Intensive Lifestyle Intervention for Remission of Metabolic Syndrome

Study Overview
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Brief Summary
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It is a multi-center, randomized, prospective clinical study in metabolic syndrome with obese and overweight of Han Chinese population. The purpose of the study is to examine the effect of a programed intensive lifestyle intervention on weight loss (15%) and the remission of metabolic syndrome, and also its underlying mechanisms.

Detailed Description
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Metabolic syndrome is a worldwide problem to public health, with a prevalence rate of 10-84% according to previous studies. It is associated with a series of chronic non-communicable diseases, including type 2 diabetes, cardiovascular diseases, non-alcoholic fatty liver, polycystic ovary syndrome, cancer, and etc. Worth noting, obesity contributed a lot to the occurrence of metabolic syndrome, and many studies had proven the positive significance of sufficient weight loss to the improvement of components of metabolic syndrome. The study is examining the effect of an intensive lifestyle intervention program, designed to achieve and maintain a 15% decrease in body weight by intensive calorie restriction and physical exercise, in overweight and obese volunteers with metabolic syndrome. In this program, volunteers will be supposed on very low calorie diet with partial diet replacement, followed by carefully managed food reintroduction and then weight loss maintenance. In addtion, mobile phone applications (apps) will be used during the weight loss program. The control group will be involved in a control condition involving a program of metabolic support and education, designed to achieve and maintain a 5% decrease in body weight. Mobile phone applications (apps) will be alos adopted during the weight loss program. The study will also test the effect of intensive lifestyle intervention on appetite, body fat, abdominal fat, gut microbiota, bone mineral density, vascular endothelial function, and etc.

Official Title
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Intensive Lifestyle Intervention for Remission of Metabolic Syndrome in Overweight or Obese Han Chinese Population

Conditions
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Metabolic Syndrome

Intervention / Treatment
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* Behavioral: Intensive Lifestyle Intervention
* Behavioral: Conventional Treatment


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: BMI of 27-45 kg/m2 Metabolic syndrome: meet at least 3 of the following 5 criteria: Waist circumference ≥85 cm (male) or 80 cm (female); TG ≥150 mg/dL or with lipid-lowering treatment; HDL<40 mg/dL (male) /50 mg/dL (female)；SBP ≥ 130 mmHg and / or DBP ≥ 85 mmHg and / or with diagnosed hypertension and anti-hypertensive treatment; fasting glucose ≥ 5.6 mmol/L and / or with diagnosed type 2 diabetes and hypoglycemic treatment. (If with type 2 diabetes, the process of the disease should not exceed 6 years, with the level of C-P ≥3/4 of the lower limit of limit; if with hypertension, BP ≤ 180/110 mmHg without anti-hypertensive agent, or BP ≤160/100 mmHg with 1-2 kinds of anti-hypertensive agents, or BP ≤140/90 mmHg with 3-4 kinds of anti-hypertensive agents; if with hyper-triglyceridemia, TG ≤ 11.2 mmol/L without lipid-lowering agent, or TG ≤ 5.6 mmol/L with lipid-lowering agent.) Han Chinese Willingness to participate Exclusion Criteria: Participants with metabolic syndrome caused by other secondary factors (genetic diseases related to obesity and hyperlipidemia, Cushing's syndrome, drug-induced obesity and etc.); Participants whose body weight fluctuated by more than 5 kg in the last 6 months; who trying to lose weight in the last 3 months; Who had used anti-obesity drugs, oral contraceptive, or glucocorticoids in the last 3 months; Participants with Type 1 diabetes or gestational diabetes or other types of diabetes; Participants with BP ≥ 180/110 mmHg, or malignant hypertension; Participants with previous severe gastrointestinal diseases; Participants with significant dysfunction of heart, liver, kidney and systemic organs (NYHA Class III or IV; ALT and / or AST ≥ 5 times the normal upper limit; GFR < 60 ml/min) or with malignant tumor; Participants with drug abuse or alcohol addiction; with serious mental and neurological disorders; Pregnant or lactating women; Those who have planned to give birth within the past 1 year; Participants with special dietary requirements, or with soy products, milk and other daily food allergies; Participants in other clinical trials.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 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: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intensive Lifestyle Intervention<br>Participants in the intensive lifestyle intervention arm are offered individual and group sessions designed to help achieve and maintain a 15% weight loss. | Behavioral: Intensive Lifestyle Intervention<br>* The lifestyle intervention is implemented with individual supervision sessions and is aimed at achieving and maintaining at least a 15% decrease in weight from baseline. It is implemented during a 12-month period with the most intensive application during the first 4 months. To help participants achieve and maintain weight loss, partial diet replacement with very low calorie diet, strengthend exercise strategies. Mobile phone applications (apps) will be used to manage metabolic syndrome during weight loss program. Optional medications on metabolic syndrome will be utilized based on a preset algorithm and participant progress.<br>|
| Active Comparator: Conventional Treatment<br>The conventional treatment arm provides group sessions on metabolic syndrome management and social support, aimed at a 5% weight loss. | Behavioral: Conventional Treatment<br>* Participants assigned to conventional treatment and education are offered metabolic syndrome management and social support every 1 month, aimed at achieving and maintaining a 5% decrease in weight in 1 year. Mobile phone applications (apps) will also be used in the weight loss program.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The remission rate of metabolic syndrome | Participants who no longer meet the diagnostic criteria of metabolic syndrome. meet 2 or less of the following 5 criteria: Waist circumference ≥85 cm (male) or 80 cm (female); TG ≥150 mg/dL or with lipid-lowering treatment; HDL<40 mg/dL (male) /50 mg/dL (female)；SBP ≥ 130 mmHg and / or DBP ≥ 85 mmHg and / or with diagnosed hypertension and anti-hypertensive treatment; fasting glucose ≥ 5.6 mmol/L and / or with diagnosed type 2 diabetes and anti-hyperglycemic treatment. | 12 months | 
| The proportion of participants with wight loss exceeding 15% | The proportion of participants maintaining a weight loss of more than 15%. | 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Remission of hypertension | The proportion with BP<130/85mmHg or BP<140/90mmHg without medication. | 12 months | 
| Remission of hyperglycemia | The proportion with fasting blood glucose <5.6 mmol/L without medication. | 12 months | 
| Remission of hypertriglyceridemia | The proportion with blood triglyceride<150 mg/dl without medication. | 12 months | 
| Remission of low HDL-C | The proportion with HDL-C≥40 mg/dl in male or ≥50 mg/dl in female without medication. | 12 months | 
| Remission of central obesity | The proportion with waist circumference <85 cm in male or <80 cm in female. | 12 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Metablolic syndrome, remission, life style, weight loss