Obesity Clinical Trial
Official title:
Impact of a Specific Micronutrient-probiotic-combination on Fatty Liver and Cardiometabolic Status of Obese Patients After Mini-Gastric Bypass Surgery
Aim of this prospective randomized intervention study is to evaluate the effect of a dietary intervention with a specific micronutrient-probiotic-combination for 12 weeks on fatty liver and cardiometabolic status in obese, nonalcoholic fatty liver disease (NAFLD) patients after Mini-Gastric Bypass (MGB) surgery.
Background:
The increasing prevalence of obesity and diabetes mellitus seems to reach epidemic
proportions worldwide. In particular visceral obesity in combination with impaired glucose
tolerance is associated with risk for progression of a broad spectrum of cardiometabolic
diseases such as type 2 diabetes, hypertension, dyslipidemia, cardiovascular disease and
non-alcoholic fatty liver disease (NAFLD). Thus, among patients undergoing bariatric surgery
more than 95% have NAFLD, with nonalcoholic steatohepatitis (NASH) being present in 32-39 %.
Only bariatric surgery currently seems to attain long-term weight loss in morbidly obese
patients. In addition, greater success in terms of improvement in obesity related
comorbidities and reduction of overall-mortality can be achieved by surgical measures. Recent
data indicate that Mini-Gastric Bypass (MGB) is an effective procedure for weight loss and
reduction of comorbidities. Although weight loss is usually recommended as therapy for
obesity with NAFLD and NASH, not all NAFLD patients benefit from surgical induced weight loss
as indicated by increase in transaminase activity. An optimized micronutrient in combination
with a probiotic supplementation could be a useful tool to prevent the transition from NAFLD
to NASH.
Aim:
Therefore this study aims to elucidate the effect of a specific
micronutrient-probiotic-combination on fatty liver and insulin resistance in obese patients
after MGB surgery. Furthermore, this study aims to help optimizing the dietary food
supplementation after MGB to reduce the progress of NAFLD/NASH and cardiometabolic diseases.
Methods:
A randomized double blind clinical trial of 12 week dietary intervention with a specific
micronutrient-probiotic-combination will be conducted in obese patients with NAFLD after
standardized MGB surgery. To this end, a total of 60 patients will be randomly assigned to a
specific micronutrient-probiotic-combination or micronutrient-placebo-combination group.
During the preoperative 4-week run-in phase, each patient receives a formula diet to improve
protein and micronutrient supply. This should align the metabolic situation within the study
group. At baseline and study end blood samples are taken for further analysis of metabolic,
clinical and biochemical parameters. Anthropometric data (body height, body weight, and waist
circumference) and bioelectrical impedance analysis are also collected at the beginning and
after 8 and 12 weeks. Fecal samples will be collected prior to surgery and after 4, 8 and 12
weeks (concomitant variable). All patients will fill out validated food intake questionnaires
and stool questionnaires (frequency and consistence) after 4, 8 and 12 weeks (concomitant
variable).
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