The Effects of a Lifestyle Modification Program (REACH) in Patients With HIV and Metabolic Syndrome
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 80
- 试验地点
- 1
- 主要终点
- WHR
研究概览
简要总结
This study is designed to determine the effects of an intensive lifestyle modification program in patients with HIV and Metabolic Syndrome. The primary endpoints will be improvement in body composition, specifically waist-to-hip ratio (WHR). The secondary endpoints will include improvement of cardiovascular indices, such as total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglyceride cholesterol levels, blood pressure, cardiac enzymes, c-reactive protein (CRP), tissue plasminogen activator (t-PA), plasminogen activator inhibitor (PAI), and insulin and glucose metabolism. We expect that quality of life indices and life skills should also improve with the lifestyle modification program.
详细描述
This study is designed as a randomized, case-control study of 80 subjects (N=80). Forty subjects will be randomized to the observation group and 40 to the intervention (REACH) group.
After two initial screening visits with medical and nutrition staff for informed consent, determination of eligibility, and evaluation of a 7-day food record, qualifying patients will be seen for a baseline visit. A nutrition questionnaire and bioimpedance analysis (BIA) testing will be done at the first screening visit, and sub-maximal stress testing and other tests with physical therapy will be done at the second screening visit.
At baseline, patients will have an interval history and physical exam, lipodystrophy evaluation by the investigator (objective) and patient (subjective) report, blood tests and body composition.
Nearly identical visits to that at baseline, with the addition of the sub-maximal stress test, and other physical therapy testing, will be repeated at 6 and 12 months. Carotid ultrasound will be repeated at the 6 and 12 month visits. There will also be a short visit at 3 and 9 months to obtain an interval history and physical exam, safety labs, and a 7-day food record for an Intake Report.
At baseline, patients will be randomized to either the observation group or the lifestyle intervention, known as "Reach for Energy, Activity, and Cardiovascular Health" (REACH). Randomization will be stratified for gender and fasting glucose < or >= 110 mg/dL.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 65 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Age greater than or equal to 18 and less than or equal to 65 years of age
- •Ability and motivation to modify behavior and make lifestyle changes
- •3 out of 5 of the following:
- •Waist circumference greater than 102 cm (40 in) in men and 88 cm (35 in) in women;
- •Triglycerides greater than or equal to 150 mg/dL or current anti-lipolytic drug treatment;
- •High-density lipoprotein (HDL) less than 40 mg/dL in men and 50 mg/dL in women;
- •Blood pressure greater than or equal to 130/85 mmHg or current antihypertensive drug treatment;
- •Fasting glucose greater than or equal to 110 mg/dL.
排除标准
- •History of unstable angina, aortic stenosis, uncontrolled hypertension, severe neuropathy, arthritis or other contraindication to exercise
- •Requiring pharmacological glucocorticoid therapy (> 7.5mg Prednisone or its equivalent/day)
- •Androgen, growth hormone or Megace within 3 months of study initiation. Subjects on a standard dose of testosterone for documented hypogonadism for > 3 months will be allowed to enter the study.
- •New anti-retroviral therapy within 1 month of study initiation
- •SGPT > 5X normal and/or clinically significant liver disease
- •Creatinine > 2.0 mg/dL and/or clinically significant renal disease
- •Hemoglobin (Hgb) < 9 g/dL
- •Current drug or alcohol abuse
- •History of diabetes mellitus or fasting glucose of greater than or equal to 126 mg/dL
- •Current therapy with insulin or other diabetic agent
- •Pregnant or actively seeking pregnancy
- •Breastfeeding
- •Inability to comply with intervention due to lack of motivation, time, social, and/or psychological support
研究组 & 干预措施
Lifestyle Modification
Goals derived from the AACE and NCEP-ATP III guidelines and the Diabetes Prevention Program are as follows: <35% calories from fat, < 7% calories from saturated fat, up to 10% calories from polyunsaturated fat, reduction of trans fatty acid intake, up to 20% calories from monounsaturated fat, and 25-35g of fiber per day. 3 hrs of physical activity/week at moderate intensity, >10,000 steps in daily activity, measured by pedometer. The curriculum is modeled after the Diabetes Prevention Program. Subjects will complete lifestyle sessions in the offices of the Program in Nutritional Metabolism or in the Clinical Research Center at MGH with protocol study staff trained to implement the curriculum.
干预措施: Lifestyle Modification (Behavioral)
Control
干预措施: No lifestyle modification (Other)
结局指标
主要结局
WHR
次要结局
- total cholesterol
- LDL
- HDL
- triglyceride cholesterol levels
- blood pressure
- cardiac enzymes
- CRP
- t-PA
- PAI
- insulin and glucose metabolism