An Optimized Programming of Healthy Children (APPROACH)

Obesity Clinical Trial

Official title:

An Optimized Programming of Healthy Children (APPROACH) - The Most Favourable Dietary Protein:Carbohydrate Ratio During Pregnancy in the Context of New Nordic Diet

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT01894139
• Other study ID #: EFFECT.C02.2012
• Status: Active, not recruiting
• Phase: N/A
• Start date: January 4, 2014
• Est. completion date: December 2027

Study information

• Verified date: September 2021
• Source: University of Copenhagen
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The Nutrition Research Unit at Copenhagen University Hospital Herlev will during the fall 2013 initiate a randomized and controlled intervention study engaging 390 obese pregnant women. The overall aim of APPROACH is to investigate how an optimal diet during pregnancy influences the programming of the offspring. The children will after birth be included in a prospective cohort according to maternal randomization and examined six times from delivery until the age of nine years.

Description:

Overweight and excessive gestational weight gain (GWG) is associated with increased risk of high birth weight; furthermore there is increased risk of the child developing overweight, diabetes and other metabolic diseases in childhood or adulthood. The effect of reducing gestational weight gain while supplying optimized amount and sources of nutrients is not well investigated. Increased knowledge to the possibility and efficacy of preventing overweight and related diseases is necessary. Modification of protein source and increase in ratio of protein in relation to amount of carbohydrate and reduction of glycaemic index (GI) has in observational studies individually been linked to improved fetal body composition, metabolism and weight control later in life, and less weight gain and weight retention for the mother. The overall aim of APPROACH is to investigate how an optimal diet during pregnancy influences the programming of the offspring. This study will increase the knowledge of the effect of a specific nutrient composition and weight retention during pregnancy on growth and development during the foetal stage and until nine years off age, risk markers later metabolic diseases, especially diabetes and metabolic syndrome. APPROACH will be a dietary intervention investigating differences in responds to a high-protein, especially marine and dairy protein and low-GI diet versus a diet according to the Nordic Nutritional Recommendations. All visits and assessment will be performed by trained staff at Copenhagen University Hospital Herlev. Subjects will be women with expected delivery at Department of Gynaecology and Obstetrics and all examinations of gestational development and foetal growth will take place her; assessment of the children will be performed at the Department of Paediatrics. A total of 390 obese (body mass index (BMI) ≥ 30 kg/m2) pregnant women will be randomized to intervention or control and engage in the program from late first trimester or early second trimester to birth. After birth the children will be included in a prospective cohort according to maternal randomization and examined six times from delivery until the age of nine years. APPROACH will increase the knowledge of the effect of a nutrient composition with high protein for carbohydrate ratio and weight retention during pregnancy on growth and development during the foetal stage and until nine years off age, risk markers later metabolic diseases, especially diabetes and metabolic syndrome. Plasma lipids, markers of metabolic diseases, epigenetics and vitamin D status will be assessed at baseline and several times during pregnancy; and in both intervention and control group these data will increase the knowledge of the effect of supplementing with marine oils and vitamin D in pregnant women. Results from the intervention will be communicated to the general population and published in peer-relieved journals.

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 280
• Est. completion date: December 2027
• Est. primary completion date: January 2018
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: Female
• Age group: 18 Years to 42 Years

Eligibility

Inclusion Criteria:

• Birth planed at Copenhagen University Hospital Herlev
• Pre-pregnancy BMI 28-45
• Age 18-42 years
• Speak and understand oral and written Danish
• Singleton pregnancy

Exclusion Criteria:

• Multiple pregnancy
• History of spontaneous abortions or gestational diabetes or preeclampsia or spontaneous preterm birth
• Dairy product intolerant or allergic
• > 10 kg weight change during the past year
• Abuse of alcohol or drugs (>14 units of alcohol per week)
• Critical or chronic disease: diabetes, kidney disease, medically treated heart diseases or arthritis, sarcoidosis, tuberculosis, cancer, liver disease, inflammatory gastrointestinal or lung disease, known active metabolic disease.

Related Conditions & MeSH terms

• Gestational Age and Weight Conditions
• Maternal Care for Excessive Fetal Growth
• Metabolic Diseases
• Metabolic Disorders
• Obesity
• Pregnancy

Intervention

Other:
• High-Protein/Low-GI Diet

• Low-protein/High-GI Diet

Locations

Country	Name	City	State
Denmark	University of Copenhagen, Faculty of Sceience, NEXS	Copenhagen	Frederiksberg

Sponsors (7)

Lead Sponsor	Collaborator
University of Copenhagen	Danish Agriculture and Food Council, LEGO Charity, Denmark, Nordea-Fonden, Denmark, Pharma Nord, Svineafgiftsfonden, The Danish Dairy Research Foundation, Denmark

Country where clinical trial is conducted

Denmark, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Gestational weight gain	Changes in bodyweight, body composition (Magnetic Resonance Imaging) and measurements of body fat by means of skinfold thickness and mid-upper arm circumference.	Gestational week 14, 15, 17, 21, 25, 28, 36, 39
Secondary	Growth and development of fetus and child	Fetus: Nuchal Translucency Scan (once gw 11+3 - 14+0) and ultrasound scan (gw 28, 32, 36); child: Height, weight, body composition (Bioimpedance (month 6,18)and Dual-energy X-ray absorptiometry, DXA (month 0, 36, year 5, 9)), skin fold thickness and mid-upper arm circumference, IGF-1.	Gestational week 11+2, 14+0, 28, 32, 36 and month 0, 6, 18, 36 and year 5, 9
Secondary	Fetal programming of obesity and metabolic disorders	Fasting blod samples (month 0 from umbilical cord), not at 6 months; dietary intake, physical activity, growth and development	Month 0, 6,18, 36 and year 5, 9

External Links

•   Homepage of Department of Nutrition, Exercise and Sports, University of Copenhagen