Effects of Time-restricted Eating Versus Daily Continuous Calorie Restriction on Body Weight and Colorectal Cancer Risk Markers Among Adults With Obesity
试验速览
- 阶段
- 不适用
- 状态
- 进行中（未招募）
- 入组人数
- 194
- 试验地点
- 2
- 主要终点
- Weight change (% kg)
研究概览
简要总结
Approximately 42% of American adults are obese, and this condition is strongly related to the development of colorectal cancer. Innovative lifestyle strategies to treat obesity and reduce colorectal cancer risk are critically needed. This research will demonstrate that time-restricted eating, a type of intermittent fasting, is an effective therapy to help obese individuals reduce and control their body weight and prevent the development of colorectal cancer.
详细描述
Approximately 42% of the U.S. adult population is obese and data suggests that persons with obesity are at a 30% greater risk of developing colorectal cancer (CRC). Therefore, efficacious approaches to preventing and treating obesity will have significant effects on CRC incidence in the U.S. Although calorie restriction through lifestyle intervention is the most common approach to treat obesity, clinically meaningful weight loss is difficult to achieve via this method due to low adherence with calorie monitoring, indicating a need for innovation. Time-restricted eating, a type of intermittent fasting, has been shown in animals to impart cancer protective effects including lower body weight, decreased systemic inflammation, and improved glucose metabolism. Time-restricted eating is where individuals are asked to consume all their food for the day within a specified time frame, and water fast for the remaining hours of the day. We recently performed two short-term (≤12-weeks) pilot studies of time-restricted eating to evaluate its safety and preliminary efficacy on body weight and chronic disease risk markers in adults with obesity. Our results show the intervention is a safe and acceptable approach to weight loss among obese adults. Moreover, time-restricted eating produced approximately 3% weight loss from baseline and reductions in systolic blood pressure, oxidative stress and insulin resistance. Although these pilot findings show promise for time-restricted eating as an effective tool for CRC risk reduction among obese individuals, these data still require confirmation by a well powered longer-term clinical trial. The present proposal aims to implement a 12-month (6-month intervention, 6-month maintenance) controlled, parallel arm trial among 255 obese adults (45-70 years old) who have had a colonoscopy. Subjects will be randomized to 1 of 3 groups: 1) 8-hour time-restricted eating (daily ad libitum food intake from 12pm - 8pm), 2) Calorie restriction (daily 25% calorie restriction), or 3) Control (daily ad libitum food intake, no meal timing restrictions) to compare the effects on: (1) Body weight, body composition, and intervention adherence; (2) Circulating metabolic, inflammation, and oxidative stress-related biomarkers; (3) Colonic mucosal gene expression profiles and mucosal inflammation, DNA damage and cellular growth; and (4) maintenance of benefits on body weight/composition and CRC markers.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Prevention
- 盲法
- Single (Outcomes Assessor)
入排标准
- 年龄范围
- 45 Years 至 70 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •45-70 years old,
- •BMI 30-49.99 kg/m2
- •Are up to date with CRC screening.
排除标准
- •Have a history of renal disease, autoimmune disorders, immunodeficiency, malabsorptive disorder, significant gastrointestinal and hepatic disease, surgical change in gastrointestinal anatomy, severe ischemic heart disease, severe pulmonary disease, severe mental health disorder, eating disorder, or bariatric surgery;
- •Abuse alcohol (> 50 grams/day), illicit drugs (other than self-reported marijuana use), or use combustible tobacco;
- •Have controlled type 2 diabetes or undiagnosed uncontrolled diabetes based on hemoglobin A1c (HbA1c) > 9.0%;
- •Have a history of cancer treatment within the past 12 months, CRC, genetic predisposition to CRC (e.g., Lynch syndrome);
- •Have a baseline body weight > 450 lbs (weight limitation of the DXA);
- •Are on a weight loss diet or actively involved in a formal weight loss program (e.g., Weight Watchers);
- •Are not weight stable for 3 months prior to the study (weight gain or loss > 4 kg);
- •Are unable to keep a food diary for 7 consecutive days during screening;
- •Are night shift workers;
- •Are pregnant or trying to get pregnant;
- •Are taking drugs that influence study outcomes (weight loss medications);
- •Are non-English speaking
- •Are taking anticoagulant medications or medications with endoscopic risk
- •Are taking antivirals or immunosuppressant medications
- •Don't have regular access to an email address and computer/smartphone/tablet
- •Are currently following a diet that requires fasting on a weekly basis
- •Currently eat for less than 10 hours of the day (determined by asking participants what time they start and stop eating on a usual day)
研究组 & 干预措施
Control
Controls will be instructed to maintain their weight throughout the 12 m trial and to not change eating or physical activity habits. Controls will not receive dietary counseling. Controls will visit the research center every 3 months for outcome measurements.
Time Restricted Eating (TRE)
During the active weight loss period, the TRE group will be instructed to eat ad libitum from 12:00pm - 8:00pm daily and fast from 8:00pm - 12:00pm. During the 8-h eating window, there will be no restrictions on types or quantities of foods consumed. During the fasting period, participants will be encouraged to drink plenty of water and may consume energy-free beverages, such as black tea or coffee. TRE subjects will meet with the TRE dietitian for 30 minutes at the start of the intervention to review instructions and goals, and then every week throughout the active weight loss period to review intervention adherence. At the beginning of the maintenance phase, total energy needs will be reassessed. Subjects will be instructed to main their body weight by consuming meals in an extended 10-h eating window every day and water fast between 8pm and 10 am, respectively.
干预措施: Time restricted eating (Behavioral)
Calorie Restriction (Cal-R)
Cal-R subjects will be instructed to restrict energy intake by 25% of their baseline total energy expenditure (TEE) daily. Subjects will meet with a study dietitian for a 60-min one-on-one session to develop individualized weight loss meal plans to help them adhere to their calorie restriction goal. Meal plans will include portion sizes and food lists that are consistent with their food preferences and prescribed calorie levels for weight loss. Food scales will be provided to help with food portioning. Cal-R subjects will meet with the dietitian every week throughout the weight loss period to review intervention adherence and modify the meal plans as needed. Subjects will be asked to maintain their baseline level of physical activity. At the beginning of the weight maintenance phase, total energy needs will be reassessed.
干预措施: Calorie Restriction (Behavioral)
结局指标
主要结局
Weight change (% kg)
时间窗: Baseline to month 6
Body weight in kg
次要结局
- Intervention adherence(Monthly, through month 6)
- Fasting plasma glucose(Baseline, month 3, month 6, month 9, month 12)
- CD3, CD163, pIKKa/b, tissue markers of inflammation(Baseline, month 6, month 12)
- Saliva microbiota(Baseline, month 3, month 6)
- Colonic mucosa gene expression profiling(Baseline, month 6, month 12)
- Weight maintenance (% kg)(Month 6 to month 12)
- Fecal Metabolites(Baseline, month 3 and month 6)
- c-caspase-3, Bax, apoptosis(Baseline, month 6, month 12)
- Total and regional body fat composition and distribution(Baseline, 6 month and 12 month)
- Plasma cytokines TNF-α, IL-6, IL1-β, and IL-10, %(Baseline, month 3, month 6, month 9, month 12)
- Plasma 8-isoprostane(Baseline, month 3, month 6, month 9, month 12)
- Ki-67, proliferation(Baseline, month 6, month 12)
- Fasting plasma insulin(Baseline, month 3, month 6, month 9, month 12)
- HOMA-IR(Baseline, month 3, month 6, month 9, month 12)
- Gut Microbiome(Baseline, month 3 and month 6)
研究者
Lisa Tussing-Humphreys
Professor
University of Illinois at Chicago