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AzTrials

Nutrition and Energy BalanceNCT03509610

Acute Responses to Dietary Carbohydrate Manipulation

A study testing Diet in people with Nutrition and Energy Balance, run by University of Bath at 1 site in United Kingdom.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Sugar is perceived negatively, leading to government taxation and targets to reduce consumption. These actions have been taken based on the limited evidence that high-sugar diets are associated with greater total energy intake. However, energy intake comprises just one half of the energy balance equation (e.g. Read more about this study

Who is it for?
Ages 18 to 65 yearsHealthy volunteers can take part
Conditions the study is for
Nutrition and Energy Balance
What is being tested?
Diet
Could I receive a placebo?
No, everyone receives an active treatment
How many people
25 participants
Where
1 siteUnited Kingdom
Study dates
4 Dec 2017to 21 May 2021
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 65 years
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • Body mass index 18.5-29.9 kg∙m-2
  • Age 18-65 years
  • Able and willing to provide informed consent and safely comply with study procedures
  • Females to maintain record of regular menstrual cycle phase or contraceptive use
  • No anticipated changes in diet/physical activity during the study (e.g. holidays or diet plans)

Who cannot join

  • Any reported condition or behaviour deemed either to pose undue personal risk to the participant or introduce bias
  • Any diagnosed metabolic disease (e.g. type 1 or type 2 diabetes)
  • Any reported use of substances which may pose undue personal risk to the participants or introduce bias into the experiment
  • Lifestyle not conforming to standard sleep-wake cycle (e.g. shift worker)
  • Any reported recent (<6 months) change in body mass (± 3%)

Trial locations and contacts

1 site in 1 country.

United Kingdom1 site
  • Department for Health, University of Bath

    Bath, BA2 7AY

Other trials in United Kingdom

About this study

Official title: The Acute Responses to Manipulating Dietary Carbohydrate Content and Type on All Major Aspects of Energy Balance

Sugar is perceived negatively, leading to government taxation and targets to reduce consumption. These actions have been taken based on the limited evidence that high-sugar diets are associated with greater total energy intake. However, energy intake comprises just one half of the energy balance equation (e.g. balance = intake - expenditure). Without considering energy expenditure, it is impossible to understand the effects of sugar on health. Sugar, and perhaps total carbohydrate intake, may be important for energy balance - perhaps by stimulating increased energy expenditure.

Understanding dietary regulators of energy balance is more important than ever before, because diseases like obesity are a consequence of energy surplus (i.e. energy intake > energy expenditure). No studies have investigated a causal role of dietary sugar or carbohydrate on energy balance. The proposed research will seek to understand the acute (e.g. 24-hour) responses to manipulating dietary carbohydrate and sugar content on energy balance and health.

Read more

This research will contribute to enabling individuals to make informed dietary choices about carbohydrate and sugar consumption.

To achieve this, healthy non-obese adults will be recruited to a randomised crossover study. Measures of energy intake, energy expenditure, metabolic health, appetite, food preference, and gut microbiota will be taken. All laboratory trials will take place at the University of Bath.

Three diets will be investigated:

  1. Control - reflecting the composition of a typical European diet
  2. Low sugar - the same composition of a typical European diet but with <5% energy intake from sugar
  3. Low carbohydrate - low carbohydrate diet with <5% energy intake from sugar and <8% energy intake from carbohydrate, replacing carbohydrate energy with fat

The study will consist of a 3-day lead-in period with the control diet followed by one trial day with each diet.

Read the detailed description

Dietary sugar is increasingly perceived in a negative way. This has led to taxation by government and guidelines by global public health bodies to reduce sugar intake to <5% of energy intake. All available public health guidelines regarding sugar advocate a reduction in sugar intake, despite a lack of evidence to support these recommendations. These guidelines focus on the association between sugar intake and energy intake, without regard for energy expenditure. This oversimplifies situations in which energy surplus is pathological, for example in diseases like obesity. This complexity is demonstrated by evidence that dietary sugar intake is decreasing in the United Kingdom, whilst rates of obesity have increased in the same timeframe.

It is important to consider energy expenditure in the context of health. The most variable component of energy expenditure between individuals is physical activity energy expenditure (PAEE), which varies from ~600-2100 kcal per day in men of a similar demographic. Current guidelines do not regard the effect that changing dietary sugar might have on PAEE and therefore total energy expenditure.

Carbohydrate availability dictates the capacity to perform physical work. However, the role of carbohydrate in regulating physical activity behaviours has only recently been considered. Ingestion of a carbohydrate-rich breakfast causes a significant increase in 24-hour PAEE compared with no breakfast consumption before midday. The magnitude of this difference is greatest prior to midday, near to when carbohydrate had been ingested and when glucose uptake to peripheral tissue is increased. This points towards a stimulatory role of carbohydrate or sugar on PAEE when carbohydrate is readily available to peripheral tissue. The amount of carbohydrate present in skeletal muscle is dictated by the amount of carbohydrate in the diet. As physical activity is performed by skeletal muscle, dietary carbohydrate intake may regulate physical activity behaviour. Consequently, reducing total carbohydrate intake may result in reduced PAEE.

Studies in which carbohydrate has been manipulated and physical activity has been measured have not been sufficient in answering this research question. Often self-report measures of physical activity are used, which are not sensitive enough to discern meaningful differences. Studies which have measured physical activity objectively, i.e. using pedometers or accelerometers, are confounded by a lack of information about actual carbohydrate intake or concurrent prescription of exercise interventions. Furthermore, government targets of reduced sugar intake to <5% of total energy intake are not aimed at overall carbohydrate intake per se. In the breakfast study mentioned, sugar intake was significantly greater amongst individuals who ate breakfast compared with individuals who fasted until midday. Therefore, it is also plausible that a regulatory role of carbohydrate on PAEE may be due to the type of carbohydrate rather than the absolute amount.

If the availability of carbohydrate to peripheral tissue plays a regulatory role on PAEE, then theoretically the effects of manipulating the amount or type of carbohydrate will be detectable acutely, within 24 hours.

Being tested
Diet
Keywords
Nutrition, Carbohydrates

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • DietOther

    Macronutrient composition (specifically type and/or amount of carbohydrate) is manipulated

Study groups in NCT03509610
Study groupRoleWhat they receive
CONTROLActive comparatorDiet consisting of 50% carbohydrate (20% sugar), 15% protein, 35% fat
Receives: Other: Diet
LOW SUGExperimentalDiet consisting of 50% carbohydrate (<5% sugar), 15% protein, 35% fat
Receives: Other: Diet
LOW CHOExperimentalDiet consisting of <8% carbohydrate (<5% sugar), 15% protein, >77% fat
Receives: Other: Diet

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. 24-hour physical activity energy expenditure (kcal/day)

    24-hour physical activity energy expenditure (kcal/day)

    Measured: 24 hours

Secondary outcomes (27)
  1. 24-hour energy intake (kcal/day)

    24-hour energy intake (kcal/day)

    Measured: 24 hours

  2. Fasting glucose concentrations

    Fasting glucose concentrations in serum samples

    Measured: 24 hours

  3. Postprandial glucose concentrations

    Postprandial glucose concentrations in serum samples

    Measured: 24 hours

  4. Fasting insulin concentrations

    Fasting insulin concentrations in serum samples

    Measured: 24 hours

  5. Postprandial insulin concentrations

    Postprandial insulin concentrations in serum samples

    Measured: 24 hours

  6. Fasting triglyceride concentrations

    Fasting and postprandial triglyceride concentrations determined in plasma samples

    Measured: 24 hours

  7. Postprandial triglyceride concentrations

    Postprandial triglyceride concentrations in serum samples

    Measured: 24 hours

  8. Fasting non-esterified fatty acid concentrations

    Fasting non-esterified fatty acid concentrations in serum samples

    Measured: 24 hours

  9. Postprandial non-esterified fatty acid concentrations

    Postprandial non-esterified fatty acid concentrations in serum samples

    Measured: 24 hours

  10. Fasting beta-hydroxybutyrate concentrations

    Fasting beta-hydroxybutyrate concentrations in serum samples

    Measured: 24 hours

  11. Postprandial beta-hydroxybutyrate concentrations

    Postprandial beta-hydroxybutyrate concentrations in serum samples

    Measured: 24 hours

  12. Subjective appetite

    Measured by 0-100 mm visual analogue scale

    Measured: 24 hours

  13. Food preference ratings

    Food preference ratings determined by bespoke computer software

    Measured: 24 hours

  14. Resting substrate oxidation

    Resting substrate oxidation determined by indirect calorimetry

    Measured: 24 hours

  15. Postprandial substrate oxidation

    Postprandial substrate oxidation determined by indirect calorimetry

    Measured: 24 hours

  16. Palatability

    Measured by 0-100 mm visual analogue scale

    Measured: 24 hours

  17. Fasting cholesterol, HDL, and LDL concentrations

    Fasting cholesterol, HDL, and LDL concentrations in serum samples

    Measured: 24 hours

  18. Postprandial cholesterol, HDL, and LDL concentrations

    Postprandial cholesterol, HDL, and LDL concentrations in serum samples

    Measured: 24 hours

  19. Fasting leptin concentrations

    Fasting leptin concentrations in serum samples

    Measured: 24 hours

  20. Postprandial leptin concentrations

    Postprandial leptin concentrations in serum samples

    Measured: 24 hours

  21. Macronutrient intake

    Macronutrient intake across 24-h

    Measured: 24 hours

  22. Fasting FGF21 concentrations

    Fasting FGF21 concentrations in serum samples

    Measured: 24 hours

  23. Postprandial FGF21 concentrations

    Postprandial FGF21 concentrations in serum samples

    Measured: 24 hours

  24. Eating rate

    Time taken to eat test meals

    Measured: 24 hours

  25. Body mass

    Body mass

    Measured: 24 hours

  26. Waist and hip circumference

    Waist and hip circumference, waist:hip ratio

    Measured: 24 hours

  27. Fasting haematology profile

    Fasting haematology profile including WBC, RBC, HGB, haematocrit, platelet count

    Measured: 24 hours

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted26 Apr 2018
  2. Study start4 Dec 2017
  3. Primary completion21 May 2021
  4. Study completion21 May 2021

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Basic science
Allocation
Randomised
Intervention model
Crossover
Masking
None (open label)
Enrolment
25 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03509610
Sponsor's protocol ID
EP 17/18 87
Status last verified
Jun 2021
First submitted
9 Apr 2018
Last updated
18 Jun 2021
Results posted
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Publications

  • Smith HA, Gonzalez JT, Thompson D, Betts JA. Dietary carbohydrates, components of energy balance, and associated health outcomes. Nutr Rev. 2017 Oct 1;75(10):783-797. doi: 10.1093/nutrit/nux045.

    PubMed 29028272
  • Betts JA, Richardson JD, Chowdhury EA, Holman GD, Tsintzas K, Thompson D. The causal role of breakfast in energy balance and health: a randomized controlled trial in lean adults. Am J Clin Nutr. 2014 Aug;100(2):539-47. doi: 10.3945/ajcn.114.083402. Epub 2014 Jun 4.

    PubMed 24898233
  • Erickson J, Sadeghirad B, Lytvyn L, Slavin J, Johnston BC. The Scientific Basis of Guideline Recommendations on Sugar Intake: A Systematic Review. Ann Intern Med. 2017 Feb 21;166(4):257-267. doi: 10.7326/M16-2020. Epub 2016 Dec 20.

    PubMed 27992898
  • Hengist A, Davies RG, Rogers PJ, Brunstrom JM, van Loon LJC, Walhin JP, Thompson D, Koumanov F, Betts JA, Gonzalez JT. Restricting sugar or carbohydrate intake does not impact physical activity level or energy intake over 24 h despite changes in substrate use: a randomised crossover study in healthy men and women. Eur J Nutr. 2023 Mar;62(2):921-940. doi: 10.1007/s00394-022-03048-x. Epub 2022 Nov 3.

    PubMed 36326863

Questions about this trial

What is this clinical trial studying?

A study testing Diet in people with Nutrition and Energy Balance, run by University of Bath at 1 site in United Kingdom.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 18 Jun 2021. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United Kingdom. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

24-hour physical activity energy expenditure (kcal/day) (time frame: 24 hours). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03509610, which also lists 4 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 18 Jun 2021.

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