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Energy BalanceCarpe DIEMNCT07122778

Impact of Diet-induced Change in Energy Balance on Metabolism in Endurance Athletes

A study testing Habitual diet with surplus snacks in people with Energy Balance and Energy Deficit, run by University of Bath at 1 site in United Kingdom.

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Sites and contacts
Official record
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Trial summary

Recent research has suggested that increasing levels of physical activity are associated with a reduction in the independent components that contribute to total energy expenditure (such as resting metabolic rate and non-exercise movement) - this occurs to conserve energy required for physical activity where energy… Read more about this study

Who is it for?
Ages 18 to 49 yearsHealthy volunteers can take part
What is being tested?
Habitual diet with surplus snacks
Could I receive a placebo?
No, everyone receives an active treatment
How many people
20 participants
Where
1 siteUnited Kingdom
Study dates
Aug 2025to May 2027
Phase
Interventional
Are there results?
Not yet: the study is under way

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 49 years
  • All sexes
  • Healthy volunteers accepted
  • Adult

Who may be able to join

  • Self-identified endurance-trained sport participants
  • Training volume: >7 hours per week endurance training
  • Training frequency: at least 5 days per week

Who cannot join

  • Diagnosis of Relative Energy Deficiency in Sport (REDs)
  • Active eating disorder (EDE-Q)
  • Active flare of a chronic disease (e.g. inflammatory bowel disease)
  • Type 1 or 2 diabetes mellitus
  • Untreated or undergoing active treatment of anaemia (any cause)
  • Current injury which precludes undertaking high volume endurance training
Show all 16Show fewer
  • Individuals following a habitual low-carbohydrate, high-fat diet
  • Any medical diagnosis which precludes intense exercise (e.g. untreated cardiac arrhythmia)
  • Allergy or intolerance to study foods
  • Blood donation within preceding 8 weeks of study start date
  • Use of medications that affect substrate utilisation (e.g. statins, corticosteroids, thyroxine, HRT)
  • For females: current pregnancy, breastfeeding within past 6 months or post-menopausal
  • Unable to undertake a treadmill running test
  • Participation in any research study in the past 8 weeks
  • Participation in a research study within the past year involving more than one DEXA scan
  • Unable to provide informed consent due to impaired cognitive capacity or decision-making ability

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Joshua J Bakker-Dyos, BSc(Hons) MBChB contact

+447740191473

jbd28@bath.ac.uk

United Kingdom1 site
  • University of Bath

    Bath, BA2 7AY

    Joshua J Bakker-Dyos, +447740191473, jbd28@bath.ac.uk

Other trials in United Kingdom

About this study

Official title: Impact of Diet-induced Change in Energy Balance on Metabolism in Endurance Athletes: the Carpe DIEM Study

Recent research has suggested that increasing levels of physical activity are associated with a reduction in the independent components that contribute to total energy expenditure (such as resting metabolic rate and non-exercise movement) - this occurs to conserve energy required for physical activity where energy provision becomes scarce. There are potential deleterious health and performance consequences of a reduced energy supply to fundamental metabolic processes, putting individuals regularly undertaking high levels of physical activity, such as endurance athletes, at risk. However, this association is largely based on observational data in only moderately active populations, and it is currently unclear what role energy balance status and biological sex has on this relationship.

This research intends to address these unknowns by assessing the impact of diet-induced manipulation of energy balance (conditions of energy deficit and energy surplus) in individuals undertaking habitually high levels of physical activity on independent components of total energy expenditure (resting metabolism, exercise and non-exercise movement).

Male and female athletes conducting regular moderate-to-high training volumes will undertake a randomised crossover study with a 7-day state of energy deficit and a 7-day state of energy surplus. Participants will continue to live and train as normal, but their diet will be controlled by specific food provision over the intervention periods in order to facilitate both conditions. Independent components of energy expenditure, markers of health, metabolism and performance will be measured to allow for comparison of conditions.

Read the detailed description

People with very active lifestyles such as athletes, dancers, and military personnel, need to eat a lot of food to make up for the large amount of energy they burn. If they don't match their food intake to their energy needs, they may enter a state of 'energy deficit'. This means their bodies are burning more calories than they're taking in, which can lower performance, increase the risk of injuries and illnesses, and potentially harm overall health.

Traditional scientific understanding assumes that more doing physically activity leads to burning more calories (the 'additive' model). However, newer studies suggest that the body might have built-in safeguards to limit how many total calories it burns, no matter how much a person exercises. This idea (the 'constrained' model) proposes that when people exercise more, their bodies might compensate by slowing down other metabolic processes to keep overall energy use within a certain range. Although this mechanism could help the body conserve energy, it may also mean that essential functions (like immune system support and reproductive function) can become impaired.

Most research on energy deficit so far has focused on people with normal or moderate levels of physical activity. Because extremely active people experience far higher daily energy demands, the 'constrained' mechanisms could manifest differently or to a greater degree and the negative health and performance consequences might be more severe. There is also limited knowledge about how quickly these changes in energy use begin and how they affect important processes at the cellular level, such as muscle mitochondrial function or immune cell health.

This study aims to fill these gaps by measuring total energy use (and its separate parts) in highly active individuals under two conditions: when participants eat enough to cover their energy demands and when participants are purposely in an energy deficit (intentionally eating less than they need). One of our main goals is to measure changes in resting metabolic rate (RMR), which is the energy the body uses at rest to keep vital functions going. Investigators will also examine cellular changes by looking at indicators like immune cell function to see how these might help us detect early signs of harmful energy shortages.

By understanding whether, and to what extent, the body's energy use is 'constrained', investigators can develop better guidelines to help very active individuals avoid unhealthy energy deficits. Ultimately, this research could improve both performance and long-term health for athletes, military personnel, dancers, and anyone else who regularly exercises at high levels.

Being tested
Controlled energy-deficit diet, Habitual diet with surplus snacks
Keywords
energy deficit, energy balance, energy availability, physical activity
Medical subject headings
Relative Energy Deficiency in Sport, Motor Activity

What participants receive

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

  • Controlled energy-deficit dietDietary supplement

    Also called Energy deficit

    Participants receive a prepared diet providing approximately 50% of their estimated daily energy expenditure to induce a sustained energy deficit

  • Habitual diet with surplus snacksDietary supplement

    Also called Energy surplus

    Participants continue their normal diet with the addition of high-calorie snack items to achieve an approximate daily energy surplus

Study groups in NCT07122778
Study groupRoleWhat they receive
Energy deficitExperimentalDiet-induced 50% energy deficit (based on estimated average total daily energy expenditure) by allocation of pre-made meals and snacks over 7-days
Receives: Dietary Supplement: Controlled energy-deficit diet
Energy surplusExperimentalDiet-induced energy surplus (approximately 500-1000kcal/day) achieved by allocation of additional snacks to be consumed on top of habitual free-living diet, to avoid inadvertent energy deficit
Receives: Dietary Supplement: Habitual diet with surplus snacks

What is being measured

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

  1. Resting metabolic rate (RMR) in kcal/day

    The effect of a 7-day period of energy expenditure-matched diet-induced energy deficit versus energy surplus on RMR. Measured via indirect calorimetry using the Douglas bag method. Expired gas will be collected in a seated, fasted state under thermoneutral conditions, and oxygen consumption and carbon dioxide production will be used to calculate energy expenditure.

    Measured: Measured at lab visits 1-5 (baseline and pre- and post-interventions) from 0 to 12 weeks.

Secondary outcomes (36)
  1. Total energy expenditure (from doubly labelled water) in kcal/day

    Measured: Measured during both 7-day interventions starting at approximately week 4 and week 9.

  2. Total energy expenditure ( from sum of independent components of energy expenditure) in kcal/day

    Measured: Measured during both 7-day interventions starting at approximately week 4 and week 9

  3. Peripheral blood mononuclear cell (PBMC) mitochondrial respiration

    Assessment of mitochondrial respiratory function in isolated PBMCs using high-resolution respirometry (Oroboros). Measures include basal (routine), leak, oxidative phosphorylation (OXPHOS), and electron transfer system (ETS) capacity states. Data will be used to assess changes in mitochondrial function in response to exercise and nutritional intervention. Units: pmol O₂·s-¹·10⁶ cells-¹ (picomoles of oxygen consumed per second per million PBMCs).

    Measured: Measured pre- and post-exercise at visits 2/3 (pre- and post-intervention 1) and visits 4/5 (pre- and post-intervention 2), approximately weeks 4-12.

  4. Sub-maximal exercise performance (during steady-state treadmill exercise)

    Running economy (oxygen consumption at a fixed submaximal speed, expressed as ml O₂·kg-¹·min-¹)

    Measured: Measured at lab visits 1-5 (baseline and pre- and post-interventions) from 0 to 12 weeks.

  5. Free T3 in pmol/L

    Measured: Measured at lab visits 2-5 (pre- and post-interventions) from 4 to 12 weeks.

  6. Interstitial glucose concentration in mmol/l

    Continuous glucose monitoring using Dexcom G7 reporting mean daily and daily variability in interstitial glucose concentration.

    Measured: Measured during both 7-day interventions starting at approximately week 4 and week 9.

  7. Bone mineral density (DEXA)

    Bone mineral density will be assessed using dual-energy X-ray absorptiometry (DEXA). DEXA will provide areal BMD (g/cm²).

    Measured: Measured at lab visits 1-5 (baseline and pre- and post-interventions) from 0 to 12 weeks.

  8. Bone mineral density (pQCT)

    Bone mineral density will be assessed using peripheral quantitative computed tomography (pQCT) at the tibia. Measures will include volumetric BMD (vBMD) in mg/cm³ in cortical and trabecular compartments.

    Measured: Measured at lab visits 1-5 (baseline and pre- and post-interventions) from 0 to 12 weeks.

  9. Subjective measures of fatigue

    Daily subjective fatigue will be assessed using the Hooper Index (fatigue subscale, 5-item 1-5 Likert scale). Higher scores indicate greater perceived fatigue.

    Units: Hooper Index: total score (5-25)

    Measured: Measured at lab visits 1-5 (baseline and pre- and post-interventions) from 0 to 12 weeks.

  10. Sleep duration in h/night

    Accelerometer-dervied using arm-worn Actigraph LEAP device.

    Measured: Measured during both 7-day interventions starting at approximately week 4 and week 9.

  11. Non-exercise activity thermogenesis (NEAT) (estimated from ActiGraph LEAP device) in kcal/day

    Measured: Measured during both 7-day interventions starting at approximately week 4 and week 9

  12. Exercise energy expenditure (estimated from ActiGraph LEAP device) in kcal/day

    Measured: Measured during both 7-day interventions starting at approximately week 4 and week 9

  13. Sub-maximal exercise performance (during steady-state treadmill exercise)

    Substrate utilisation (absolute in g·min-¹)

    Measured: Measured at lab visits 1-5 (baseline and pre- and post-interventions) from 0 to 12 weeks

  14. Sub-maximal exercise performance (during steady-state treadmill exercise)

    Substrate utilisation (relative as % total energy expenditure)

    Measured: Measured at lab visits 1-5 (baseline and pre- and post-interventions) from 0 to 12 weeks

  15. Bone mineral density (pQCT)

    Cross-sectional area in mm²

    Measured: Measured at lab visits 1-5 (baseline and pre- and post-interventions) from 0 to 12 weeks

  16. Bone mineral density (pQCT)

    Strength-strain index in mm³

    Measured: Measured at lab visits 1-5 (baseline and pre- and post-interventions) from 0 to 12 weeks

  17. Subjective measures of fatigue

    Daily subjective fatigue will be assessed using the Fatigue Assessment Scale (FAS), a 10-item validated questionnaire scored from 10 to 50. Higher scores indicate greater perceived fatigue.

    Units: total score (10-50).

    Measured: Measured at lab visits 1-5 (baseline and pre- and post-interventions) from 0 to 12 weeks.

  18. Total testosterone in nmol/L

    Measured: Measured at lab visits 2-5 (pre- and post-interventions) from 4 to 12 weeks

  19. Free testosterone in pg/mL

    Measured: Measured at lab visits 2-5 (pre- and post-interventions) from 4 to 12 weeks

  20. cortisol in nmol/L

    Measured: Measured at lab visits 2-5 (pre- and post-interventions) from 4 to 12 weeks

  21. IGF-1 in ng/mL

    Measured: Measured at lab visits 2-5 (pre- and post-interventions) from 4 to 12 weeks

  22. leptin in ng/mL

    Measured: Measured at lab visits 2-5 (pre- and post-interventions) from 4 to 12 weeks

  23. Female-specific hormones: oestradiol in pmol/L

    Measured: Measured at lab visits 2-5 (pre- and post-interventions) from 4 to 12 weeks

  24. Female-specific hormones: FSH in IU/L

    Measured: Measured at lab visits 2-5 (pre- and post-interventions) from 4 to 12 weeks

  25. Female-specific hormones: LH in IU/L

    Measured: Measured at lab visits 2-5 (pre- and post-interventions) from 4 to 12 weeks

  26. Inflammatory markers: interleukin-6 (IL-6) in pg/mL

    Measured: Measured at lab visits 2-5 (pre- and post-interventions) from 4 to 12 weeks

  27. high-sensitivity C-reactive protein (hsCRP) in mg/L

    Measured: Measured at lab visits 2-5 (pre- and post-interventions) from 4 to 12 weeks

  28. ferritin in µg/L

    Measured: Measured at lab visits 2-5 (pre- and post-interventions) from 4 to 12 weeks

  29. serum iron in µmol/L

    Measured: Measured at lab visits 2-5 (pre- and post-interventions) from 4 to 12 weeks

  30. transferrin in g/L

    Measured: Measured at lab visits 2-5 (pre- and post-interventions) from 4 to 12 weeks

  31. total iron binding capacity (TIBC) in µmol/L

    Measured: Measured at lab visits 2-5 (pre- and post-interventions) from 4 to 12 weeks

  32. transferrin saturation as a percentage

    Measured: Measured at lab visits 2-5 (pre- and post-interventions) from 4 to 12 weeks

  33. soluble transferrin receptor in mg/L

    Measured: Measured at lab visits 2-5 (pre- and post-interventions) from 4 to 12 weeks

  34. hepcidin in ng/mL

    Measured: Measured at lab visits 2-5 (pre- and post-interventions) from 4 to 12 weeks

  35. Lipid markers: total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides in mmol/L; non-esterified fatty acids (NEFA) in mmol/L; and glycerol in µmol/L.

    Measured: Measured at lab visits 2-5 (pre- and post-interventions) from 4 to 12 weeks

  36. HbA1c will be reported in both % (DCCT-aligned) and mmol/mol (IFCC standard).

    Measured: Measured at lab visits 2-5 (pre- and post-interventions) from 4 to 12 weeks

Timeline

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

  1. First posted14 Aug 2025
  2. Study startAug 2025 (estimated)
  3. Primary completionAug 2026 (estimated)
  4. Study completionMay 2027 (estimated)

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
20 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07122778
Sponsor's protocol ID
6854-11590
Other IDs
345572
Acronym
Carpe DIEM
Status last verified
Aug 2025
First submitted
14 Apr 2025
Last updated
14 Aug 2025
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Questions about this trial

What is this clinical trial studying?

A study testing Habitual diet with surplus snacks in people with Energy Balance and Energy Deficit, 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 3 inclusion and 16 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: opening soon, as of the sponsor's last update on 14 Aug 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 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?

This study is still under way. Results are not available in the source record yet.

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

Contact Joshua J Bakker-Dyos, BSc(Hons) MBChB (+447740191473, jbd28@bath.ac.uk), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Resting metabolic rate (RMR) in kcal/day (time frame: Measured at lab visits 1-5 (baseline and pre- and post-interventions) from 0 to 12 weeks.). 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 14 Aug 2025.

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