease (serum creatinine concentrations greater than or equal to 1.5 mg/dl and/or overt proteinuria)
Central nervous system disease (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 (e.g., Stage 1 cervical cancer)
Alcohol (more than 3 drinks per day) and/or drug abuse (such as amphetamines, cocaine, heroin, or marijuana)
Current or past history of: bipolar disorder, schizophrenia or presence of psychotic symptoms, bulimia nervosa or anorexia nervosa, or current major depressive disorder
Pregnancy or lactation
Taking weight loss medications
Weight change of plus or minus 5% in the last 3 months

Conditions not specifically mentioned above may serve as criteria for exclusion at the discretion of the investigators. Additionally, potential subjects might be excluded if they demonstrate a style of interpersonal relationships that would inhibit successful completion of the study.

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00687115

Contacts

Contact: Susanne Votruba, M.D.

(602) 200-5336

votrubas@mail.nih.gov

Locations

United States, Arizona
NIDDK, Phoenix	Recruiting
Phoenix, Arizona, United States, 85014

Sponsors and Collaborators

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

More Information

Publications:

Adams M, Montague CT, Prins JB, Holder JC, Smith SA, Sanders L, Digby JE, Sewter CP, Lazar MA, Chatterjee VK, O'Rahilly S. Activators of peroxisome proliferator-activated receptor gamma have depot-specific effects on human preadipocyte differentiation. J Clin Invest. 1997 Dec 15;100(12):3149-53.

Allison DB, Heshka S, Sepulveda D, Heymsfield SB. Counting calories--caveat emptor. JAMA. 1993 Sep 22-29;270(12):1454-6.

Astrup A, Buemann B, Christensen NJ, Madsen J, Gluud C, Bennett P, Svenstrup B. The contribution of body composition, substrates, and hormones to the variability in energy expenditure and substrate utilization in premenopausal women. J Clin Endocrinol Metab. 1992 Feb;74(2):279-86.

Study ID Numbers:	999908140, 08-DK-N140
Study First Received:	May 29, 2008
Last Updated:	July 18, 2008
ClinicalTrials.gov Identifier:	NCT00687115
Health Authority:	United States: Federal Government

Keywords provided by National Institutes of Health Clinical Center (CC):

24 Hour Energy Expenditure
Respiratory Chamber
Obesity
Weight Loss

Overfeeding
Obesity
Weight Loss
24 Hour Energy Expenditure

Study placed in the following topic categories:

Body Weight
Signs and Symptoms
Obesity
Weight Loss
Body Weight Changes

Nutrition Disorders
Overweight
Overnutrition
Weight Gain
Hyperphagia

ClinicalTrials.gov processed this record on January 16, 2009