MLCT Oil for Fatty Liver - PASS Trial

Study Overview
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Brief Summary
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The main objective of this randomised pilot study is to explore the relative efficacy of dietary MLCT oil versus LCT oil (corn oil) in augmenting therapy of overweight and obese NAFLD patients with at least a 1-stage reversal between F1 and F4.

Detailed Description
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The hypothesis of the study will be that daily intake of MLCT oil is more effective than corn oil in improving either NAFLD or NASH phenotype, with a greater reduction in liver fibrosis stage of participants with NASH. The single-centre trial is a 2-arm, randomized pilot study with stratification by BMI. Up to 30 participants with biopsy/imaging proven NAFLD / NASH would undergo blinded 1:1 allocation to either control or test group. All participants would be offered biopsy, whereby a repeat liver biopsy would be undertaken at the end of the study (6 months) to investigate the efficacy of dietary MLCT versus corn oil in augmenting therapy of NASH. Dietary counselling for the participants will be provided by NUH dietician on 6 weekly basis on how to adhere to the required dietary regimen. For the first 12 weeks, participants are to consume only the 3 provided RTE meals (breakfast, lunch and dinner), with additional fruits or low calories snacks to be advised by dietician. During the second 12-week experimental period, participants will follow strict dietary guideline under the recommendation of the NUH dietician and have oil-containing products [chocolate sauce / oatmeal biscuits] with 30 g of corn or MLCT oil per day. During the 6 months, study participants would be followed up at 0, 3, 6, 9, 12, 18 and 24 weeks. During each of the follow up visit, the participant would have blood drawn, urine and stool collected as per study schedule.

Official Title
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A Randomised Controlled Pilot Study to Test the Role of Medium- and Long-chain Triacylglycerols (MLCT) in Reversing the Phenotype of Non-alcoholic Steatohepatitis (NASH) Patients

Conditions
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Non-Alcoholic Fatty Liver Disease, Non-Alcoholic Steatohepatitis, NAFLD

Intervention / Treatment
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* Dietary Supplement: MLCT Oil
* Dietary Supplement: LCT Oil (Corn Oil)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Between 21 to 65 years old; Body mass index (BMI) 23 kg/m2 or higher; NAFLD or NASH as determined by liver biopsies within last 2 years with fibrosis stage F1-F4; OR Presence of steatosis and fibrosis via Transient Elastography / MRI Participants willing and able to adhere to the prohibitions and restrictions specified in the protocol; Participants willing and able to adhere to the dietary prescription as in the study protocol; Participants willing and able to provide written informed consent. Participants able to read and write English, and own a smartphone with a data plan Exclusion Criteria: Poorly controlled diabetes Poorly controlled hypertension Estimated glomerular filtration rate of less than 60 ml/min/1.73m2; Presence of active alcoholic liver disease, chronic viral hepatitis, drug-induced hepatitis; autoimmune hepatitis, and liver cancer; A history of Type 1 diabetes mellitus or previous admission for diabetic ketoacidosis; Recurrent urinary tract infection (2 or more over the past one year); Having any medical condition that would affect metabolism (i.e. Cushing syndrome, known active hyperthyroidism or hypothyroidism); Serious medical disease with likely life expectancy less than 5 years; Recently started on selected diabetes / hypertensive medications. Must be on stable doses. Ongoing eating disorder or significant weight loss or weight gain as defined by change of 5% or more within 12 weeks before screening visit; History of any malignancy within 5 years of screening; Women who are pregnant or plan to become pregnant; Taking alcohol above the limit recommended (i.e. consumed more than 10 g/day for women or 20 g/day for men); Participation in other clinical trial in the 30 days before randomization; Participants who cannot be followed up for at least 6 weeks (due to health situation or travel); Having allergies / intolerances to the ingredients in the prepared meals or oil-containing products of the study; Having chronic gastrointestinal disorders; Having taken antibiotics in the last 3 months; Participants with arthropathy, CVM, CVA disorder or any systemic disorder which render or when intervention may be dangerous.

Ages Eligible for Study
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Minimum Age: 21 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: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Treatment<br>MLCT oil (provided through ready to eat meals and snacks) | Dietary Supplement: MLCT Oil<br>* 1st 12 weeks: frozen ready to eat meals prepared with the oil Last 12 weeks: own diet with provided snacks containing the oil<br>|
| Placebo Comparator: Control<br>Corn oil (provided through ready to eat meals and snacks) | Dietary Supplement: LCT Oil (Corn Oil)<br>* 1st 12 weeks: frozen ready to eat meals prepared with the oil Last 12 weeks: own diet with provided snacks containing the oil<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Liver Fibrosis | Change in liver fibrosis through liver biopsy or imaging | 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Body Weight | Change in body weight (kg) | 6 months | 
| Body fat composition | Change in body fat composition using MRI body profiler (%) | 6 months | 
| Blood pressure | Change in blood pressure using blood pressure monitor (mmHg) | 6 months | 
| Body circumferences | Change in waist and hip circumference using measuring tape (cm) | 6 months | 
| Blood lipid profile (HDL, LDL, Total cholesterol, Triglycerides) | Change in fasting blood lipid profile (mmol/L) | 6 months | 
| Fasting Insulin and Glucose | Change in fasting Insulin and Glucose (mmol/L) | 6 months | 
| Haemoglobin A1c | Change in HBA1c (mmol/mol) | 6 months | 
| Liver function panel (Albumin, Bilirubin, ALT, AST, ALP, LDH, GGT) | Change in Albumin (g/L), bilirubin (umol/L), ALT, AST, ALP, LDH, GGT (U/L) | 6 months | 
| Creatinine | Change in serum and urine creatinine (umol/L) | 6 months | 
| Beta-hydroxybutyrate | Change in beta-hydroxybutyrate (mmol/L) | 6 months | 
| C-peptide | Change in C-peptide (pmol/L) | 6 months | 
| Oral glucose tolerance test | Change in glucose level at 120hr timepoint (mmol/L) | 6 months | 
| C-reactive protein (CRP) | Change in CRP (mg/L) | 6 months | 
| Inflammatory markers - IL-6, IL-1, TNFalpha | Change in inflammatory markers - IL-6, IL-1, TNFalpha | 6 months | 
| Gut microflora composition | Change in gut microbiota using gut metagenomics profiling | 6 months |