Effects of Long-lasting Bicarbonate-Sulfate-Calcium-Magnesium Water Intake on Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)-Related Outcome
- Conditions
- MASLD - Metabolic Dysfunction-Associated Steatotic Liver Disease
- Registration Number
- NCT07211113
- Lead Sponsor
- University of Campania Luigi Vanvitelli
- Brief Summary
Background: Fonte Essenziale®, a mineral water rich in bicarbonate, sulphate, calcium, and magnesium, has shown potential in modulating the gut-liver axis and microbiota in hepatic steatosis. However, its long-term effects on intestinal permeability (IP), systemic inflammation (SI), and oxidative stress-key factors in Metabolic dysfunction-Associated Steatotic Liver Disease (MASLD) -remain unexplored.
MASLD patients will be consecutively endoller and randomized into two groups: group A receiving Fonte Essenziale® (400 ml/day, fasting) plus a controlled nutritional regimen for 12 months, followed by a 6-month water washout; group B followed only the controlled nutritional regimen. IP markers, SI (IL-1β, IL-6, TNF-α), oxidative stress (dROMs/BAP), and clinical data (including Controlled Attenuation Parameter - CAP) will be assessed at baseline (T0), 12 months (T12), and post-washout (T18). Baseline increased IP (in-IP) was defined by fecal zonulin \>110 ng/ml and serum LBPp \>10 µg/ml; improvement (im-IP) required normalization of both. A ≥30% CAP reduction will indicate hepatic steatosis improvement.
- Detailed Description
This will be a prospective, randomized, controlled clinical trial conducted at the Hepatogastroenterology Division of the University of Campania "Luigi Vanvitelli" (Naples, Italy). The study will be designed and implemented under the framework of the Ferrarelle-Vanvitelli research agreement (n. 390-01583577-30059 - dated 09/02/2023), which previously enabled the investigation of mineral water as a non-pharmacological intervention in chronic liver disease.
Patients meeting the diagnostic criteria for MASLD \[17\] will be consecutively screened for potential eligibility. All individuals considered potentially eligible will undergo Transient Elastography (TE) with Liver Stiffness Measurement (LSM) to exclude those with LSM-defined advanced fibrosis (AF) (\> F3).
Eligible participants will then be randomized in a 1:1 ratio into two study arms: Group A and Group B. Group A will receive 400 ml/day of Fonte Essenziale® mineral water, administered each morning on an empty stomach for 12 consecutive months, in addition to a specialist-prescribed controlled nutritional regimen (see dedicated subsection), followed by a 6-month washout period during which only the nutritional regimen will be maintained. Group B will follow the same 12-month nutritional protocol without water supplementation. The selected water dose and fasting administration will be based on the original protocol and prior studies, given that gastric emptying is accelerated and absorption more consistent under fasting conditions, potentially enhancing mucosal interaction.
Three study time-points will be defined: baseline (T0), after 12 months (T12), and post-washout (T18), the latter applicable only to Group A. At each time-point, anthropometric, clinical, and demographic data-including age, sex, smoking status, MASLD-related comorbidities, and Body Mass Index (BMI)-will be collected, alongside routine biochemical parameters and TE-derived liver disease progression metrics, including both LSM-defined fibrosis staging and Controlled Attenuation Parameter (CAP)-based steatosis grading. At T12, a ≥30% reduction in baseline CAP values will be considered indicative of steatosis improvement.
Additionally, at each time-point, following the collection of 20 ml serum and 200 mg fecal samples, intestinal permeability (IP) will be assessed via a biomarker panel comprising fecal zonulin (ng/ml), serum LPS-binding protein (LBPp) (µg/ml), indicative of systemic endotoxin exposure, and serum occludin and claudin-1 (ng/ml), representing epithelial tight-junction integrity. At T0, concurrent fecal zonulin \>110 ng/ml and serum LBPp \>10 µg/ml will define increased IP (in-IP) \[6,13\]. At T12, improvement in IP (im-IP) will be defined by simultaneous reductions in fecal zonulin \<110 ng/ml and serum LBPp \<10 µg/ml. This dual-marker approach will be adopted to enhance diagnostic reliability, as single biomarkers may inadequately reflect barrier integrity and function.
IP-associated systemic inflammation (SI) will be evaluated at all time-points by measuring circulating LPS (ng/ml) and pro-inflammatory cytokines \[interleukin (IL)-1β, IL-6, and Tumor Necrosis Factor alpha (TNF-α), pg/ml\]. Finally, systemic oxidative stress will be assessed using the Biological Antioxidant Potential (BAP) and derivatives of Reactive Oxygen Metabolites (dROM) tests, both validated tools in chronic liver disease contexts.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 87
Not provided
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Primary Outcome Measures
Name Time Method Intestinal permeability changes T0-T12 (after the 12 months of intervention) Improving increased intestinal permeability (IP) in group A compared with group B
Primary End-point (composite):
Statistically significant reduction of fecal zonulin, simultaneously with a significant increase occludin and claudin 1 serum levels, in group A (compared with group B)
Note: In each patient, the simultaneous reduction of fecal zonulin (\< 110 ng/ml) and serum LPBp (\< 10 microg/ml) defined an improvement in IP (i-IP).Impacting on intestinal permeability After the 12 months of intervention Improving increased intestinal permeability (IP) in group A compared with group B Endpoint: Statistically significant reduction of fecal zonulin, simultaneously with a significant increase occludin and claudin 1 serum levels, in group A (compared with group B)
Note:In each patient, the simultaneous reduction of fecal zonulin (\< 110 ng/ml) and serum LPBp (\< 10 microg/ml) defined an improvement in IP (i-IP).
- Secondary Outcome Measures
Name Time Method Impacting on altered Intestinal Permeability-related systemic inflammation T0-T12 (after the 12 months of intervention) Improving systemic chronic inflammation status in group A compared with group B , as well as in patients of group A presenting improved IP, compared with those not reaching this outcome
Secondary End-point:
Statistically significant reduction of IL-1, TNF-a, IL-6, LPS serum levels in group A (compared with group B), as well as in patients of group A presenting improved IP, compared with those not reaching this outcomeImpacting on clinical outcomes T0-T12 (after 12 months-intervention) Improving hepatic steatosis severity and metabolic features in group A compared with group B, as well as in patients of group A presenting improved IP, compared with those not reaching this outcome
End-point: Statistically significant reduction of CAP levels in group A (compared with group B), as well as in patients of group A presenting improved IP, compared with those not reaching this outcome
End-point: Statistically significant reduction of FPG, insulin, TG levels, and increase in HDL serum levels in group A (compared with group B), as well as in patients of group A presenting improved IP, compared with those not reaching this outcome
Trial Locations
- Locations (1)
University of Campania Luigi Vanvitelli
🇮🇹Napoli, Campania, Italy
University of Campania Luigi Vanvitelli🇮🇹Napoli, Campania, Italy