Metabolic Flexibility, Gut Microbiota, Healthy Diet and Exercise in NAFLD on Genetics Base

Study Overview
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Brief Summary
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Nonalcoholic fatty liver disease (NAFLD) is associated to obesity, metabolic syndrome and genetic predisposition: specific variants of the genes PNPLA3 and TM6SF2 are the most involved. Also biochemical mechanisms that affect the metabolic flexibility need to be better clarified. It is known that a dietary intervention, accompanied by a physical personalized training, reduce either the hepatic fat content either insulin resistance. Therefore, the aim of the study is to evaluate metabolic flexibility in obese NAFLD subjects taking in account the presence or absence of PNPLA3 and TM6SF2 polymorphism and the histopathological diagnosis of either simple steatosis or nonalcoholic steatohepatitis (NASH). The composition of gut microbiota will be also evaluated. Finally, two distinct healthy dietary profiles accompanied by a personalized physical training, will be tested to comprehend whether and how healthy diets could operate in the clinical treatment of NAFLD and related conditions.

Detailed Description
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Nonalcoholic fatty liver disease (NAFLD) is frequently associated to obesity and metabolic syndrome. In NAFLD, a heritable component to disease susceptibility has been demonstrated: the variants of the genes PNPLA3 and TM6SF2 are the most involved genetic determinants. To date, biochemical mechanisms that affect the metabolic flexibility in obese NAFLD subjects, in presence or absence of genetic susceptibility, need to be better clarified. Different studies demonstrated that a dietary intervention, accompanied by a physical personalized training, significantly reduce either the hepatic fat content either insulin resistance in overweight and obese subjects, independently of weight loss. On these bases, the aim of the study is to evaluate metabolic flexibility in obese NAFLD subjects taking in account their genetics (presence or absence of PNPLA3 and TM6SF2 polymorphisms) and the histopathological diagnosis of either simple steatosis or nonalcoholic steatohepatitis (NASH). In addition, the composition of gut microbiota will be evaluated. Finally, in this study, two distinct healthy dietary profiles accompanied by a personalized physical training, will be tested in order to comprehend whether and how healthy diets could be effective not only in the prevention, but also in the clinical treatment of NAFLD and other related conditions.

Official Title
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Body Composition, Adiposity Phenotype, Metabolic Flexibility, and Gut Microbiota in PNPLA3 and TM6SF2 Gene Variant Carriers and Non-carriers With Nonalcoholic Fatty Liver Disease. Effects of a Nutritional Intervention Combined to Exercise

Conditions
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Non-alcoholic Fatty Liver Disease, Obesity

Intervention / Treatment
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* Dietary Supplement: Mediterranean diet
* Dietary Supplement: Low fat diet
* Other: Aerobic exercise


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: body mass index (BMI) > 30 Kg/m2 and < 40 Kg/m2; Caucasian Italian subjects hepatic steatosis according with ultrasonographic Hamaguchi's criteria and/or hypertransaminasemia (ALT >30 IU/L in men and >20 IU/L in women) Exclusion Criteria: any malignant disease during the last 5 years; any inflammatory or autoimmune disease; corticosteroids for systemic use; renal failure (GFR<90 ml/min); heart failure (NYHA classes II-IV); history of viral or autoimmune liver disease; any cause cirrhosis; excessive alcohol intake (>140g/week for men and 70g/week for women); participation in a reducing-weight program in the last 3 months; level of physical activity higher than 3 METs; therapy with antibiotics during the last 3 months; bile salts, cholestyramine during the last 6 months before enrollment; previous cholecystectomy; gallbladder disease

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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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Nonalcoholic fatty liver disease (NAFLD) is associated to obesity, metabolic syndrome and genetic predisposition: specific variants of the genes PNPLA3 and TM6SF2 are the most involved. Also biochemical mechanisms that affect the metabolic flexibility need to be better clarified. It is known that a dietary intervention and a physical personalized training, reduce either the hepatic fat content either insulin resistance. Therefore, the aim of the study is to evaluate metabolic flexibility in obese NAFLD subjects taking in account the presence or absence of PNPLA3 and TM6SF2 polymorphism and the histopathological diagnosis of either simple steatosis or nonalcoholic steatohepatitis (NASH). The composition of gut microbiota will be also evaluated. Finally, two distinct healthy dietary profiles accompanied by a personalized physical training, will be tested to comprehend whether and how healthy diets could operate in the clinical treatment of NAFLD and related conditions.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Mediterranean diet<br>Hypocaloric Mediterranean diet for a 4-month period; Aerobic exercise training for a 4-month period; | Dietary Supplement: Mediterranean diet<br>* In the Mediterranean diet fat intake will be equal to 35% of the total energy intake minus carbohydrate and protein energy carbohydrate as 65% of total calorie intake, dietary cholesterol <300 mg/day, dietary fiber 25 g/day.<br>Other: Aerobic exercise<br>* A personalized program of aerobic exercise will be prescribed to the participants of both arms, following the FITT principles (frequency, intensity, time and type).<br>|
| Experimental: Low fat diet<br>Hypocaloric low fat diet supplemented by branched and essential amino acids considering the total protein intake for a 4- month period; Aerobic exercise training for a 4- month period; | Dietary Supplement: Low fat diet<br>* In the hypocaloric low fat diet, fat will represent less than 25% of the total energy intake. Branched and essential amino acids will be administered taking into account the total protein intake.<br>Other: Aerobic exercise<br>* A personalized program of aerobic exercise will be prescribed to the participants of both arms, following the FITT principles (frequency, intensity, time and type).<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cholesterol assessment | total cholesterol, HDL- cholesterol, LDL- cholesterol levels reported as mg/dl | baseline | 
| Cholesterol assessment | total cholesterol, HDL- cholesterol, LDL- cholesterol levels reported as mg/dl | 18 weeks after baseline | 
| triglycerides assessment | tryglicerides levels reported as mg/dl | baseline | 
| triglycerides assessment | tryglicerides levels reported as mg/dl | 18 weeks after baseline | 
| metabolic flexibility variation in liver function; | alanine aminotransferase (ALT) [U/L] , aspartate aminotransferase (AST) [UI/L] | baseline | 
| metabolic flexibility variation in liver function; | alanine aminotransferase (ALT) [U/L] , aspartate aminotransferase (AST) [UI/L] | 18 weeks after baseline | 
| Waist circumference measurements; | waist circumference reported as cm | baseline | 
| Waist circumference measurements; | waist circumference reported as cm | 18 weeks after baseline | 
| anthropometric measurements; | Body mass index reported as kg/m^2 | baseline | 
| anthropometric measurements; | Body mass index reported as kg/m^2 | 18 weeks after baseline | 
| Ultrasonographic examination; | Liver ultrasonography according with criteria by Hamaguchi | baseline | 
| Ultrasonographic examination; | Liver ultrasonography according with criteria by Hamaguchi | 18 weeks after baseline | 
| Glucidic profile | fasting glucose reported as mg/dl | baseline | 
| Glucidic profile | fasting glucose reported as mg/dl | 18 weeks after baseline | 
| Insulinemia | insulin reported as µU/mL | baseline | 
| Insulinemia | insulin reported as µU/mL | 18 weeks after baseline |