Impact of the Metabolic Syndrome on the Incidence of Neuropathy in Obese Subjects

Study Overview
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Brief Summary
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The primary purpose of this study is to discover modifiable risk factors for the development of neuropathy, specifically looking at the metabolic syndrome.

Detailed Description
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The investigators propose to follow obese individuals and determine the impact of the aspects of the metabolic syndrome on the incidence of neuropathy compared to lean individuals. While there are many well established relationships between obesity and disease, the association of obesity and the metabolic syndrome with peripheral neuropathy is less clear. The investigators will be following a population of 300 adult individuals age 18 years or older with obesity and 300 adult individuals without obesity or any aspect of the metabolic syndrome (hyperlipidemia, hypertriglyceridemia, hypertension, hyperglycemia, obesity). Obese subjects will be recruited through the Investigational Weight Management Clinic. A proportion of the subjects will be recruited through Blue Care Network of Michigan (BCN) as part of their Healthy Blue Living campaign which is supporting clinical care of up to 400 individuals in the clinic. The individuals not recruited directly through the clinic will be identified via flyer, word of mouth, and umclinicalstudies.org. The phenotyping information for the obese subjects will be already completed as part of the initial project. Lean subjects will undergo screening for eligibility, which includes taking height, weight, blood pressure, lipid profile, and glucose tolerance test. Neuropathy measures completed at baseline and 2 years (obese subjects only) include: definite clinical neuropathy will be established using Toronto consensus guidelines based upon neurologic exam, nerve conduction studies, Michigan Neuropathy-Specific Instrument, Utah Early Neuropathy Scale, balance and hip strength measures, cognitive testing (computerized cognitive screening to determine how obesity affects the central nervous system) (also done at time 12 +/- 4 weeks and 52 +/- 4 weeks post-baseline visit), neurothesiometer testing, skin biopsy to determine nerve fiber density, Quantitative Sudomotor Axon Reflex Test (QSART) to measures the autonomic nerves that control sweating, heart rate variability/cardiac autonomic neuropathy testing to assess for autonomic neuropathy, quantitative sensory testing to assess for small fiber neuropathy, Sudoscan to assess sweat gland function, and the following questionnaires: Neuropathy Quality of Life, McGill Pain, Autonomic symptoms profile. The investigators intend to demonstrate that obesity and other aspects of the metabolic syndrome have a direct impact on the incidence of peripheral neuropathy.

Official Title
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The Impact of the Metabolic Syndrome on the Incidence of Neuropathy in Obese Subjects

Conditions
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Metabolic Syndrome, Obesity, Neuropathy

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age over 18 Willing and able to provide written informed consent, enrolled in the Investigational Weight Management Clinic at the University of Michigan Exclusion Criteria: Taking blood thinning medications, except aspirin, Evidence of inherited disorders of lipid metabolism History of cancer within the last 5 years Human immunodeficiency virus (HIV) antibody positive Subjects with solid organ transplants Participation in any other clinical trial within 90 days of entry into this trial Pregnant or lactating females Uncontrolled thyroid disease Unstable angina or New York heart association class II failure or above Gastrointestinal disease specifically gastrointestinal motility disorders Unstable neuropsychiatric disease including major depression/anxiety, bulimia, or anorexia End stage renal or hepatic disease Autoimmune disorders (e.g. lupus) Body weight fluctuation of more than 5 kg in the previous 3 months Prior bariatric surgery A history or current substance abuse, change in smoking habits, or cessation in the past 6 months Women of childbearing age must use a reliable form of contraception Any medical condition, which would make the patient unsuitable for recruitment, or could interfere with the patient participating in or completing the protocol

Ages Eligible for Study
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Minimum Age: 18 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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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Obese participants<br>Obese participants recruited from the University of Michigan Investigational Weight Management Clinic. Subjects in this group complete the five surveys, undergo extensive metabolic phenotyping, and a comprehensive neuropathy assessment at study entry and again at 2 years. | |
| Lean participants<br>Healthy lean age and gender matched controls recruited via the umclinicaltrials.org complete the five surveys, complete an oral glucose tolerance test and cholesterol panel, as well as the complete comprehensive neuropathy assessment. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Neurologist history and examination for presence of neuropathic symptoms, abnormal sensory examination findings, and abnormal reflexes (no specific instrument) | Toronto definition of probable clinical neuropathy (2 or 3 out of 3 of the following: neuropathic symptoms, sensory examination findings, and reflexes) | Baseline | 
| Nerve fiber density at the leg |  | Change from baseline to year 2 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Sural sensory nerve conduction amplitude | Physiologic parameter | Baseline and 2 year | 
| Peroneal motor nerve conduction amplitude | Physiologic parameter | Baseline and 2 year | 
| Tibial motor nerve conduction amplitude | Physiologic parameter | Baseline and 2 year |