Obesity Clinical Trial
Official title:
A Mechanistic Examination of Dietary Composition on Metabolic Fuels Availability
This study will evaluate a potential physiologic mechanism underlying the effects of dietary composition on control of body weight
The challenge in maintaining long-term weight loss is well known, however new research
suggests diet quality may be the driving factor. A pilot study from our group demonstrated
that a higher carbohydrate-containing diet was associated with lower total energy expenditure
during weight loss maintenance (Ebbeling et al). These findings will be confirmed in the
ongoing Framingham State Food Study (NCT02068885): Following weight loss on a standard diet,
150 overweight or obese adults (aged 18 to 65 years) will be randomized to one of three
weight-loss maintenance diets varying in carbohydrate to fat ratios for 20 weeks.
However, the specific mechanisms underlying the calorie-independent effects of diet remain
unclear. Another study from our group demonstrated lower energy availability (calculated
based on caloric content of circulating metabolic fuel concentrations) in the fasting and
late post-prandial periods in 8 overweight or obese young adults who were maintained on a
low-fat (high-carbohydrate) diet (Walsh et al). We hypothesize that this lower metabolic fuel
availability on a high carbohydrate diet results in part from increased anabolic changes
within the adipocyte, favoring fat storage in preference to oxidation.
We will invite subjects already enrolled in the Framingham State Food Study to participate,
aiming for a total of 30 subjects (with the goal of approximately equal numbers per diet
group following randomization to assigned test diet in the parent study). Participants will
be admitted to a research unit for a 24-hour period during weight maintenance on the test
diet, during which they will undergo frequent blood sampling for the measurement of
circulating metabolic fuels, hunger and satiety ratings, while consuming their assigned diet
meals. Each participant will also undergo two abdominal subcutaneous fat aspiration biopsies
under local anesthesia, the first immediately following weight loss (before initiating the
test diet) and the second during weight maintenance, in order to perform gene expression
analyses on the adipose tissue. Our main outcomes will be a comparison in energy availability
(the sum of energy in the major metabolic fuels in the blood) between diet groups in the late
postprandial period and changes in adipose tissue gene expression within-individuals and by
diet group assignment. Other outcomes will include differences in hunger and satiety ratings,
total 24-hour energy availability, and specific metabolic fuel concentrations.
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