Time Restricted Eating to Mitigate Obesity in Veterans With Spinal Cord Injury

Study Overview
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Brief Summary
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Spinal cord injury (SCI) causes paralysis and muscle atrophy and leads to weight gain and obesity. Obesity directly contributes to functional impairment and cardiometabolic dysfunction. There is a critical need to reduce the growing prevalence of obesity and cardiometabolic disease after SCI. My overall objective in this project is to gather crucial feasibility data on time restricted eating (TRE), a novel form of intermittent fasting. TRE is a straightforward method to induce weight loss without the need for calorie counting. TRE allows individuals to eat all their daily calories in a time restricted window and fast outside that window. A growing body of literature supports the safety and efficacy of TRE. Given the feasibility, high adherence, and substantial benefits of TRE in able-bodied individuals, it is important to test TRE to determine its feasibility in Veterans with SCI. The investigators will first test this intervention in Veterans with thoracic paraplegia, who are at greatest risk of muscle-joint upper body injury given the need to support body weight during activity. The investigators will determine adherence to a TRE window for 6-weeks duration in a convenience sample of Veterans with thoracic paraplegia and obesity. Based on the expected outcomes of good adherence, this study will lay the groundwork for future work by informing the design of a randomized controlled trial to test the efficacy of TRE to facilitate weight loss and improve function.

Official Title
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Time Restricted Eating to Mitigate Obesity in Veterans With Spinal Cord Injury

Conditions
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Spinal Cord Injury, Obesity

Intervention / Treatment
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* Behavioral: Time Restricted Eating


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Veteran, age 18 to 75 years old The Syracuse SCI registry includes adults only, so the youngest age of enrollment is 18. The effects of fasting on age-induced sarcopenia remain uncertain; therefore, the investigators will cap the age at 75 years old A member of the Spinal Cord Injury/Disorder (SCI/D) registry through the Syracuse VA, including both hub and spoke sites A qualifying diagnosis of SCI within the SCI/D registry Neurologic level of injury from T1 to T12, based on most recent Status Update or ASIA examination ASIA Impairment Scale grade A-D Chronic SCI (> 1 year from date of SCI or diagnosis of SCI) BMI = 22 - the BMI used to diagnose obesity in individuals with SCI Mean eating window of at least 12 hours per day Exclusion Criteria: Females who are pregnant (tested via urinary hCG), planning to become pregnant in the next 6 months, or breast-feeding A member of the SCI/D registry through the Syracuse VA, with a qualifying diagnosis of MS or ALS Diagnosis of heart failure Diagnosis of diabetes mellitus, type 1 Diagnosis of diabetes mellitus, type 2, and on insulin or other antidiabetic agent with high incidence of hypoglycemia o Of note, antidiabetic agents with low incidence of hypoglycemia are: metformin, GLP-1 receptor agonists, SGLT2 inhibitors, DPP4 inhibitors, alpha glucosidase inhibitors, thiazolidinediones (as discussed with VA pharmacist) Diagnosis of End Stage Renal Disease Diagnosis of dementia Diagnosis of orthostatic hypotension and prescribed midodrine or fludrocortisone History of syncopal episode in the month prior to the study History of significant weight loss (> 10% body weight) in the month prior to the study History of eating disorders (e.g., anorexia or bulimia) within the last five years, or clearance from a mental health provider History of active suicidal ideation in the last six months, or clearance from a mental health provider Currently prescribed weight loss medication (e.g., liraglutide) Currently prescribed corticosteroids Current acute medical issues including cancer, sepsis, advanced liver failure, porphyria, or uncontrolled hyperthyroidism

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 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: Other
Intervention Model: Single Group Assignment
Interventional Model Description: Intervention: This is a single-arm study in a convenience sample of Veterans with thoracic paraplegia and obesity. Research Design: Those with mean eating windows of at least 12 hours per day will be eligible to participate in the TRE intervention. Tests for adherence (food logs and time-stamped digital data) will be collected.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Time Restricted Eating<br>This is a single-arm study in a convenience sample of Veterans with thoracic paraplegia and obesity. The intervention will test adherence of participants to a TRE window with a self-selected start time. The duration of the eating window will initially be 12 hours, then transition to 10 hours at the end of week 2, maintained through study's end (end of week 6). | Behavioral: Time Restricted Eating<br>* Time Restricted Eating Protocol: Subjects will be instructed to limit caloric consumption to a 12-hour TRE window for the first two weeks of the study, and then transition to a 10-hour TRE window. The window start-time will be self-selected (individualized). During the eating window, subjects will not be restricted on types or quantities of food consumed, and will be advised to continue their usual diets. Subjects will not be required to monitor their caloric intake. During the fasting period, subjects will be encouraged to stay hydrated and drink ample water. Outside the designated eating window, subjects are only permitted to consume medication, water, or zero-calorie herbal drinks such as unsweetened tea or black coffee.<br>* Other names: TRE;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in the daily eating window | Measured by questionnaire (assesses the time the participant started and stopped eating each day) | Measured weekly from baseline to week 6 |