Developmental ORIgins of Healthy and Unhealthy AgeiNg: the Role of Maternal Obesity

Insulin Resistance Clinical Trial

— DORIAN  

Official title:

Developmental ORIgins of Healthy and Unhealthy AgeiNg: the Role of Maternal Obesity

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT01931540
• Other study ID #: T55/2012b
• Secondary ID: EC-FP7-278603
• Status: Completed
• Phase: N/A
• First received: April 22, 2013
• Last updated: March 21, 2016
• Start date: June 2012
• Est. completion date: June 2015

Study information

• Verified date: March 2016
• Source: Turku University Hospital
• Contact: n/a
• Is FDA regulated: No
• Health authority: Finland: Ethics CommitteeFinland: National Advisory Board on Health Care EthicsFinland: Valvira - National Supervisory Authority for Welfare and Health
• Study type: Interventional

Clinical Trial Summary

The prevalence of obesity in the developed world has increased markedly over the last 20 years. Considering the prevalence of obese and overweight adult subjects, and the fact that pregnancy itself induces a state of insulin resistance and inflammation, maternal obesity may be the most common health risk for the developing fetus. It is well established that what we eat has a major impact on our health. However, there is growing evidence to suggest that diet during pregnancy and lactation may be particularly important as not only does it influence the health of the mother, it may have a permanent effect on the health of her children and even her grandchildren. The concept that environmental factors, such as nutrition during early development, influence both our health span and lifespan has been termed the developmental origins of health and disease hypothesis.

The objective of the study are:

• to compare subjects with frailty (condition developed with ageing) with controls and characterize the unhealthy aged condition with the measurements described below

• to examine if signs of frailty can be reversed by lifestyle induced modifications (exercise training programme) of its primary components (IR, sarcopenia, psychological profile) in offspring of overweight/obese (OOM) vs lean mothers (OLM).

The study consists of 37 frail old subjects, age ≥ 65 sub-grouped in 17 OOM, and 20 OLM and 11 non frail controls. These subjects will be studied with positron emission tomography (PET), computed tomography (CT), magnetic resonance imaging (MRI) and spectroscopy (MRS) and ultra sounds (US). In addition functional MRI (fMRI) will be performed. Adipose tissue biopsies will be taken.

Subjects will undergo characterization of biohumoral markers, a 75 g oral glucose tolerance test, imaging biomarkers (PET/CT, US, fMRI-MRS), genetic biomarkers (DNA and telomere damage) and inflammatory biomarkers (macrophage infiltration) before and after the 4-month lifestyle intervention period (physical exercise). By PET/CT it will be measured tissue-specific IR in skeletal muscle, adipose tissue, liver, myocardium and targeted brain regions. MRS will be used to measure organ steatosis in the skeletal muscle and liver, MRI will be used to measure fat masses in abdominal areas, and fMRI will be performed to assess activation in brain regions regulating cognition and appetite/energy control. US will be used to assess cardiovascular markers (IMT, strain and function).

Recruitment information / eligibility

• Status: Completed
• Enrollment: 48
• Est. completion date: June 2015
• Est. primary completion date: April 2014
• Accepts healthy volunteers: No
• Gender: Female
• Age group: N/A and older

Eligibility

Inclusion Criteria:

• Subjects must be already participating the Helsinki Birth Cohort Study

Frailty Groups Inclusion Criteria:

• (Frailty) with lowest half of adult grip strength (measured 2001-2004)

• Group OM: (Offspring of Obese mothers) Highest quartile of maternal BMI

• Group LM: (Offspring of Normal weight/Lean mothers) Lowest two quartiles of maternal BMI

Control group Inclusion Criteria:

• (no Frailty) with highest half of adult grip strength (measured 2001-2004)

• Offspring of normal weight mothers

Exclusion Criteria:

• Subjects whose mothers were pre-eclamptic during pregnancy

• Oral corticosteroid or Warfarin therapy

• Recent myocardial infarction

• Severe chronic disorder that can prevent to participate the intervention

• Chronic atrial fibrillation and pacemaker

• Cancer less than 5 years ago

• Current smoking

• Diabetes requiring insulin treatment or fasting glucose more than 7 mmol/l

• Weight more than 170 kg and Waist circumference > 150 cm

• Inner ear implants

• Metal objects in body including metallic prostheses, artificial valve prostheses, surgical clips, braces, foreign fragments or tattoo

Study Design

Allocation: Non-Randomized, Intervention Model: Parallel Assignment, Masking: Single Blind (Investigator), Primary Purpose: Treatment

Related Conditions & MeSH terms

• Insulin Resistance
• Maternal-Fetal Relations
• Muscle Weakness
• Paresis

Intervention

Behavioral:
• Exercise Training
Three times a week, for four months.

Locations

Country	Name	City	State
Finland	University of Helsinki, Department of General Practice and Primary Health Care	Helsinki
Finland	Turku PET Centre (Turku University Hospital)	Turku

Sponsors (5)

Lead Sponsor	Collaborator
Turku University Hospital	Fondazione C.N.R./Regione Toscana "G. Monasterio", Pisa, Italy, Helsinki University, Istituto Superiore di Sanità, University of Turku

Country where clinical trial is conducted

Finland, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Baseline group comparison and Change from Baseline in Insulin-stimulated whole body and organ-specific glucose uptake at 4 months	Assessed via 18F-Fluorodeoxyglucose (FDG)-PET/CT+Clamp technique	At day 1 and after 4 months of intervention (for the 15 controls only at baseline)	No
Primary	Baseline group comparison and Change from Baseline in Epigenetic characterization of DNA samples (Telomere length, H2A.X phosphorilation, mtDNA deletion, p66) at 4 months	Telomere length, H2A.X phosphorilation, mtDNA deletion are measurements performed in Pisa, National Research Council p66 presence is measured in Rome, Istituto Superiore di Sanita'	At day 1 and after 4 months of intervention (for the 15 controls only at baseline)	No
Secondary	Baseline group comparison and Change from Baseline in Fat masses and content via MRI and MRS at 4 months	Adipose tissue fat masses in different depots (subcutaneous, visceral, pericardial) Liver, skeletal muscle, vertebral fat content	At day 1 and after 4 months of intervention (for the 15 controls only at baseline)	No
Secondary	Baseline group comparison and Change from Baseline in MRI brain anatomy and fMRI characterization of activation response to food stimuli of different brain regions at 4 months	MRI anatomy: White matter volume, Cortex thickness, Nerve tracks found with Diffusor Tension Imaging fMRI will be used to identify different brain regions activated by food stimuli while subjects perform three different task: watch the food, think of eating the food, control the urge to eat the food.	At day 1 and after 4 months of intervention	No