The Causal Role of Ketone Bodies in Obesity-associated Disease Prevention - Combining Genetic Epidemiology With a Randomised Trial to Infer Causality

NCT ID: NCT06668168

Last Updated: 2025-07-31

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

RECRUITING

Clinical Phase

NA

Total Enrollment

69 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-05-06

Study Completion Date

2030-01-31

Brief Summary

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Excess weight increases the risk of several diseases including cardiovascular disease, type 2 diabetes, kidney disease and various cancers. There is a need for preventative strategies for obesity-associated disease, especially for people in the overweight and moderately obese ranges where pharmacological intervention may not be suitable.

Low-carbohydrate (ketogenic) diets are popular for weight control. Ketogenic diets increase circulating ketones, which can have favourable effects on cardiometabolic health markers. However, the ketogenic diet has a nutrient composition associated with harms (high-saturated fat/red meat, and low-fibre). The net effects of ketogenic diets on long-term health are unclear. Ketone supplements can increase circulating ketones and could provide benefits of ketosis without needing to adhere to a potentially harmful diet.

Establishing causality between complex exposures (e.g., diet) and long-term outcomes (e.g., disease), is challenging. The MRC \& NIHR Review of Nutrition and Human Health Research (2017) highlighted an "overreliance (as opposed to reasonable reliance) on observational studies" as a key barrier to progression in the field of nutrition and health. Randomised controlled trials (RCTs) facilitate causal inference, but for long-term outcomes are expensive, time-consuming, and often suffer from waning adherence. Mendelian randomization (MR) can estimate causal effects subject to key assumptions. A challenge to these assumptions includes complex behavioural exposures (e.g., diet), which could be intercorrelated with causal factors.

Our proposal will address these limitations with a novel combination of study designs to establish causal effects of ketosis (via diet and supplementation) on obesity-associated disease risk in humans.

The investigators will combine a tightly controlled, short-term RCT, with MR to link short-term responses to long-term endpoints. The investigators will examine the circulating (blood) and tissue-specific (adipose) transcriptomic and proteomic responses in the fasted and postprandial state in response to our dietary interventions and translate these to MR by identifying single-nucleotide polymorphisms from genome wide association studies. This approach overcomes limitations of RCTs and MR, as adherence to diets will be confirmed with controlled feeding, and intermediate molecular traits as exposure for MR are less likely to be intercorrelated with causal traits.

Detailed Description

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Conditions

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Nutrition Obesity and Overweight

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

BASIC_SCIENCE

Blinding Strategy

NONE

Outcome assessors will be masked to the group allocation when analysis is outsourced from the University.

Study Groups

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CONTROL

Group Type NO_INTERVENTION

No interventions assigned to this group

KETONE ESTER

Group Type ACTIVE_COMPARATOR

Ketone Monoester (KE)

Intervention Type DIETARY_SUPPLEMENT

25g ketone ester 3x/day. The ketone ester will be a beta-hydroxybutyrate monoester \[(R)-3-hydroxybutyl (R)-3-hydroxybutyrate\].

KETOGENIC DIET

Group Type EXPERIMENTAL

Ketogenic diet

Intervention Type BEHAVIORAL

Ketogenic diet (\<50 g carbohydrate per day)

Interventions

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Ketone Monoester (KE)

25g ketone ester 3x/day. The ketone ester will be a beta-hydroxybutyrate monoester \[(R)-3-hydroxybutyl (R)-3-hydroxybutyrate\].

Intervention Type DIETARY_SUPPLEMENT

Ketogenic diet

Ketogenic diet (\<50 g carbohydrate per day)

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Body mass index: 25-45 kg/m2
* Waist circumference \>93.9 (males) or \>79.9 (females)

Exclusion Criteria

* Glucose or lipid lowering medication
* Diagnosis of cardiovascular disease, renal failure, liver disease or type 2 diabetes
* Contraindications to a ketogenic diet (e.g., pancreatitis, liver failure, disorders of fat metabolism, primary carnitine deficiency, carnitine palmitoyltransferase deficiency, carnitine translocase deficiency, porphyrias, or pyruvate kinase deficiency)
* Unable to understand English language
Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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University of Bristol

OTHER

Sponsor Role collaborator

Imperial College London

OTHER

Sponsor Role collaborator

University of Bath

OTHER

Sponsor Role lead

Responsible Party

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Javier Gonzalez

Professor of Nutrition and Metabolism

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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University of Bath

Bath, Bath, United Kingdom

Site Status RECRUITING

Countries

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United Kingdom

Central Contacts

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Javier Gonzalez

Role: CONTACT

+441225385518

Sophie L Russell, PhD

Role: CONTACT

+44 7966 975316

Facility Contacts

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Javier Gonzalez, PhD

Role: primary

+441225385518

Other Identifiers

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23-09665

Identifier Type: -

Identifier Source: org_study_id

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