Metabolic Inflexibility is Related to Elevated Muscle Anaerobic Glycolysis

NCT ID: NCT04320264

Last Updated: 2025-08-07

Basic Information

• Recruitment Status: RECRUITING
• Total Enrollment: 100 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2020-03-03
• Study Completion Date: 2025-12-31

Brief Summary

The focus of this proposal is on overweight (25>BMI<30 kg/m2) subjects, as these individuals exhibit a high risk of becoming obese and/or developing metabolic diseases. We hypothesize that in some overweight individuals there is a "metabolic program" in skeletal muscle which predisposes them to the development of obesity. Findings may lead to clinical screening tools for determining risk for obesity in non-obese individuals and targeting this group for prevention.

Detailed Description

Our overall hypothesis is that increased reliance on anaerobic glycolysis in muscle shifts fasting metabolism from fat towards carbohydrate utilization, which results in metabolic inflexibility and subsequent metabolic disease (i.e. obesity). To test our hypothesis, overweight subjects (BMI 25 to 30 kg/m2) will be recruited and screened for reliance on anaerobic glycolysis (resting/fasting plasma lactate concentrations). Subjects with high (top quartile) and low (bottom quartile) resting/fasting plasma lactate will be chosen. The premise of this screening is that subjects with low lactate will have high muscle aerobic substrate oxidation, while those with elevated lactate will have low muscle oxidative metabolism. Severely obese subjects will be studied as a comparator group. In aim 1 in vivo muscle lactate release and respiratory exchange ratio (RER) will be determined to investigate if subjects with high reliance on anaerobic glycolysis exhibit a shift towards carbohydrate utilization at the whole-body level. Aim 2 will test whether subjects with elevated reliance on anaerobic glycolysis in muscle are metabolically inflexible. To establish causality, aim 3 is designed to follow subjects after an intervention that shifts skeletal muscle metabolism from carbohydrate to fat utilization. Our preliminary findings indicate that bariatric surgery normalizes muscle lactate production; therefore, severely obese subjects will be studied before and after gastric bypass surgery (aim 3).

The study (MetFlex) will enroll 74 adults; (Group 1) 60 overweight (BMI 25 to 30 kg/m2) males and females ages 18-50 years old and (Group 2) 14 severely obese (BMI 40 to 50 kg/m2) adult females who are scheduled for bariatric surgery.

Endpoints to be investigated in the 3 specific aims.

Carbohydrate/fat oxidation (RER) in the fasting condition. High lactate vs low lactate groups (aim 1). Pre-surgery vs post-surgery (aim 3)

Muscle oxygen consumption (substrate oxidation) in the fasting condition. High lactate vs low lactate groups (aim 1). Pre-surgery vs post-surgery (aim 3)

Muscle lactate release in the fasting condition. High lactate vs low lactate groups (aim 1). Pre-surgery vs post-surgery (aim 3)

Endogenous glucose production in the fasting condition. High lactate vs low lactate groups (aim 1). Pre-surgery vs post-surgery (aim 3)

Insulin sensitivity (clamp M value). High lactate vs low lactate groups (aim 1)

Change in Carbohydrate/fat oxidation (RER) in response to glucose + insulin (metabolic flexibility). High lactate vs low lactate groups (aim 2)

Change in muscle fat oxidation in response to high fat feeding (metabolic flexibility). High lactate vs low lactate groups (aim 2)

Change in muscle oxygen consumption (substrate oxidation) in response to high fat feeding (metabolic flexibility). High lactate vs low lactate groups (aim 2)

Our basic premise is that elevated fasting plasma lactate causes glucose production to be increased and that a "Vicious Cori cycle" is the underlying cause of the metabolic syndrome.

Conditions

Metabolic Inflexibility

Study Design

• Observational Model Type: COHORT
• Study Time Perspective: PROSPECTIVE

Study Groups

Low oxidizers/high lactate

Individuals with low aerobic oxidation

No interventions assigned to this group

High oxidizers/low lactate

Individuals with high aerobic oxidation

No interventions assigned to this group

Obese

Severely obese scheduled for surgery

Weight loss surgery

Intervention Type: PROCEDURE

Severely obese women (BMI \>40) undergo sleeve gastrectomy

Interventions

Weight loss surgery

Severely obese women (BMI \>40) undergo sleeve gastrectomy

Intervention Type: PROCEDURE

Eligibility Criteria

Inclusion Criteria

• 18-50 years old
• BMI of 25 - 30 kg/m2
• BMI > 40kg/m2
• Lactate levels in top and lower 25%

Exclusion Criteria

• Pregnant women
• Mentally disabled
• Prisoners
• Smokers
• Subjects with heart disease
• Type 1 and 2 diabetes
• Endocrine disease
• Hypertension
• Musculoskeletal disease
• Peripheral occlusion
• Hepatic disease
• Have had weight fluctuations exceeding + 3% in the previous 12 months
• On medications which alter carbohydrate metabolism will not be studied

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 50 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Duke University

OTHER

Sponsor Role: collaborator

University of Arkansas

OTHER

Sponsor Role: collaborator

East Carolina University

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Joseph Houmard, PhD

Role: PRINCIPAL_INVESTIGATOR

East Carolina University

Locations

East Carolina University

Greenville, North Carolina, United States

Site Status: RECRUITING

Countries

United States

Central Contacts

Terry Jones, PhD

Role: CONTACT

joneste@ecu.edu

2527446249

Nicholas Broskey, PhD

Role: CONTACT

broskeyn19@ecu.edu

2527374684

Facility Contacts

Terry Jones, PhD

Role: primary

joneste@ecu.edu

2527446249

Nicholas Broskey, PhD

Role: backup

broskeyn19@ecu.edu

2527374684

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Reference Type: BACKGROUND

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Other Identifiers

UMCIRB 19-000914

Identifier Type: -

Identifier Source: org_study_id