Evaluation of Intestinal Microbiome in Obese Kids

Study Overview
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Brief Summary
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The goal of this study is to investigate comparisons between the intestinal microbiome in patients with obesity and in patients with obesity and Non-Alcoholic Fatty Liver Disease (NAFLD). With this protocol we hope to better understand how the microbiome of each individual works with disease progression.

Detailed Description
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The goal of this study is to investigate and compare the composition of the intestinal microbiome in patients with obesity only to patients with obesity and Non-Alcoholic Fatty Liver Disease (NAFLD). In addition, we will investigate the relationship between alterations in the intestinal microbiome, immune activation, and the progression of NAFLD to Non-Alcoholic Steatohepatitis (NASH). We hypothesize that alterations in the intestinal microbiome are associated with increased immune activation and progression of obesity associated NAFLD. Based on this hypothesis we propose the following aims: Aim 1. Identify and enroll pediatric cohort with obesity or obesity/NAFLD to study the role of the intestinal microbiome on the development of NAFLD. Enroll participants through the NEW Kids program for treatment of pediatric obesity at Children's Hospital of Wisconsin (CHW). Identify and classify participants through initial clinical evaluation, collect clinical metadata, and obtain and process blood and stool samples for analysis. Demonstrate feasibility by showing that participants can be recruited and participate in the specific study protocol. Follow study population through nutritional/exercise intervention, with follow up collection of clinical data, stool, and blood samples. Aim 2. Characterize the intestinal microbiome through quantitative PCR and high throughput sequencing analysis of stool specimens in participants with obesity and obesity/NAFLD. Demonstrate feasibility by showing that sampling aliquots from patient fecal samples can be successfully analyzed by proposed methods and yield consistent results for duplicate samples. Compare sequencing results and metagenomic analysis for study groups with particular attention to bacterial composition and metabolic capacity associated with energy harvest, lipid and carbohydrate transport, enhancement of epithelial barrier integrity, and choline metabolism. Investigate whether intervention (nutritional/exercise) results in longitudinal alterations in the intestinal microbiome. Aim 3. Characterize evidence of systemic inflammation by C-reactive protein (CRP), Tumor necrosis factor alpha (TNF-alpha)Transforming growth factor beta 1 (TGF-beta and LPS Binding Protein (LBP) levels, and analyze results in relationship to the intestinal microbiome and the presence of NAFLD. Compare levels of systemic inflammatory markers of participants with obesity vs. obesity/NAFLD Investigate whether intervention (nutritional/exercise) results in longitudinal alterations in systemic inflammation.

Official Title
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Evaluation of the Intestinal Microbiome in Obese Children With and Without Non-Alcoholic Fatty Liver Disease

Conditions
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Obesity, Non-Alcoholic Fatty Liver Disease

Intervention / Treatment
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* Other: Blood Draw
* Other: Stool collection
* Other: BodPod Measurement
* Other: Liver Ultrasound


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 5-18 Years old Willing to consent/undergo necessary procedures Obese (BMI>30) Speak English or Spanish Exclusion Criteria: any other causes of liver disease any chronic illnesses or life threatening conditions

Ages Eligible for Study
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Minimum Age: 5 Years
Maximum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Controls<br>Obese (BMI>30) and normal AST and ALT. Between the ages of 5 and 18 years old. | Other: Blood Draw<br>* 2 tablespoons of blood will be drawn from participants at study entry, 3 months after study entry, and 6 months after study entry.<br>Other: Stool collection<br>* Stool will be collected from participants 3 times during the study -- at study entry, 3 months from study entry, and 6 months after study entry.<br>Other: BodPod Measurement<br>* Body composition will be measured using a BodPod at study entry, 3 months after study entry, and 6 months after study entry.<br>Other: Liver Ultrasound<br>* A liver ultrasound will be performed at study entry and 6 months after study entry.<br>|
| Liver Disease<br>Obese (BMI>30) and elevated AST and/or ALT (evidence of NAFLD). Between the ages of 5 and 18 years old. | Other: Blood Draw<br>* 2 tablespoons of blood will be drawn from participants at study entry, 3 months after study entry, and 6 months after study entry.<br>Other: Stool collection<br>* Stool will be collected from participants 3 times during the study -- at study entry, 3 months from study entry, and 6 months after study entry.<br>Other: BodPod Measurement<br>* Body composition will be measured using a BodPod at study entry, 3 months after study entry, and 6 months after study entry.<br>Other: Liver Ultrasound<br>* A liver ultrasound will be performed at study entry and 6 months after study entry.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Alterations in the intestinal microbiome are associated with increased immune activation and progression of obesity associated NAFLD. |  | 3 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Characterize the intestinal microbiome through quantitative analysis of stool samples in participants with obesity and those with obesity and NAFLD. |  | 3 years | 
| Characterize inflammatory markers of participants with obesity versus those obese participants that also have NAFLD. |  | 3 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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NAFLD, Obesity, Microbiome