Dietary Oxysterols and β-Cell Function Among African Americans

NCT ID: NCT05072587

Last Updated: 2021-10-11

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

24 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-07-01

Study Completion Date

2022-10-31

Brief Summary

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African Americans (AAs) have a higher risk of developing type 2 diabetes than the general population. AAs are also more likely to eat foods that contain cholesterol oxides/oxysterols.

Dietary oxysterols can harm the cells that produce insulin and decrease insulin production.

This pilot study seeks to determine if removing dietary oxysterols with a plant-based diet will improve insulin production and decrease the risk of type 2 diabetes among AAs.

Detailed Description

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African Americans (AAs) have almost twice the incidence and prevalence of Type 2 diabetes (T2D) compared to the general population. T2D occurs when pancreatic β-cell dysfunction prevents secretion of sufficient insulin to overcome insulin resistance. While the causes of β-cell dysfunction are not fully understood, the role of cytotoxic oxidative stress is well documented. Serum oxysterols are biomarkers of oxidative stress. Oxysterols form endogenously or exogenously when cholesterol in food is exposed to light, heat, and processing. Dietary oxysterols are cytotoxic, they are absorbed and carried in the blood by lipoprotein carriers or circulate freely in serum. 7-Ketocholesterol (7-KC), the most common oxysterol in food and serum is a biomarker of cholesterol oxidation. High serum levels of 7-KC are associated with an increased risk of T2D. AAs who consume Southern dietary pattern foods such as fried and processed meats have a higher consumption of dietary oxysterols than the general population. Our central hypothesis is that the higher consumption of dietary oxysterols among AAs contributes to β-cell dysfunction and higher rates of T2D. The aim of this pilot study is to determine the effect of lowering dietary oxysterols on serum 7-KC and β-cell function among AAs with prediabetes and early T2D (HbA1c 5.7% - 7.0%). The expected outcome is that decreased exposure to dietary oxysterols will decrease serum oxysterols and β-cells oxidative stress which will improve β-cell function and glycemic control. The knowledge gained from this study may lead to improved T2D prevention and treatment strategies that may decrease the burden of T2D in all communities and eliminate the racial disparity among AAs.

Conditions

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Type 2 Diabetes

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

This pilot study is a longitudinal prospective randomized clinical trial with two parallel arms. Participants in both arms of the study will receive prepared meals based on ADA dietary guidelines for 12 weeks. One group will be given a plant-based ADA diet that contains no oxysterols (PB-ADAØ). The other group will be given the Standard ADA diet (SADA). The dietary 7-KC content of both diets will be estimated from oxysterol food composition databases. Sample meals from both groups will be analyzed to determine the 7-KC food content and the accuracy of the estimates.
Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

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Group A - Standard ADA dietary guidelines (SADA)

Participants in this group will be given prepared meals based on standard ADA dietary guidelines for 12 weeks.

Group Type ACTIVE_COMPARATOR

Standard ADA Diet (SADA)

Intervention Type BEHAVIORAL

This group will be given 3 prepared meals a day with macronutrient content: 60% of calories from carbohydrates, 15% protein, and 25% fat. Calories: 25 kcal/kg ideal body weight (IBW). The goal is weight maintenance, but weight loss may occur. 1-5% weight loss will be acceptable and not deemed a potential confounder. Participants will be screened for food allergies and intolerances prior to receiving their research diets. All meals will include culturally familiar foods to enhance adherence. The dietary intervention will be conducted over 4 3-month periods (12 months). Meals will be packaged labeled and distributed to participants once per week. Participants will consume their meals at home.

Group B - Plant Based ADA diet with no oxysterols (PB-ADAØ).

Participants in this group will be given prepared meals based on ADA guidelines but with no dietary cholesterol oxides/oxysterols - Plant-based ADA diet

Group Type EXPERIMENTAL

Plant-based diet with no oxysterols

Intervention Type BEHAVIORAL

This group will be given 3 prepared plant-based meals a day with macronutrient content: 60% of calories from carbohydrates, 15% protein, and 25% fat. Calories: 25 kcal/kg ideal body weight (IBW). The goal is weight maintenance, but weight loss may occur. 1-5% weight loss will be acceptable and not deemed a potential confounder. Participants will be screened for food allergies and intolerances prior to receiving their research diets. All meals will include culturally familiar foods to enhance adherence. The dietary intervention will be conducted over 4 3-month periods (12 months). Meals will be packaged labeled and distributed to participants once per week. Participants will consume their meals at home.

Interventions

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Plant-based diet with no oxysterols

This group will be given 3 prepared plant-based meals a day with macronutrient content: 60% of calories from carbohydrates, 15% protein, and 25% fat. Calories: 25 kcal/kg ideal body weight (IBW). The goal is weight maintenance, but weight loss may occur. 1-5% weight loss will be acceptable and not deemed a potential confounder. Participants will be screened for food allergies and intolerances prior to receiving their research diets. All meals will include culturally familiar foods to enhance adherence. The dietary intervention will be conducted over 4 3-month periods (12 months). Meals will be packaged labeled and distributed to participants once per week. Participants will consume their meals at home.

Intervention Type BEHAVIORAL

Standard ADA Diet (SADA)

This group will be given 3 prepared meals a day with macronutrient content: 60% of calories from carbohydrates, 15% protein, and 25% fat. Calories: 25 kcal/kg ideal body weight (IBW). The goal is weight maintenance, but weight loss may occur. 1-5% weight loss will be acceptable and not deemed a potential confounder. Participants will be screened for food allergies and intolerances prior to receiving their research diets. All meals will include culturally familiar foods to enhance adherence. The dietary intervention will be conducted over 4 3-month periods (12 months). Meals will be packaged labeled and distributed to participants once per week. Participants will consume their meals at home.

Intervention Type BEHAVIORAL

Other Intervention Names

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Cholesterol Oxide-free plant-based diet ADA Diet

Eligibility Criteria

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Inclusion Criteria

1. HbA1c: 5.7% - 7.0%: This HbA1c range reflects mild to moderate β-cell dysfunction.
2. Self-identified AA: This group has higher rates of T2D than the general population.
3. Adults over18 years old: This age group is at higher risk of T2D.
4. Ability to read, understand and communicate effectively in English: All information about the study and instructions for the study protocol will be in English.
5. Committed to eating the allocated study diet for 12 weeks: This is important to ensure that the study protocol is followed, and the data collected from participants is meaningful/valid.
6. On stable medication dosages for the three months prior to recruitment: This is to avoid bias or confounding with new medications or dosages changes.
7. Able to safely store a week's supply of prepared meals: Participants will receive packages of prepared food that has to stored and last them for the following week.
8. Mentally competent and able to follow the study protocol and provide informed consent
9. Currently eating the Standard American diet: The baseline diet of the participants will be assessed and correlated their baseline serum 7-KC levels and HOMA2 Index of β-cell function.

Exclusion Criteria

1. Be pregnant or lactating: Fetuses and breast-feeding infants are a protected vulnerable group. The risk of involving them in research must outweigh the benefits, Hormonal levels and other factors in pregnant and lactating woman may confound study results.
2. Be taking statin medications or any other cholesterol lowering drugs or supplements: These medications may artificially lower serum cholesterol and oxysterol levels.
3. Be currently on a vegan, vegetarian, or any type of plant-based diet for the 3 months prior to recruitment: Participants currently on these diets may not see significant changes on the dietary interventions of the study protocol.
4. Be a current smoker: Smoking is a risk factor for oxidative stress - this could be an effect modifier or a confounding faction for this study.
5. Be on medications or supplements to lower blood glucose or treat diabetes: This will be an effect modifier or confounding factor. We will not know the effect of the dietary intervention if the participants are also on medications for diabetes.
6. Be status post blood transfusion in the previous 3 months: This will interfere with the test for HbA1c levels. This is one of our primary outcomes:
7. Have a hemoglobin or any other blood disorder: This will interfere with the test for HBA1c which measures glycation of hemoglobin in red blood cells.:
8. Be taking biotin supplements: This interferes with the test for fasting C-Peptide.
9. Be on dialysis or have any stage of renal failure: Dialysis patients need special diets and more intense monitoring than is planned for the participants in this study.
10. Have food allergies: Participants will be screened for food allergies. This is to prevent food sensitivities or adverse reactions to the prepared meals in the study.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Emory University

OTHER

Sponsor Role collaborator

Morehouse School of Medicine

OTHER

Sponsor Role lead

Responsible Party

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Jennifer Rooke, MD, MPH

Assistant Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Jennifer Rooke

Role: PRINCIPAL_INVESTIGATOR

Morehouse School of Medicine

Locations

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Morehouse School of Medicine

Atlanta, Georgia, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Jennifer Rooke, MD, MPH

Role: CONTACT

404-317-7268

Facility Contacts

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Jennifer Rooke, MD, MPH

Role: primary

404-317-7268

References

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Other Identifiers

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MorehouseSM

Identifier Type: -

Identifier Source: org_study_id

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