Exercise and Diet Intervention Attenuated Inflammation Through ASC Gene and Inflammatory Markers in Obese Adults

Study Overview
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Brief Summary
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Background: Obesity is one of the most important health problems worldwide, several factors related to lifestyle as physical inactivity and unbalanced diets increase their development. This condition is characterized by low-chronic inflammation by excess of adipose tissue. The apoptosis-associated speck-like protein containing a caspase recruitment domain (ASC) protein is part of NLRP3 inflammasome, a complex related to inflammation and metabolic alterations. Purpose: The aim of this study was to evaluate the effect of physical exercise program on ASC gene expression and inflammatory markers in obese adults. Methods: 37 obese individuals were randomized to exercise-diet group or diet-group during a 4-month follow-up period. The dietary evaluation was analyzed by Nutritionist Pro software. Body composition was evaluated by bioimpedance (InBody 370). All biochemical determinations were analyzed by dry chemistry (Vitros 350). ASC messenger ribonucleic acid (mRNA) expression was performed by real-time polymerase chain reaction (PCR) using Taqman probes and by the 2-ΔΔcq quantification method. Cytokine levels was performed using the Bio-PlexPro™ HumanTh17Cytokine Assays (MagPix) panel. Statistical analysis was performed with Statistical Package for the Social Sciences (SPSS) v.22 software.

Detailed Description
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A randomized clinical trial was conducted in the Institute of Translational Nutrigenetics and Nutrigenomics, Department of Molecular Biology in Medicine, Health Sciences Center, at the University of Guadalajara, Guadalajara, Jalisco, Mexico, from February of 2018 to February of 2019. All participants were recruited through flyers and social media invitations. Sample size was determined according to the mean difference formula for clinical trials. To achieve a statistical power of 80% and an alpha of 5%, a sample size of 13 participants in each study group was required. However, 37 obese individuals who met the selection criteria were randomized in exercise-diet group or diet-group. Blood sample, height and weight were measured after 8-12 hour fast and wearing light clothes. The participants in the exercise-diet group were cited in the Respiratory Unit of the University of Guadalajara with the indication of not consuming caffeine, tobacco or energy drinks 24 hours before the test, and not having eaten food at least two hours before the Astrand-rhyming Test. This study was approved by the Ethics and Biosafety Committee of the Health Sciences Center, University of Guadalajara (registry number CUCS/CINV/0476/18). The procedures were in accordance with this institution's guidelines and all the participants signed a written consent-informed.

Official Title
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Exercise Program and Diet Intervention Attenuated Inflammation Through Down-regulation of ASC Gene and Inflammatory Markers in Obese Adults

Conditions
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Inflammatory Response, Obesity, Abdominal Obesity, Diet Habit, Exercise

Intervention / Treatment
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* Behavioral: Exercise-Diet Intervention
* Behavioral: Diet Intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: BMI greater than 30 kg/m^2 Sedentary individuals Both genres Waist circumference greater than 80 centimeters in women and greater than 90 centimeters in men Exclusion Criteria: Pregnant or breastfeeding women Diagnosis of any metabolic disease or cancer Alcohol or tobacco consumption Muscle or joint injury

Ages Eligible for Study
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Minimum Age: 25 Years
Maximum Age: 50 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: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Exercise-Diet Group<br>The participants receive a personal exercise program according to Astrand-rhyming test baseline results, and a hypo-caloric diet intervention | Behavioral: Exercise-Diet Intervention<br>* The participants who performed exercise-diet intervention performed an Astrand-rhyming test before and after the exercise program intervention. Participants followed a progressive exercise-program during four months according to initial physical fitness. The main exercises consisted of improving aerobic, speed and resistance performance. During all single sessions, breathlessness and fatigue were measured using 0 to10 Borg scale. A personal trainer certified by American College of Sports Medicine (ACSM) supervised three sessions per week, the other two unsupervised training days the subjects were given the detailed training program to do in house/park. And also, this group received a diet intervention that consisted of a 20 percentage reduction of total energy expenditure estimated by the Mifflin formula with a nutrients distribution as follows: 50% carbohydrates, 30% lipids, and 20% proteins.<br>|
| Active Comparator: Diet Group<br>The participants no receive a personal exercise program, only the hypo-caloric diet | Behavioral: Diet Intervention<br>* This group received a diet intervention that consisted of a 20 percentage reduction of total energy expenditure estimated by the Mifflin formula with a nutrients distribution as follows: 50% carbohydrates, 30% lipids, and 20% proteins.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in ASC mRNA Expression | The polymorphonuclear cells were separated using Dextran treatment from peripheral blood samples. Subsequently, TRIzol® reagent was using according to the manufacturer´s instructions. The complementary DNA (cDNA) synthesis was performed according to standard techniques. Quantitative real-time PCR was performed using TaqMan® probes in Light Cycler 96 equipment considering standards PCR conditions to analyze ASC mRNA relative expression by 2-ΔΔcq method. The amplification reactions were performed in duplicate using β-Actin gene as constitutive gene to normalized the samples. | Mean change from baseline (0 Month) to end of treatment at 4th Month. | 
| Change in Pro-inflammatory and Anti-inflammatory Cytokines | The pro-inflammatory and anti-inflammatory cytokines quantification were using Bio-Plex Pro™ Human cytokine Standard 17-Plex, Group I kit following the supplier's instructions, and the read was immediately by MAGPIX™ analyzer. | Mean change from baseline (0 Month) to end of treatment at 4th Month. | 
| Change in Astrand-rhyming Submaximal Test | The Astrand-rhyming submaximal test was performed as described by Astrand. | Mean change from baseline (0 Month) to end of treatment at 4th Month. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in Height | Height in meters using a stadiometer. | At the baseline (0 Month) and 1st month, 2nd month, 3th month and the 4th month. 1st month, 2nd month, 3th month and the 4th month. | 
| Changes in Weight | The weight was measured in kilograms on InBody 370. | At the baseline (0 Month) and 1st month, 2nd month, 3th month and the 4th month. | 
| Changes in Body Mass Index (BMI) | Weight and height were be combined to report BMI in kg/m^2 | At the baseline (0 Month) and 1st month, 2nd month, 3th month and the 4th month. | 
| Changes in Waist Circumference | Waist circumference was measured at the narrowest point between the edge of the inner rib and the iliac crest, with the participant in an abducted and relaxed position, after expiration using a Lufkin Executive® tape. | At the baseline (0 Month) and 1st month, 2nd month, 3th month and the 4th month. | 
| Changes in Fat Mass | The Fat Mass was measured in kilograms by electrical bioimpedance on InBody 370. | At the baseline (0 Month) and 1st month, 2nd month, 3th month and the 4th month. | 
| Changes in Musculoskeletal Mass | The musculoskeletal mass was measured in kilograms by electrical bioimpedance on InBody 370. | At the baseline (0 Month) and 1st month, 2nd month, 3th month and the 4th month. | 
| Changes in Serum Glucose | It was measured in mg/dL using a dry chemistry system in Vitros 350 equipment. | At the baseline (0 Month) and 1st month, 2nd month, 3th month and the 4th month. | 
| Changes in Serum Insulin | Were determined through Insulin Model ELISA kit following the supplier's instructions. | At the baseline (0 Month), 3th month and the 4th month. | 
| Changes in homeostatic model assessment - insulin resistance (HOMA-IR) | Serum glucose and Insulin levels were be combined to report HOMA-IR calculated as described by Matthews. | At the baseline (0 Month), 3th month and the 4th month. | 
| Changes in Total Cholesterol | It was measured in mg/dL using a dry chemistry system in Vitros 350 equipment. | At the baseline (0 Month) and 1st month, 2nd month, 3th month and the 4th month. | 
| Changes in High-density lipoprotein (c-HDL) | It was measured in mg/dL using a dry chemistry system in Vitros 350 equipment. | At the baseline (0 Month) and 1st month, 2nd month, 3th month and the 4th month. | 
| Changes in Atherogenic Index | Serum total cholesterol and c-HDL were be combined to report atherogenic index, calculated through formula [Total cholesterol (mg/dL) / HDL-c (mg/dL)]. | At the baseline (0 Month) and 1st month, 2nd month, 3th month and the 4th month. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Nutrition, Exercise, Diet, Inflammation, Obesity