Gut Hormone LEAP2 in Metabolism and Eating Behaviour: Fixed Meal Testing

Study Overview
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Brief Summary
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The goal of this interventional study is to measure the blood levels of the gut hormones LEAP2 and acyl ghrelin (AG), appetite and food intake after consuming liquid meals of different caloric sizes, in healthy adults with and without obesity. AG is a stomach-derived homone that increases appetite, and LEAP2 a liver-gut derived hormone that decreases appetite, which interferes the action of AG ant its receptor in the brain called the growth hormone secretagogue receptor (GHSR). Blood levels of AG and LEAP2 change in opposite directions after food intake (AG decreasing, LEAP2 increasing). AG is formed from an inactive version of hormone called desacyl ghrelin (DAG). Previous studies have shown that greater food intake leads to a greater decrease in blood levels of total ghrelin (AG + DAG), but this has not been studied for changes in blood AG or LEAP2 after eating. Blood levels of AG and total ghrelin when fasted and after food intake are lower, while blood levels of LEAP2 are higher, in adults with than those without obesity. The main study questions are: Are there greater increases in blood levels of LEAP2 and greater decreases in blood levels of AG after consuming larger meals (by amount of calories they contain)? Are greater decreases in appetite after connsuming larger meals related to greater increases in blood levels of LEAP2 and greater decreases in blood levels of AG? Are greater decreases in food intake at a buffet lunch after consuming larger meals eaten a few hours previously related to greater increases in blood levels of LEAP2 and greater decreases in blood levels of AG? Do the above findings differ between adults without obesity and with obesity? Healthy adults (without and with obesity) will consume liquid meals containing different amounts of calories (0, 600, 1200, 1800 kcal, of identical total volume) after an overnight fast and have measurements of blood LEAP2 and AG and appetite ratings from 0 to 180 min, and have food intake at a buffet lunch measured at 180 mins.

Official Title
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Gut Hormone LEAP2 in Metabolism and Eating Behaviour: Fixed Meal Testing

Conditions
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Eating Behavior, Obesity, Appetitive Behavior

Intervention / Treatment
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* Other: 0 kcal liquid
* Dietary Supplement: 600 kcal liquid meal
* Dietary Supplement: 1200 kcal liquid meal
* Dietary Supplement: 1800 kcal liquid meal


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Male or female between the ages of 18 and 60 years; Without obesity with body mass index (BMI) 18.0-29.9 kg/m2 or with obesity with BMI 30.0-50.0 kg/m2; Healthy as determined by medical history and vital signs; Capable of giving written informed consent, which includes compliance with the requirements and restrictions listed in the consent form; Participant is able to read, comprehend and record information written in English. Exclusion Criteria: History of, or current abuse or dependence on alcohol or drugs; Current smoker or less than 2 years since quitting (cigarette, cigars, e-cigarettes) or use of nicotine replacement therapy; Significant current or past medical or psychiatric history that, in the opinion of the investigators, contraindicates their participation; History of type 1 or type 2 diabetes mellitus; History of ischaemic heart disease, heart failure, cardiac arrhythmia, peripheral vascular, cerebrovascular disease or uncontrolled hypertension; Current diagnosis of anaemia or iron deficiency; Body weight instability (change in body weight of more than 5% over the preceding 3 months); Use of current regular prescription or over-the-counter medications that in the opinion of the Investigators may affect participant safety or outcome measures; Clinically significant abnormalities in screening blood tests abnormalities which in the opinion of the study physician, is clinically significant e.g. diabetes mellitus, hypothyroidism, renal impairment, abnormal liver function tests [bilirubin, alanine transaminase (ALT), aspartate transaminase (AST), gamma-glutamyl transferase (GGT)] >3x upper limit of normal, other than due to fatty liver disease; Current pregnancy or breast-feeding in female volunteers (the Investigators will recommend using contraception for the duration of the visits to avoid participant drop-out); Pulse rate <40 or >100 beats per minute OR systolic blood pressure >160 and <100 OR diastolic blood pressure >95 and <50 in the semi-supine position; Volunteer has participated in a clinical trial and has received an investigational product within the following time period prior to the first experimental visit in the current study: 90 days, 5 half-lives or twice the duration of the biological effect of the investigational product (whichever is longer); Exposure to more than 3 new investigational medicinal products within 12 months prior to the scan; Vegan, gluten or lactose-intolerant (as test meals in the paradigms may include animal products, dairy and wheat products); Volunteers who have donated, or intend to donate, blood within three months before the screening visit or following study visit completion; Known history of SARS-CoV-2 infection (Covid-19) in the last 4 weeks; Ongoing symptoms suggestive of complications from previous SARS-CoV-2 infection ('long Covid-19') such as loss or change in sense of smell or taste, shortness of breath, palpitations, lethargy; SCOFF questionnaire score >1/5 indicating eating disorders (Luck et al. 2002); DSM-V criteria for alcohol use disorder (AUD) >2/11 indicating mild AUD (American-Psychiatric-Association 2013); Participants who have had previous obesity surgery or are on medications for obesity.

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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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: Crossover Assignment
Interventional Model Description: within participant
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Healthy adults without obesity<br>Liquid meals with different caloric sizes (0-1800 kcal) | Other: 0 kcal liquid<br>* Flavoured water<br>Dietary Supplement: 600 kcal liquid meal<br>* Fortisip Compact Vanilla<br>Dietary Supplement: 1200 kcal liquid meal<br>* Fortisip Compact Vanilla<br>Dietary Supplement: 1800 kcal liquid meal<br>* Fortisip Compact Vanilla<br>|
| Experimental: Healthy adults with obesity<br>Liquid meals with different caloric sizes (0-1800 kcal) | Other: 0 kcal liquid<br>* Flavoured water<br>Dietary Supplement: 600 kcal liquid meal<br>* Fortisip Compact Vanilla<br>Dietary Supplement: 1200 kcal liquid meal<br>* Fortisip Compact Vanilla<br>Dietary Supplement: 1800 kcal liquid meal<br>* Fortisip Compact Vanilla<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Post-prandial plasma concentration acyl ghrelin | Incremental area under curve (iAUC 0-180 minutes) | 0, 30, 60, 120, 180 minutes | 
| Post-prandial plasma concentration LEAP2 | Incremental area under curve (iAUC 0-180 minutes) | 0, 30, 60, 120, 180 minutes | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| VAS ratings of appetite | Incremental area under curve (iAUC 0-180 minutes) | 0, 30, 60, 120, 180 minutes | 
| Ad libitum food intake | Total kilocalories adjusted for estimated percentage of resting energy expenditure | 180 minutes | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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LEAP2, ghrelin, appetite, food intake, eating behaviour