Clinical trial NCT02375438: Nutritional Assessment in Mitochondrial Cytopathy
Official title: Nutritional Assessment in Patients Affected by Mitochondrial Cytopathy
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Mitochondrial Diseases
Mitochondrial Myopathies
Mitochondrial Cytopathies
Keywords: nutrition
mitochondrial cytopathy
malnutrition
energy intake
nutritional risk
Lead sponsor: Insel Gruppe AG, University Hospital Bern
Sponsor class: OTHER
First posted: 2015-03-02
Enrollment: 26
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: The patients affected by mitochondrial cytopathy from the outpatient's clinic of the Department of Neurology of the University Hospital of Bern who fulfill the inclusion criteria will be asked to participate in the study. All potential participants will be provided with a patient information sheet and will be given adequate time to consider participation in the study. Those who will participate will be asked to provide written informed consent.

Brief summary: The aim of this study is to assess nutritional intake (quantitatively and qualitatively), nutritional state and body composition of patients suffering from mitochondrial cytopathy, compared to healthy controls. The energy intake will be calculated through dietary protocols, the energy expenditure by indirect calorimetry and body composition will be performed with bio-impedance analysis. Further on, the investigators expect to be able to provide nutritional counselling to this population in order to increase energy and protein intake, which may improve health and well-being.

Detailed description: Background

Mitochondrial diseases are a group of genetic disorders. The prognosis for patients with mitochondrial myopathies varies greatly, depending largely on the type of disease and the degree of involvement of various organs. This situation can lead into malnutrition and worse the outcome. In the literature there are no data, which deal with malnutrition or nutritional intake in patients with mitochondrial myopathy. Sorensen et al. assessed the malnutrition risk in European hospitals and showed that 45% of patients with neurological illness (neurological vascular disease excluded) are at high risk of malnutrition. Furthermore, the patient at risk exhibited higher rates of complications and mortality. These findings suggest that malnutrition play an important role in the clinical outcome of this patient's population, reflecting the investigators' many years of experience. In several case reports, it was shown that malnutrition itself could aggravate myopathy. Sometimes there are challenging symptoms facing patients with mitochondrial myopathy that interfere with obtaining balanced and healthy nutrition, such as fatigue, muscle weakness, dysmotility, dysphagia, nausea and vomiting, ataxia, and reflux. In addition, in the investigators' clinical experience, they see many patients who describe that some specific food intake would even modify their symptoms.

This is an observational cohort study, and the investigators expect a total sample size of 30 patients and 20 healthy age- and sex-matched controls. The entire study will be conducted during the period from first of October 2014 till End of March 2015.

The investigator is a pharmacy student (master level) interested in clinical nutrition. She will collect the data und do all measurements along with the support of the clinical nutrition research team of the University Hospital of Bern. The investigator will contact the patients individually and arrange a suitable timetable for the interview and examination. Sex, age, current medical conditions, current myopathy symptoms, current gastrointestinal symptoms, unintentional weight loss, eating and drinking habits, living and social situation, daily activity, medications (in particular those drugs that interfere with the mitochondrial metabolism as valproic acid, statins, and certain antibiotics like aminoglycosides, etc.) smoking, alcohol intake, and main diagnosis will be recorded. The investigators will preform the following measurements: basic demographic data, structured patient interviews, dietary questionnaire, nutritional risk screening, quality of life, physical functioning, body composition, energy expenditure, blood and urine analysis. The study will be conducted in accordance with the ethical guidelines of the 1957 Declaration of Helsinki, and informed consent will be obtained from all participants. The healthy volunteers and patients will not be exposed to any risk due to this study.

Objective

The aim of this study is to assess the nutritional intake and the nutritional state of patients with mitochondrial myopathy compared to healthy controls. The investigators expect to be able to provide general nutritional advice (nutritional counselling) to increase the ingestion of balanced/healthy food and the energy intake, and therefore they expect to improve health and well-being in this population.

Methods

Questionnaire, indirect calorimetry, bioimpedance analysis BIA, Hand grip test, Anthropometrics and 7-days food recall protocol

Eligibility criteria: Inclusion Criteria:

* Patients with a clinical presentation suggestive of mitochondrial cytopathy, in whom mitochondrial deletions above 20% have been found in muscle
* =/\>18 years
* Willing and able to give written informed consent

Exclusion Criteria

* Patients with poor knowledge of the study languages (German and French)

Primary outcomes:
measure: Energy and nutrients intake (Measured in kcal)
timeFrame: At baseline
Secondary outcomes:
measure: Differences in nutritional risk (Measured in NRS2002)
timeFrame: At baseline
measure: Differences in nutritional status Measured in laboratory parameters (blood and urine)
timeFrame: At baseline
measure: Difference in body composition Measured in bioimpedance analysis BIA and anthropometrics (TSF [mm], MAMC (cm^2), Handgrip test (kg))
timeFrame: At baseline
measure: Difference in resting energy expenditure Measured in kcal (indirect calorimetry)
timeFrame: At baseline
measure: Difference in quality of life Measured in SF36v2 score
timeFrame: At baseline
Other outcomes:
Locations:
city: Bern
country: Switzerland
facility: Department of Endocrinology, Diabetes and Clinical Nutrition, Bern University Hospital
Study officials:
affiliation: Department of Endocrinology, Diabetes and Clinical Nutrition University Hospital
name: Zeno Stanga, Prof. Dr. med. MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Arpa J, Cruz-Martinez A, Campos Y, Gutierrez-Molina M, Garcia-Rio F, Perez-Conde C, Martin MA, Rubio JC, Del Hoyo P, Arpa-Fernandez A, Arenas J. Prevalence and progression of mitochondrial diseases: a study of 50 patients. Muscle Nerve. 2003 Dec;28(6):690-5. doi: 10.1002/mus.10507.
citation: El-Hattab AW, Scaglia F. Mitochondrial DNA depletion syndromes: review and updates of genetic basis, manifestations, and therapeutic options. Neurotherapeutics. 2013 Apr;10(2):186-98. doi: 10.1007/s13311-013-0177-6.
citation: Sorensen J, Kondrup J, Prokopowicz J, Schiesser M, Krahenbuhl L, Meier R, Liberda M; EuroOOPS study group. EuroOOPS: an international, multicentre study to implement nutritional risk screening and evaluate clinical outcome. Clin Nutr. 2008 Jun;27(3):340-9. doi: 10.1016/j.clnu.2008.03.012. Epub 2008 May 27.
citation: Kondrup J, Rasmussen HH, Hamberg O, Stanga Z; Ad Hoc ESPEN Working Group. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr. 2003 Jun;22(3):321-36. doi: 10.1016/s0261-5614(02)00214-5.