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ObesityECALNCT03638895

Energy Expenditure From ECAL Indirect Calorimeter in a Multicomponent Weight Management Service

A study testing ECAL Indirect Calorimeter and Diet, exercise & behaviour modification therapy in people with Obesity and Severe Obesity, run by University of Liverpool 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

Whether greater weight loss is as a result of a smaller reduction in energy expenditure with caloric restriction is not known. Resting energy expenditure and 24-hour energy expenditure vary substantially between individuals. Read more about this study

Who is it for?
Ages 18 to 70 yearsHealthy volunteers can take part
Conditions the study is for
Obesity, Severe Obesity, Sleep Apnoea
What is being tested?
ECAL Indirect Calorimeter and Diet, exercise & behaviour modification therapy
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
51 participants
Where
1 siteUnited Kingdom
Study dates
28 Nov 2018to 25 Aug 2022
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 70 years
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • BMI > or equivalent to 30 kg/m2 to - 60 kg/m2
  • Stable weight (change of <5% within 12 weeks before screening based on medical history)
  • Subjects are well-motivated, capable and willing to learn how to undergo indirect calorimetry testing
  • Willing and able to adhere to prohibitions and restrictions specified within this protocol
  • For Subjects participating in the glycaemic variability sub-study:
  • Subject understands instructions on the use of continuous glucose monitor sensor and is willing to undergo appropriate training and testing

Who cannot join

  • Taking weight loss medication within 12 weeks prior to randomisation
  • Previous or planned bariatric surgery
  • History of Type 1, Type 2 diabetes mellitus, DKA or diabetes secondary to pancreatitis
  • Has HbA1c > or equal to 6.5% or Fasting Plasma Glucose > or equal to 7.0 mmol/L at screening.
  • NOTE: a one-time repeat measurement is allowed, if value of HbA1c and/or FPG is not consistent with prior values
  • History of obesity with a known secondary cause (Cushing's disease/syndrome)
Show all 14Show fewer
  • Oral corticosteroid use (except in the short term use of a 7-10 day course)
  • Ongoing, inadequately controlled thyroid disorder defined as thyroid-stimulating hormone > 6 mIU/litre or < 0.4 mIU/litre
  • History of malignancy within 3 years before screening (or diagnosis of malignancy within this period)
  • estimated glomerular filtration rate < 30 ml/min/1.73m2 on serum testing
  • Alanine aminotransferase level is <2.0 times the upper limit of normal or total bilirubin is >1.5 times the upper limit of normal at screening
  • Other major illness likely to preclude participation in the trial
  • History of glucagonoma
  • A myocardial infarction, unstable angina, revascularisation procedure (stent or bypass graft surgery) or cerebrovascular accident within 12 weeks before screening

Trial locations and contacts

1 site in 1 country.

United Kingdom1 site
  • University Hospital Aintree

    Liverpool, L9 7AL

Other trials in United Kingdom

About this study

Official title: Randomised Controlled Trial to Evaluate Impact of Energy Expenditure Information on the Outcome of Weight Loss During a Standardised Multicomponent Weight Management Intervention

Whether greater weight loss is as a result of a smaller reduction in energy expenditure with caloric restriction is not known. Resting energy expenditure and 24-hour energy expenditure vary substantially between individuals. In some cases, relatively reduced rates of 24h EE predict weight gain in some populations who have high prevalence of obesity. Obese individuals that lose weight experience a decrease in 24-h EE and resting energy expenditure that is lower than predicted based on changes in body composition. Most weight loss studies have found a large individual variation in the amount of weight change, and whether an individual's response to an intervention can be predicted is not clear. Measurements of 24-hour EE in response to fasting may help predict weight loss. The ECAL indirect calorimeter (ECAL) is a validated device purpose-built to provide the practitioner and patient with energy information that allows for more accurate, reliable method of establishing an obese individuals' metabolic profile. The aim of this study is to determine whether providing energy information from ECAL indirect calorimeter as an adjunct to the multicomponent weight management intervention in non-diabetic obese and severely obese individuals would help predict the response of weight loss.

Read the detailed description

Weight loss is important to improve overall health and reduce risk of obesity-related comorbidities such as diabetes. Numerous studies performed on individuals with predisposed genetic propensity to obesity who are deemed to be metabolically 'thrifty', require further structured intensification of caloric restriction and change in physical activity in order to achieve weight loss. Whether greater weight loss is as a result of smaller reduction in energy expenditure with calorie restriction is not known. Resting energy expenditure and 24-hour energy expenditure vary substantially between individuals. Obese individuals that lose weight experience a decrease in 24-h EE and resting energy expenditure that is lower than predicted based on changes in body composition. Most weight loss studies have found a large individual variation in the amount of weight change, and whether an individual's response to an intervention can be predicted is not clear. Measurements of 24-hour EE in response to fasting may help predict weight loss. The ECAL indirect calorimeter (ECAL) is a validated device purpose-built to provide the practitioner and patient with energy information that allows for more accurate, reliable method of establishing an obese individuals' metabolic profile. The ECAL device also measures the respiratory quotient (RQ) which is the ratio of the volume of carbon dioxide expired to that of oxygen consumed by the individual for every breath. Previous studies demonstrated variability in role of RQ in predicting weight loss, but individuals who demonstrated an RQ in the lower range (<0.72) were more likely to maintain the weight-loss achieved on a caloric restriction and avoid a weight loss rebound as compared to those with RQ in the higher range (>0.75). This suggests that RQ could prove useful in clinical practice as a prognostic marker for long-term effectiveness of low- and very-low-calorie diets used to induce weight loss. Baltimore Longitudinal Study on Aging shared a similar finding that fasting RQ or respiratory exchange ratio adjusted for age, BMI, and fat free mass was positively related to weight change. The aim of this study is to determine whether providing energy information from ECAL indirect calorimeter as an adjunct to the multicomponent weight management intervention in non-diabetic obese and severely obese individuals would help predict the response of weight loss.

Being tested
ECAL Indirect Calorimeter, Diet, exercise & behaviour modification therapy
Keywords
weight management, obesity, severe obesity, structured dietary intervention, calorie restriction, indirect calorimetry, resting energy expenditure, resting metabolic rate, respiratory quotient, substrate oxidation, glycemic variability, insulin sensitivity, peripheral neuropathy
Medical subject headings
Obesity, Obesity, Morbid, Sleep Apnea Syndromes, Insulin Resistance, Peripheral Nervous System Diseases

What participants receive

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

  • ECAL Indirect CalorimeterDevice

    The ECAL is an open-circuit portable indirect calorimeter that measures both volume of CO2 expired and O2 consumed using a small mixing chamber. Participants will breathe through a mouthpiece with a nose clip applied whilst lying in a restful and comfortable position for 15 minutes. ECAL device will provide breath-by-breath measurements of the resting energy expenditure and respiratory quotient which will allow both practitioners and participants to monitor their metabolic health and compare the effect of dietary and physical activity intervention over the course of the structured intensive lifestyle intervention (24-weeks).

  • Diet, exercise & behaviour modification therapyBehavioural

    Standard care (SC) - participants receive standard care (diet, exercise \& behaviour modification therapy) as part of the multicomponent weight management intervention within the tier 3 weight management service. Practitioners will rely on standard predictive equations to provide dietary advice and intervention.

Study groups in NCT03638895
Study groupRoleWhat they receive
ECAL groupActive comparatorIntervention group (ECAL) - practitioners and participants receive measured energy information from ECAL indirect calorimeter including resting energy expenditure and respiratory quotient to diagnose, manage and advise on modification of caloric restriction and physical activity level. Energy information also allows participant and practitioner to monitor and compare changes to their metabolic health throughout the duration of intervention.
Receives: Device: ECAL Indirect Calorimeter
SC groupPlacebo comparatorStandard care (SC) - participants receive standard care (diet, exercise \& behaviour modification therapy) as part of the multicomponent weight management intervention within the tier 3 weight management service. Practitioners will rely on standard predictive equations to provide dietary advice and intervention.
Receives: Behavioral: Diet, exercise & behaviour modification therapy

What is being measured

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

  1. Magnitude of weight loss (in kg)

    Measured: 6 months

Secondary outcomes (10)
  1. Resting metabolic rate (RMR)

    The measurement of number of calories that the body burns at rest in 24 hours, expressed as kcal/day

    Measured: 6 months

  2. Respiratory Quotient (RQ)

    The ratio of carbon dioxide production to oxygen consumption and reflects the relative contribution of fat, carbohydrate, and protein in the oxidation fuel mixture.

    Measured: 6 months

  3. Secretion of gut hormones (GLP-1, GIP, PYY)

    Secretion of appetite regulating gut hormone (GLP-1, GIP, PYY) in fasting and post-prandial phase

    Measured: 6 months

  4. Glycaemic variability

    Change from baseline in the swings in blood glucose levels, expressed as the mean amplitude of glycaemic excursion (MAGE)

    Measured: 6 months

  5. Insulin sensitivity

    Change from baseline in the measure of insulin rise in response to blood sugar levels, expressed as the homeostasis model assessment (HOMA). HOMA estimates steady state beta cell function and insulin sensitivity as percentages of the normal reference population.

    Measured: 6 months

  6. Sensory Neuropathy Testing in Prediabetic Obese Individuals

    Change from baseline in vibration perception threshold measurement using the neurothesiometer

    Measured: 6 months

  7. Douleur Neuropathique en4 Questions (DN4)

    Change from baseline in Douleur Neuropathique en4 Questions (DN4) using seven interview questions and three physical tests.

    Measured: 6 months

  8. Visual analogue score

    Change from baseline in visual analogue score of pain, expressed as Units on a scale of 0 to 100. where 0 is worst possible health and 100 is the best possible health.

    Measured: 6 months

  9. modified Total Neuropathy Score

    Change from baseline in modified Total Neuropathy Score (mTNS) questionnaire expressed as the average of the five components

    Measured: 6 months

  10. Brief Pain Inventory Short Form

    Change from baseline in brief pain inventory short form (BPI-SF) scored as the mean of the seven interference items.

    Measured: 6 months

Timeline

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

  1. First posted20 Aug 2018
  2. Study start28 Nov 2018
  3. Primary completion25 Aug 2022
  4. Study completion25 Aug 2022

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
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Parallel assignment
Masking
Double blind
Who is masked
Participant, Care provider
Enrolment
51 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03638895
Sponsor's protocol ID
UoL001379
Acronym
ECAL
Status last verified
Jul 2023
First submitted
13 Aug 2018
Last updated
28 Jul 2023
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Wang X, Wang Y, Ding Z, Cao G, Hu F, Sun Y, Ma Z, Zhou D, Su B. Relative validity of an indirect calorimetry device for measuring resting energy expenditure and respiratory quotient. Asia Pac J Clin Nutr. 2018;27(1):72-77. doi: 10.6133/apjcn.032017.02.

    PubMed 29222882
  • Das SK, Saltzman E, McCrory MA, Hsu LK, Shikora SA, Dolnikowski G, Kehayias JJ, Roberts SB. Energy expenditure is very high in extremely obese women. J Nutr. 2004 Jun;134(6):1412-6. doi: 10.1093/jn/134.6.1412.

    PubMed 15173405
  • Melo CM, Tirapegui J, Ribeiro SM. [Human energetic expenditure: concepts, assessment methods and relationship to obesity]. Arq Bras Endocrinol Metabol. 2008 Apr;52(3):452-64. doi: 10.1590/s0004-27302008000300005. Portuguese.

    PubMed 18506270
  • Lam YY, Ravussin E. Indirect calorimetry: an indispensable tool to understand and predict obesity. Eur J Clin Nutr. 2017 Mar;71(3):318-322. doi: 10.1038/ejcn.2016.220. Epub 2016 Nov 16.

    PubMed 27848941
  • McLay-Cooke RT, Gray AR, Jones LM, Taylor RW, Skidmore PML, Brown RC. Prediction Equations Overestimate the Energy Requirements More for Obesity-Susceptible Individuals. Nutrients. 2017 Sep 13;9(9):1012. doi: 10.3390/nu9091012.

    PubMed 28902175
  • Alves VG, da Rocha EE, Gonzalez MC, da Fonseca RB, Silva MH, Chiesa CA. Assessement of resting energy expenditure of obese patients: comparison of indirect calorimetry with formulae. Clin Nutr. 2009 Jun;28(3):299-304. doi: 10.1016/j.clnu.2009.03.011. Epub 2009 Apr 23.

    PubMed 19398250
  • Lim J, Alam U, Cuthbertson D, Wilding J. Design of a randomised controlled trial: does indirect calorimetry energy information influence weight loss in obesity? BMJ Open. 2021 Mar 24;11(3):e044519. doi: 10.1136/bmjopen-2020-044519.

    PubMed 33762240

Questions about this trial

What is this clinical trial studying?

A study testing ECAL Indirect Calorimeter and Diet, exercise & behaviour modification therapy in people with Obesity and Severe Obesity, run by University of Liverpool 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 6 inclusion and 14 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 28 Jul 2023. 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. Some participants in this study may receive a placebo. 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?

Magnitude of weight loss (in kg) (time frame: 6 months). 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 NCT03638895, which also lists 7 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 28 Jul 2023.

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