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Severe ObesityGUTERRINGNCT05832190

Correcting GUT MicrobioTa by Combined Supplementation of FibERs and BIotiN to Improve Microbiome and Optimize Bariatric Surgery Outcomes

A study testing Biotin supplement and Fiber supplement in people with Severe Obesity and Metabolic Syndrome, run by Assistance Publique - Hôpitaux de Paris at 1 site in France.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial summary

Bariatric surgery improves health outcomes with a maximal weight loss on average occurring 1 year after surgery but with dramatic between-subjects variability in weight loss (ranging from 20 to 160% excess weight loss) for reasons that remain to be elucidated. Read more about this study

Who is it for?
Ages 18 to 60 years
Conditions the study is for
Severe Obesity, Metabolic Syndrome
What is being tested?
Biotin supplement and Fiber supplement
Type of treatment
Pill or oral medicine
Could I receive a placebo?
No, everyone receives an active treatment
How many people
5 participants
Where
1 siteFrance
Study dates
24 Jul 2023to 24 Dec 2024
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 60 years
  • All sexes
  • No healthy volunteers
  • Adult

Who may be able to join

  • Age ≥ 18 years and < 60 years
  • BMI ≥ 40 kg/m² or BMI > 35 kg/m² with at least one comorbidity belonging to metabolic syndrome (hyperglycemia (fasting glycemia > 1g/l, Non diabetic with HbA1C<7% without antidiabetic treatment), dyslipidemia (HDL-cholesterol <0.5 g/l or receiving treatment against dyslipidemia), or increased blood pressure (SBP >13, DBP>9 or treated by antihypertensive drug)), or sleep apnoea, weight stable (less than 3 kg variation in the 2 months before
  • Usual Fiber intake < 20g/day in food consumption evaluated by 24h recall
  • Signature of the informed consent
  • Effective contraception in women of childbearing age
  • Subject with health insurance (except AME)

Who cannot join

  • Patients receiving antibiotics (ATB) at the selection time or within the 2 previous months.
  • (if agreeing to participate to the study, the patients will be proposed randomization 3 months after stopping ATB)
  • Type 1 or type 2 diabetes
  • HIV, HBV, HCV
  • Gastrointestinal disease: Acute or chronic diarrhea (i.e. more than 3 liquid or fluid stools/day)
  • Previous history of gastrointestinal neoplasia or polyps
Show all 12Show fewer
  • Factors that may affect the composition of the intestinal microbiota: Special Diet (exclusion diet, vegetarian diet), taking immunosuppressants (eg calcineurin inhibitors, corticosteroids, biological agents, etc.), taking transit modulators (osmotic or prebiotics such as lactulose).
  • Pregnancy or breastfeeding women
  • Subject under guardianship or curatorship
  • Subject deprived of their liberty by a judicial or administrative decision
  • Patient participating to another interventional clinical research (Jardé 1)
  • Subject physically unable to give his or her written consent

Trial locations and contacts

1 site in 1 country.

France1 site
  • hôpital Pitié Salpêtrière

    Paris, France, 75013

Other trials in France

About this study

Bariatric surgery improves health outcomes with a maximal weight loss on average occurring 1 year after surgery but with dramatic between-subjects variability in weight loss (ranging from 20 to 160% excess weight loss) for reasons that remain to be elucidated.

The investigators hypothesize that targeting the 3 months pre-surgery period by a calibrated dietary intervention, with fiber enrichment and biotin, will improve gut microbiota richness and subsequently improve subjects' metabolic health that may optimize post bariatric surgery outcomes.

The study is designed as a pilot, comparative, randomized, open-label trial with 4 arms: standard of care, biotin only, fibers only, biotin + fibers.

Read the detailed description

This is a pilot open label study that aims to examine the efficacy of biotin supplementation with or without enriched soluble and insoluble fibers given during 3 months before the bariatric surgery, on gut microbiota composition and functional capacity to produce B vitamins (primary outcomes), compared to standard of care (e.g. patient preparation to bariatric surgery).

The study is a 4-arm clinical trial:

Arm 1: patients with usual follow-up (standard of care) receiving during 3 months before the surgery usual general dietary recommendations regarding balanced diet comprising legumes and fruits, meat or equivalent, dairy products and starch and bread Arm 2: Same usual general dietary recommendations PLUS Biotin 450 µg per day (1 capsule per day) during 3 months before the surgery.

Arm 3: Same usual general dietary recommendations PLUS 3 servings per day of PureLean® Fiber, a powdered blend of fibers and prebiotics, during 3 months before the surgery Arm 4: Same usual general dietary recommendations PLUS 3 servings per day of PureLean® Fiber and Biotin 450 µg per day (1 capsule per day), during 3 months before the surgery.

There will be two periods: period 1 during the 3 months before bariatric surgery and period 3 after bariatric surgery (usual standard of care follow-up). The 4 groups will be compared before bariatric surgery and up to 6 months afterward

Patients will receive a schedule of hospitalizations and visits before and after the surgery:

  • V0: 3 months before surgery
  • V1: presurgery visit, one day hospitalization
  • V2: 3 months post-surgery
  • V3: 6 months post-surgery
  • V4:12 months post-surgery

At each visit (V0, V1, V2 , V3 and V4), will be performed as part of research:

  • Adipose tissue aspiration
  • Questionnaires
  • Fecal samples
  • Saliva samples (oral microbiota)
  • Blood samples
  • Urine samples This planning is part of the standard of care. The same follow-up will be performed in the 4 arms.

Patients will be called 3 times between V0 and V1 by dietician as part of research.

Being tested
Standard of care, Biotin supplement, Fiber supplement
Keywords
GUT microbioTa, Supplementation, Fibers, Biotin, Microbiome, Bariatric surgery
Medical subject headings
Obesity, Morbid, Metabolic Syndrome

What participants receive

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

  • Standard of careOther

    Patients receiving during 3 months before the surgery usual general dietary recommendations regarding balanced diet comprising legumes and fruits, meat or equivalent, dairy products and starch and bread

  • Biotin supplementDietary supplement

    1 capsule per day of Biotin 450µg during 3 months before the surgery.

  • Fiber supplementDietary supplement

    3 servings per day of PureLean® Fiber, a powdered blend of fibers and prebiotics, during 3 months before the surgery

Study groups in NCT05832190
Study groupRoleWhat they receive
Arm 1: patient with usual follow-up (standard of care)Active comparatorreceiving during 3 months before the surgery usual general dietary recommendations regarding balanced diet comprising legumes and fruits, meat or equivalent, dairy products and starch and bread
Receives: Other: Standard of care
Arm 2: Same usual general dietary recommendations PLUS BiotinExperimentalPatients will receive the same usual general dietary recommendations PLUS 1 capsule per day of Biotin 450 µg per day during 3 months before the surgery.
Receives: Other: Standard of care; Dietary Supplement: Biotin supplement
Arm 3: Same usual general dietary recommendations PLUS FiberExperimentalPatients will receive the same usual general dietary recommendations PLUS 3 servings per day of PureLean® Fiber, a powdered blend of fibers and prebiotics, during 3 months before the surgery
Receives: Other: Standard of care; Dietary Supplement: Fiber supplement
Arm 4: Same usual general dietary recommendations PLUS Fiber PLUS BiotinExperimentalPatients will receive the same usual general dietary recommendations PLUS 3 servings per day of PureLean® Fiber and Biotin 450 µg per day (1 capsule per day), during 3 months before the surgery.
Receives: Other: Standard of care; Dietary Supplement: Biotin supplement; Dietary Supplement: Fiber supplement

What is being measured

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

  1. 3-month variation of gut microbiota richness 3 months after the start of the different dietary interventions

    Access to gut microbiota richness will be provided after gut microbiota sequencing (by INRAE) with the acquisition of a table comprising the number of genes as well as the record of bacterial genes implicated in synthesis and transport of biotin. Based on preclinical observation, it is expected that the arm 4 combining biotin and fibers will show the highest richness

    Measured: At the inclusion and 3 months after supplementation

Secondary outcomes (29)
  1. Assess changes in body weight between the visit 3 months before surgery and the pre-surgery visit, the visit at 3 and 6 months after surgery.

    Body Weight will be obtained at each visit between 8 and 10 am using standardized procedures: Body weight will be obtained with a scale (Seca GmbH \& Co., Hamburg, Germany) in kilograms

    Measured: At the inclusion, 3months after supplementation, 3, 6 and 12 months after surgery

  2. Assess changes in BMI between the visit 3 months before surgery and the pre-surgery visit, the visit at 3 and 6 months after surgery

    Height will be obtained with measuring scale rounded to the nearest 0.5 cm in centimeters Weight and height will be combined to report BMI in kg/m^2

    Measured: At the inclusion, 3months after supplementation, 3, 6 and 12 months after surgery

  3. Assess changes in waist circumference between the visit 3 months before surgery and the pre-surgery visit, the visit at 3 and 6 months after surgery

    Twaist circumference will be measured in centimeters at the level of the iliac crest and hip circumference at the level of the symphysis-great trochanter to the nearest 1 cm.

    Measured: At the inclusion, 3 months after supplementation, 3, 6 and 12 months after surgery

  4. Assess changes in fat mass between the visit 3 months before surgery and the pre-surgery visit, the visit at 3 and 6 months after surgery

    For the measurement of fat mass (in kilograms and percentage of body weight), patients will undergo DEXA analysis, using the Hologic Inc. machine, QDR 4500W t using standard software (Hologic Inc., S/N 47168 VER. 11.2)

    Measured: At the inclusion, 3 month after supplementation, 3, 6 and 12 months after surgery

  5. Assess changes in lean mass between the visit 3 months before surgery and the pre-surgery visit, the visit at 3 and 6 months after surgery

    For the measurement of lean mass (in kilograms and percentage of body weight), patients will undergo DEXA analysis, using the Hologic Inc. machine, QDR 4500W t using standard software (Hologic Inc., S/N 47168 VER. 11.2)

    Measured: At the inclusion, 3 month after supplementation, 3, 6 and 12 months after surgery

  6. Assess changes in visceral adipose tissue mass between the visit 3 months before surgery and the pre-surgery visit, the visit at 3 and 6 months after surgery

    For the measurement of visceral adipose tissue mass (in kilograms and percentage of body weight), patients will undergo DEXA analysis, using the Hologic Inc. machine, QDR 4500W t using standard software (Hologic Inc., S/N 47168 VER. 11.2)

    Measured: At the inclusion, 3 month after supplementation, 3, 6 and 12 months after surgery

  7. Assess changes in blood pressure between the visit 3 months before surgery and the pre-surgery visit, the visit at 3 and 6 months after surgery.

    Blood pressure (Systolic and Diastolic) will be measured three times with a mercury sphygmomanometer in the right arm, with patients in a sitting position after five minutes of rest. The average of the three measurements will be considered for analysis

    Measured: At the inclusion, 3 months after supplementation, 3, 6 and 12 months after surgery

  8. Assess changes in insulin resistance markers between the visit 3 months before surgery and the pre-surgery visit, the visit at 3 and 6 months after surgery.

    To predict insulin resistance, homeostatic model assessment of insulin resistance (HOMA-IR) will be calculated according to the following formula: HOMA-IR = [fasting insulin (mU/l) x fasting blood glucose (mmol/l)]/22.5.

    Measured: At the inclusion, 3 months after supplementation, 3, 6 and 12 months after surgery

  9. Assess changes in insulin sensitivity markers between the visit 3 months before surgery and the pre-surgery visit, the visit at 3 and 6 months after surgery

    Quantitative insulin sensitivity check index (QUICKI) will be calculated according to the following formula: QUICKI= 1/[log(fasting insulin) + log(fasting blood glucose)

    Measured: At the inclusion, 3 months after supplementation, 3, 6 and 12 months after surgery

  10. Assess change in Leptin between the visit 3 months before surgery and the pre-surgery visit, the visit at 3 and 6 months after surgery.

    Leptin (ng/mL) will be measured according to standard protocols using human Leptin ELISA Kit (MyBioSource, Cod. MBS9425103)

    Measured: At the inclusion, 3 months after supplementation, 3, 6 and 12 months after surgery

  11. Assess change in Adiponectin between the visit 3 months before surgery and the pre-surgery visit, the visit at 3 and 6 months after surgery.

    Adiponectin (µg/mL) will be measured according to standard protocols using human Adiponectin /Acrp30 Quantikine ELISA kit (DRP300, R\&D Systems)

    Measured: At the inclusion, 3 months after supplementation, 3, 6 and 12 months after surgery

  12. Assess changes in glucose between the visit 3 months before surgery and the pre-surgery visit, the visit at 3 and 6 months after surgery

    A fasting venous blood draw will be taken from a vein on the forearm to verify blood glucose (g/L) using commercial kits

    Measured: At the inclusion, 3 months after supplementation, 3, 6 and 12 months after surgery

  13. Assess changes in lipid profile between the visit 3 months before surgery and the pre-surgery visit, the visit at 3 and 6 months after surgery

    A fasting venous blood draw will be taken from a vein on the forearm to verify triglycerides ( g/L), total cholesterol (g/L), HDL- cholesterol(g/L), LDL- cholesterol (g/L), using commercial kits

    Measured: At the inclusion, 3months after supplementation, 3, 6 and 12 months after surgery

  14. Assess changes in liver function between the visit 3 months before surgery and the pre-surgery visit, the visit at 3 and 6 months after surgery

    A fasting venous blood draw will be taken from a vein on the forearm to verify alanine aminotransferase (ALT) (UI/L), aspartate aminotransferase (AST) (UI/L), gamma-glutamyl transferase (GGT) (UI/L), using commercial kits

    Measured: At the inclusion, 3 months after supplementation, 3, 6 and 12 months after surgery

  15. Assess change in inflammatory marker (C-reactive protein) between the visit 3 months before surgery and the pre-surgery visit, the visit at 3 and 6 months after surgery.

    C-reactive protein (mg/l) will be measured by multiplex analysis

    Measured: At the inclusion, 3 months after supplementation, 3, 6 and 12 months after surgery

  16. Assess changes in inflammatory markers (IL6, sCD14, IL1b, IL10, TNF-R) between the visit 3 months before surgery and the pre-surgery visit, the visit at 3 and 6 months after surgery.

    IL6, sCD14, IL1b, IL10, TNF-R (pg/mL) will be measured by multiplex analysis

    Measured: At the inclusion, 3 months after supplementation, 3, 6 and 12 months after surgery

  17. Assess changes in adipose tissue gene expression for biotin-dependent carboxylases and inflammatory genes

    Adipose tissue aspiration (100 mg): measure for adipose cell size and gene expression study (5-carboxylase depending of biotin and inflammatory markers).

    Measured: At the inclusion, 3 months after supplementation, 3, 6 and 12 months after surgery

  18. Assess changes in quality of life

    Information regarding their usual lifestyle by autoquestionnaire: SF-36 (Medical Outcome Study Short Form - 36) ranging from 0 to 100. A low score reflects a perception of poor health, loss of function, presence of pain. A high score reflects a perception of good health, an absence of functional deficit and pain

    Measured: At the inclusion, 3 months after supplementation, 3, 6 and 12 months after surgery

  19. Assess changes in emotional eating

    Information regarding their usual lifestyle by autoquestionnaire : Dutch Eating Behaviour Questionaire ( DEBQ) : this questionnaire is composed by 33 items divided into 3 scores. Of the original 100 items, 33 will be maintained and divided into 3 scores. Each question allows for 5 possible answers rated from 0 to 5 points. The possible answers are: never (1 point), rarely (2 points), sometimes (3 points), often (4 points), very often (5 points). The scores are as follows:

    • Restriction score: 10 questions on the "organised" will to control one's weight.
    • Emotionality score: 13 questions divided into two sub-scores, diffuse emotionality for 4 questions and definite emotionality for 9 questions
    • Externality score: 10 questions For each score, if the average of the responses is higher than 30, the subject is considered respectively: restricted, emotional eating or external.

    Measured: At the inclusion, 3 months after supplementation, 3, 6 and 12 months after surgery

  20. Assess changes in physical activity

    Information regarding their usual lifestyle by autoquestionnaire : Recent Physical Activity Questionnaire ( RPAQ) :

    • Interpretation of the physical activity (PA) level : Total sum week + weekend :
    • <8.3 MET.h/week: inactive ;
    • From 8.3 MET.h/week: active, with the possibility of two levels:
    • From 8.3 to 16.7: moderate PA;
    • >16.7: high PA.
    • interpretation of the time spent inactive : For weekdays and weekends:
    • ≤7h/d: non-sedentary ;
    • >7h/d: sedentary.

    Measured: At the inclusion, 3 months after supplementation, 3, 6 and 12 months after surgery

  21. Assess changes in anxiety

    Information regarding their usual lifestyle by autoquestionnaire : HAD questionnaire (Hospital Anxiety and Depression questionnaire) : the HAD scale is an instrument to screen for anxiety and depressive disorders. It consists of 14 items rated from 0 to 3. Seven questions relate to anxiety (total A) and seven others to the depressive dimension (total D). (total D), thus allowing two scores to be obtained (maximum score for each score = 21).

    For each of the scores (A and D):

    • 7 or less: no symptomatology
    • 8 to 10: doubtful symptomatology
    • 11 and more: definite symptomatology.

    Measured: At the inclusion, 3 months after supplementation, 3, 6 and 12 months after surgery

  22. Assess changes in sleep quality

    Information regarding their usual lifestyle by autoquestionnaire : STOP band (Snoring - Tired - Observed apnea - Pressure - BMI - Age - Neck size - Gender) questionnaire:

    Interpretation of the STOP-BANG:

    The STOP-BANG score can be used to identify subjects at risk of sleep apnea (S.A.).

    • Low risk of S.A.: Score from 0 to 2.
    • Moderate risk of S.A.: Score of 3 to 4.
    • High risk of S.A.: Score of 5 to 8, or STOP ≥ 2 and male sex, or STOP ≥ 2 and BMI > 35, or STOP ≥ 2 and neck circumference > 40cm.

    Measured: At the inclusion, 3 months after supplementation, 3, 6 and 12 months after surgery

  23. Assess changes in stool consistency

    Patients will be asked to answer a Bristol stool scale : the Bristol Scale has seven types of profiles, ranging from constipation (type 1 and 2) to diarrhea (type 6 and 7). Each type corresponds to a specific description of the stool.

    Measured: At the inclusion, 3 months after supplementation, 3, 6 and 12 months after surgery

  24. Assess changes in stool inflammatory markers

    Fecal calprotectin (in µg/g of feces) will be measured through ELISA kit

    Measured: At the inclusion, 3 months after supplementation, 3, 6 and 12 months after surgery

  25. Change in gut microbiota composition by quantitative metagenomics.

    Total fecal DNA will be extracted, sequenced by oxford nanopores technology and analysed using momr R package.

    Measured: At the inclusion, 3 months after supplementation, 3, 6 and 12 months after surgery

  26. Change in intestinal permeability by Zonuline dosage

    Zonuline dosage (ng/mL)

    Measured: At the inclusion, 3 months after supplementation, 3, 6 and 12 months after surgery

  27. Change in intestinal permeability by LPS-binding protein dosage

    LPS-binding protein dosage (mg/L)

    Measured: At the inclusion, 3 months after supplementation, 3, 6 and 12 months after surgery

  28. Systemic measurement of Biotin (B8),B6 and B9-vitamins

    Biotin (B8),B6 and B9 (nmol/L) will be measured by Elisa dosage from blood samples

    Measured: At the inclusion, 3 months after supplementation, 3, 6 and 12 months after surgery

  29. Systemic measurement of B12-vitamin

    B12 (pmol/L) will be measured by Elisa dosage from blood samples

    Measured: At the inclusion, 3 months after supplementation, 3, 6 and 12 months after surgery

Timeline

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

  1. First posted27 Apr 2023
  2. Study start24 Jul 2023
  3. Primary completion24 Dec 2024
  4. Study completion24 Dec 2024

Why it stopped: end of ERC funding period

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
Other
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
5 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05832190
Sponsor's protocol ID
APHP220972
Other IDs
2022-A02251-42
Acronym
GUTERRING
Status last verified
Jan 2025
First submitted
10 Feb 2023
Last updated
15 Jan 2025
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A study testing Biotin supplement and Fiber supplement in people with Severe Obesity and Metabolic Syndrome, run by Assistance Publique - Hôpitaux de Paris at 1 site in France.

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 12 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: stopped early, as of the sponsor's last update on 15 Jan 2025. 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 France. 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 was stopped early (reason given: end of ERC funding period). Results are not available in the source record.

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?

3-month variation of gut microbiota richness 3 months after the start of the different dietary interventions (time frame: At the inclusion and 3 months after supplementation). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
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 15 Jan 2025.

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