Alleviation Of Metabolic Endotoxemia In Adults With Metabolic Syndrome With Milk Fat Globule Membrane

Study Overview
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Brief Summary
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Metabolic syndrome (MetS) adults (n = 24; 18-65 y) will be enrolled to complete a 2-arm, double-blind, randomized controlled, crossover trial. They will be randomized in 4-unit blocks to receive, for 14 d, a controlled diet with dairy milk (3.5% fat; 3 servings/d) enriched with milk fat globule membrane (MFGM, MEB) or a matched dairy milk that instead contains soy lecithin/phospholipid (control, COMP). All foods during each study period will be provided to ensure weight maintenance and to increase homogeneity of gut and host responses. Anthropometrics and blood pressure will be assessed at days 0, 7, and 14. Prior to (day 0) and after each 2-wk arm (day 14), a fasting blood sample will be collected to assess serum endotoxin and metabolic chemistries (glucose, lipids, insulin), and Toll-like receptor 4 /nuclear factor kappaB (TLR4/NFκB)-dependent genes from whole blood. A breath sample will be collected to assess the correlation analysis of plasma metabolic biomarkers. After the 2-week intervention, from fecal samples collected on day 13, the investigators will assess microbiota composition and function, short chain fatty acids (SCFA), and intestinal inflammatory markers (calprotectin, myeloperoxidase). On d 14, participants in the fasted state will receive a high-fat/high-glucose meal challenge to induce gut-derived endotoxin translocation. At 30-minute intervals for 3-hour, the investigators will evaluate circulating endotoxin, glucose, and insulin; TLR4/NFκB-dependent genes will be assessed from whole blood at 0 hour and 3-hour. Gut permeability probes will be co-administered with the test meal challenge, and 24-hour urine will be collected to assess gut barrier integrity. Participants will then undergo a 2-week washout prior to receiving the alternative treatment and completing all procedures in an identical manner.

Detailed Description
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Background and hypothesis: Our preclinical evidence shows that phospholipid-rich milk fat globule membrane (MFGM) attenuates lipopolysaccharide-induced increases in gut permeability and pro-inflammatory cytokines. MFGM also attenuates inflammation in association with a prebiotic and/or antimicrobial activity that modulates microbiota composition. Our central hypothesis is that MFGM-enriched dairy milk compared with a matched milk beverage containing soy lecithin (control) decreases metabolic endotoxemia and improves glucose tolerance in metabolic syndrome (MetS) adults by increasing gut barrier integrity in association with alleviating gut dysbiosis and inflammation. Study Design: The investigators will enroll male and female MetS adults (n = 24; 18-65 y) to complete a 2-arm, double-blind, randomized controlled, crossover trial. They will be randomized in 4-unit blocks to receive, for 14 days, a controlled diet with dairy milk (3.5% fat; 3 servings/d) enriched with MFGM-derived phospholipid or a matched dairy milk that instead contains coconut and palm oil (control). The investigators will provide all foods during each study period to ensure weight maintenance and to increase homogeneity of gut and host responses. Subjects: Participants will be recruited from Columbus, OH area. Participants having no history of liver or cardiovascular disease or cancer will be enrolled. They will have ≥3 established criteria for MetS: i) glucose (100-126 mg/dL), ii) waist circumference (>89 or >102 cm for F/M), iii) HDL-C (<50 or <40 mg/dL in F/M), iv) TG >150 mg/dL, and iv) blood pressure >130/85 mmHg. Major exclusion criteria include: unstable body mass (±2 kg over prior 3-mo) vegetarian; food allergies or lactose intolerance; user of dietary supplements or probiotics (within past 1-mo); pregnancy, lactation, changes in birth control (within 6-month); any gastrointestinal disorders; chronic diarrhea; smoker; excess alcohol (>2 drinks/day); excess aerobic exercise (>7 h/week); recent antibiotic or anti-inflammatory agent use; blood pressure >140/90 mmHg. Dietary Control: The intervention will be performed in the Human Nutrition Metabolic Kitchen under the auspice of a registered dietitian (PI Bruno). In each 2-wk intervention, participants' diet will be rigorously controlled. All foods will be prepared, packaged, and provided every 3-4 days to supply a weight maintenance (i.e. eucaloric) diet. To assess compliance, participants will return MFGM/coconut/palm oil milk bottles for counting and any uneaten food portions for weighed measurement. Milk beverages will also be formulated to contain para-aminobenzoic acid (PABA; 80 mg/milk serving). Spot urine samples will be collected 4 times during each study arm coinciding when participants pick up test foods. Urinary PABA will be measured by spectrophotometry. Separate from this, participants will also keep food logs to document any dietary deviation. Diets will be standardized at 50-60% of energy from carbohydrate with low fiber intakes ( 15 g/day) similar to Americans' diets to prevent potential masking of the benefits of MFGM, 15-20% from protein, and 25-30% from fat. Importantly, other than test beverages provided as part of the eucaloric diet, diets will be otherwise devoid of significant amounts of dairy foods, fermented products, and probiotics to prevent confounding effects. Measurements: Anthropometrics and blood pressure will be assessed at days 0, 7, and 14. Prior to (day 0), at day 7 and after each 2-wk arm (day 14), a fasting blood sample will be collected to assess serum endotoxin and metabolic chemistries (glucose, insulin, lipids (triglyceride, total and HDL cholesterol), and TLR4/NFκB-dependent genes from whole blood. A breath sample will be collected to assess the correlation analysis of plasma metabolic biomarkers. After the 2-week intervention, from fecal samples collected on day 13, the investigators will assess microbiota composition and function, SCFAs, and intestinal inflammatory markers (calprotectin, myeloperoxidase). During this period, participants will also record daily stool characteristics using a 7-point Bristol Stool scale. On days 14, participants in the fasted state will receive a high-fat/high-glucose meal challenge to induce gut-derived endotoxin translocation. At 30-minute intervals for 3 hours, the investigators will evaluate circulating endotoxin, glucose, and insulin; TLR4/NFκB-dependent genes will be assessed from whole blood at 0 hour and 3-hour. Gut permeability probes will be co-administered with the test meal challenge, and 24-hour urine will be collected to assess gut barrier integrity. Participants will then undergo a 2-week washout prior to receiving the alternative treatment and completing all procedures in an identical manner.

Official Title
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Alleviation Of Metabolic Endotoxemia In Adults With Metabolic Syndrome With Milk Fat Globule Membrane

Conditions
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Metabolic Syndrome, Metabolic Endotoxemia

Intervention / Treatment
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* Dietary Supplement: MFGM-enriched full-fat dairy milk
* Dietary Supplement: Soy phospholipid/lecithin milk


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Serum Glucose 100-126 mg/dl Waist C >89/102 cm; F/M Serum HDL-C: <50/40 mg/dl; F/M Serum TG: >150 mg/dl BP >130/85 mmHg Serum Endotoxin >25 EU/ml Exclusion Criteria: Unstable body mass (±2 kg over prior 3-mo) Vegetarian Food allergies or lactose intolerance User of dietary supplements or probiotics (within past 1-mo) Pregnancy, lactation, changes in birth control (within 6-mo) Any gastrointestinal disorders Chronic diarrhea Smoker Excess alcohol (>2 drinks/d) Excess aerobic exercise (>5 h/wk) Recent antibiotic or anti-inflammatory agent use BP >140/90 mmHg

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 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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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Crossover Assignment
Interventional Model Description: 2-arm, double-blind, randomized controlled, crossover trial
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: MFGM-enriched full-fat dairy milk<br>Participants in this arm will receive MFGM-enriched full-fat dairy milk (3 servings/d) that contains MFGM at 10% phospholipid (relative to total lipid content) delivering MFGM at  10-times that in full-fat dairy milk. | Dietary Supplement: MFGM-enriched full-fat dairy milk<br>* MetS adults with metabolic endotoxemia will be enrolled to complete a 2-arm, double-blind, randomized controlled, crossover trial to test the independent benefits of MFGM. For each 2-wk arm, they will receive MFGM-enriched full-fat dairy milk (3 servings/d) or a matched dairy milk that instead contains soy phospholipid/lecithin (control). Milks have been formulated with soy lecithin or MFGM at 10% phospholipid (relative to total lipid content). This delivers MFGM at  10-times that in full-fat dairy milk, which reflects that consumers obtain MFGM from dairy foods other than whole milk.<br>|
| Placebo Comparator: Soy phospholipid/lecithin milk<br>Participants in this arm will receive a matched dairy milk that instead contains soy phospholipid/lecithin. | Dietary Supplement: Soy phospholipid/lecithin milk<br>* MetS adults with metabolic endotoxemia will be enrolled to complete a 2-arm, double-blind, randomized controlled, crossover trial to test the independent benefits of MFGM. For each 2-wk arm, they will receive MFGM-enriched full-fat dairy milk (3 servings/d) or a matched dairy milk that instead contains soy phospholipid/lecithin (control). Milks have been formulated with soy lecithin or MFGM at 10% phospholipid (relative to total lipid content).<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Serum Endotoxin (LPS) | Between-treatment change in serum endotoxin (fasting) on day 14 relative to day 0 | day 14 | 
| Serum Endotoxin (LPS) | Between-treatment difference in the area under the curve of serum endotoxin (0-3 hours) on day 14 | day 14 (0, 30, 60, 90, 120, 150, 180 minutes post-meal challenge) | 
| Plasma Glucose | Between-treatment change in plasma glucose (fasting) on day 14 relative to day 0 | day 14 | 
| Plasma Glucose | Between-treatment difference in the area under the curve of plasma glucose (0-3 hours) on day 14 | day 14 (0, 30, 60, 90, 120, 150, 180 minutes post-meal challenge) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Plasma Insulin | Between-treatment change in plasma (fasting) on day 14 relative to day 0 | day 14 | 
| Plasma Insulin | Between-treatment difference in the area under the curve of plasma insulin (0-3 hours) on day 14 | day 14 (0, 30, 60, 90, 120, 150, 180 minutes post-meal challenge) | 
| Plasma HDL-C | Between-treatment change in plasma HDL-C (fasting) on day 14 relative to day 0 | day 14 | 
| Plasma Triglyceride | Between-treatment change in plasma triglyceride (fasting) on day 14 relative to day 0 | day 14 | 
| Plasma Total Cholesterol | Between-treatment change in plasma total cholesterol (fasting) on day 14 relative to day 0 | day 14 | 
| Plasma glucagon-like peptide-1 | Between-treatment change in plasma glucagon-like peptide-1 (fasting) on day 14 relative to day 0 | day 14 | 
| Urine Lactulose | Between-treatment difference in 24 hour urinal excretion of lactulose post-meal challenge on day 14 | day 14 | 
| Urine sucralose | Between-treatment difference in 24 hour urinal excretion of sucralose post-meal challenge on day 14 | day 14 | 
| Urine erythritol | Between-treatment difference in 24 hour urinal excretion of erythritol post-meal challenge on day 14 | day 14 | 
| Urine mannitol | Between-treatment difference in 24 hour urinal excretion of mannitol post-meal challenge on day 14 | day 14 | 
| Fecal bacterial abundance and composition | Between-treatment difference in fecal bacterial abundance and composition on day 13 | day 13 | 
| Fecal Acetate | Between-treatment difference in fecal acetate on day 13 | day 13 | 
| Fecal Butyrate | Between-treatment difference in fecal butyrate on day 13 | day 13 | 
| Fecal Propionate | Between-treatment difference in fecal propionate on day 13 | day 13 | 
| Plasma gastric inhibitory polypeptide (GIP) | Between-treatment change in plasma gastric inhibitory polypeptide (GIP) (fasting) on day 14 relative to day 0 | day 14 | 
| Fecal Calprotectin | Between-treatment difference in fecal calprotectin on day 13 | day 13 | 
| Fecal Myeloperoxidase | Between-treatment difference in fecal myeloperoxidase on day 13 | day 13 | 
| Circulating Toll-like receptor 4 mRNA | Between-treatment change in circulating Toll-like receptor 4 mRNA (fasting) on day 14 relative to day 0 | day 14 | 
| Circulating IL-6 mRNA | Between-treatment change in circulating IL-6 mRNA (fasting) on day 14 relative to day 0 | day 14 | 
| Circulating TNFa mRNA | Between-treatment change in circulating TNFa mRNA (fasting) on day 14 relative to day 0 | day 14 | 
| Circulating Toll-like receptor 4 mRNA | Between-treatment change in circulating Toll-like receptor 4 mRNA post meal challenge (0-3 h) on day 14 | day 14 (0, 3 hour post-meal challenge) | 
| Circulating IL-6 mRNA | Between-treatment change in circulating IL-6 mRNA post meal challenge (0-3 h) on day 14 | day 14 (0, 3 hour post-meal challenge) | 
| Circulating TNFa mRNA | Between-treatment change in circulating TNFa mRNA post meal challenge (0-3 h) on day 14 | day 14 (0, 3 hour post-meal challenge) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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metabolic endotoxemia, milk fat globule membrane, gut health, endotoxin, inflammation, obesity