Synbiotic Therapy on Intestinal Microbiota and Insulin Resistance in Obesity

Study Overview
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Brief Summary
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Background : There is a plausible relationship between microbial gut and insulin resistance. Intervention to prevent insulin resistance by modifying the microbial gut has been proposed but limited studies demonstrates the expected impact. One of the possible way to manipulate the microbial gut is the administration of synbiotic (prebiotic and probiotic). Objective : This study aim to address the impact of synbiotic administration to the microbial gut and insulin resistance. Brief Methodology : A Quasi Experimental study with multiple arms is conducted to healthy participants. All subjects will undergo a microbial gut taxonomic analysis using faecal sample and blood examination to determine the insulin resistance status (using Homeostatic Model Assessment for Insulin Resistance/HOMA-IR approach). Synbiotic will be given to intervention arm and active comparator will use maltodextrin. Repeated measurement will be conducted after 8 weeks and 12 weeks from the day of administration. Hypothesis : A superiority trial hypothesis is applied, assuming that the synbiotic group will demonstrates higher variety of microbial gut and lower HOMA-IR level

Detailed Description
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Study Location : This study will recruit the healthy participants from the university Target Population: Healthy Participants General Study Design : Quasi Experimental study with a comparator Sample Size calculation : Difference between two means of HOMA IR from pilot data (7) and standard deviation 2.9, with 5% Type I error, and 80% Power yielded a total of 16 participants for two arms Management of Sample: Faecal Sample handling Patient should undergo 8 hours of fasting prior to faecal examination DNA Extraction Lysate preparation and centrifuge faecal sample Mixing lysate with sample Column wash DNA elution DNA storing DNA sequencing and analysis taxonomical analysis Fasting blood glucose Patient should undergo 8 hours of fasting prior to Fasting blood glucose Blood is taken from cubital vein Spectrometry is conducted based on the NADPH formation from the equation below D-glucose+ATP -----> Glucose-6-phospate+ADP Glucose-6-phospate+NAD ---- G-6-PDH ---> D-Gluconate-6 phospate+NADH+H Insulin level Centrifuge blood to obtain the serum The monoclonal anti-insulin antibody is given to the serum detection is based on the anti-insulin antibody and insulin complex formation Homeostatic Model Assessment for Insulin Resistance/ HOMA-IR value is calculated from glucose level multiply by insulin level and divided by 405. Protection for adverse event All subjects are given the consent regarding the potential harm of synbiotic administration All subjects will follow the protocol of reporting the any adverse event (most likely, severe constipation) All subjects will be treated accordingly and hospitalisation if needed. Statistical Analysis General Analysis : Intention To Treat (ITT) Propensity Score Matching will be conducted prior to intervention A repeated measure ANOVA will be performed, whereas Generalized Linear Mixed Model treating the intervention as dummy variable will be performed if ANOVA assumptions can not be fulfilled.

Official Title
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The Effect of Synbiotic on Intestinal Microbiota and HOMA-IR (Homeostatic Model Assessment of Insulin Resistance) on Obesity

Conditions
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Obesity, Insulin Resistance

Intervention / Treatment
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* Dietary Supplement: Synbiotic (Rillus)
* Drug: Placebo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age above 18 years old Not receive antibiotic prescription within the last 6 months Exclusion Criteria Taking medication that alters the blood sugar Taking probiotic or synbiotic product (such as yogurt) Participant who do not take the synbiotic intervention for more than 3 days consecutively incomplete follow up examination results Develop adverse effect

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: A multiple-arm study involves three different groups receiving synbiotic (probiotic + prebiotic) and placebo. Observation of intestinal microbiota and insulin resistance is observed in repeated measurement
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Synbiotic<br>A fine powder to be taken orally consists of Viable cell 1,0 x 10^9 Colony Forming Unit of : Lactobacillus plantarum 8,55 mg Streptococcus thermophilus 8,55 mg Bifidobacterium bifidum 2,55 mg Fructooligosaccharide 480 mg Additional components : isomalt, xylitol | Dietary Supplement: Synbiotic (Rillus)<br>* Participants in this group will be given a fine powder of synbiotic formula and should be taken orally without diluted with water.<br>* Other names: Rillus;|
| Active Comparator: Placebo<br>A powder of 5 gram maltodextrin is given as active comparator, taken orally. | Drug: Placebo<br>* Participants in this group will be given a fine powder of maltodextrin formula and should be taken orally without diluted with water.<br>* Other names: Maltodextrin;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) | a value representing the insulin resistance yielded by multiplying the blood glucose value and insulin value, then divided by 405 (considering the unit of values are in mg/dL not mmol) | Changes of HOMA IR value from baseline to 8 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Intestinal Microbiota, Probiotic, Insulin Resistance, Obesity