Effects of Dietary Fructose on Gut Microbiota and Fecal Metabolites in Obese Men and Postmenopausal Women: A Pilot Study
Study Details
Study Description
Brief Summary
Non alcoholic fatty liver disease (NAFLD) is the most common cause of abnormal liver function tests in the U.S. (Browning, et al., 2004), ranging from steatosis to end-stage liver disease. Fructose ingestion by the American public has steadily increased since the 1980's, and with it increases in NAFLD, fatty liver hepatitis (NASH), diabetes, obesity, and cardiovascular disease. Foods and beverage in the U.S. are typically sweetened with sucrose (50% glucose and 50% fructose) or high fructose corn syrup (45-58% glucose and 42-55% fructose) (Stanhope, et al., 2009). Research into the role that added fructose plays in the emerging chronic health issues is necessary to affect public policy and provide the connection between fructose and the increasing incidence of these co-morbidities.
There is evidence that gut bacteria contribute to a range of human diseases including those of the liver and gastrointestinal tract. Dietary fructose has been suggested to play a role in the development of these diseases and has been shown to alter gut microbes in animals. If the investigators find that dietary fructose alters bacteria in the human gut, this would suggest a potential targetable link between high fructose diet and disease.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Detailed Description
Non- alcoholic fatty liver disease (NAFLD) occurs in 30% of the adult US population (Luther, J., et al., 2015). Eating large amounts of fructose (a dietary sugar) increases liver fat accumulation and worsens NAFLD. In addition, fructose consumption has been shown to greatly increase triglycerides(fat) in the blood after meals, increasing the risk of heart disease,(Stanhope,et al., 2009) insulin resistance and diabetes. Current theories on liver disease caused by consuming fructose focuses on changes in the breakdown of fat by the liver. In experimental animals, fructose feeding changes the bacteria population (microbiota) in the gut, causes NAFLD and NASH, and increases leaking of toxins from the intestine (intestinal permeability) to the blood stream resulting in inflammation.
In humans, fructose consumption rapidly increases liver fat. However, changes in gut microbiota have not been studied. The proposed study will compare the addition of fructose or glucose to the study subjects' usual diet in a crossover design. They will not know which sugar they are receiving.
The Investigators plan to study postmenopausal, moderately obese but healthy women, and moderately obese but healthy men (age 45-70 years) to find out the effect of fructose verses glucose on the bacteria in their stool and inflammation in the bowel. The Investigators hypothesize that adding fructose to the participant's usual diet, compared to glucose, will change stool bacteria composition and the products that the bacteria produce, which may increase intestinal leakage, and increase markers of inflammation in the stool and blood due to this leakage. These changes may contribute to fructose -induced liver disease.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Glucose, Then Fructose Participants first receive Glucose Solution (75 grams) from Day 3 through Day 16 of an inpatient stay with usual diet. After a 2-3 week washout period, they will then receive Fructose Solution (75 Grams) from Day 3 through Day 16 on a second inpatient stay with usual diet. |
Other: Fructose Solution (75 Grams)
Fructose given in divided doses at breakfast and dinner.
Other: Glucose Solution (75 grams)
Glucose given in divided doses at breakfast and dinner.
Other Names:
|
| Experimental: Fructose, Then Glucose Participants first receive Fructose Solution (75 grams) from Day 3 through Day 16 of an inpatient stay with usual diet. After a 2-3 week washout period, they will then receive Glucose Solution (75 grams) from Day 3 through Day 16 on a second inpatient stay with usual diet. |
Other: Fructose Solution (75 Grams)
Fructose given in divided doses at breakfast and dinner.
Other: Glucose Solution (75 grams)
Glucose given in divided doses at breakfast and dinner.
Other Names:
|
Outcome Measures
Primary Outcome Measures
- Difference in the Distribution of Fecal Microbiota in Each Participant [assessed at Day 16 of each intervention, up to 64 days]
Difference in the distribution of fecal microbiota in each participant, between the fructose versus glucose supplemented diet arms of the study, as measured at the end of each intervention.
Eligibility Criteria
Criteria
Inclusion Criteria:
-
Post menopausal female, last menstrual period at least 24 months ago OR male
-
Age 45-70
-
Willing to consume usual diet with either fructose or glucose added during (2) 16-18 day inpatient stays
-
Willing to consume usual diet during 2 week wash-out period at home
-
BMI 30.0-39.9
-
Willingness not to travel long distances while on study, including wash-out period
-
Willingness not to be exposed to new pets while on study including wash-out period
Exclusion Criteria:
-
Fasting serum triglycerides >200mg/dl
-
Fasting blood glucose >126mg/dl
-
Renal function tests >2x Upper limit of normal
-
Liver Function Tests > 1.5x Upper limit of normal
-
Currently on statins
-
Daily use of a cathartic
-
Broad spectrum antibiotic use within the past 45 days
-
Currently on proton pump inhibitor
-
Currently on insulin or oral hypoglycemic agents
-
Active viral Hepatitis
-
Chronic constipation
-
Inflammatory bowel disease
-
Chronic diarrhea
-
GI resection
-
Any evidence of cardiovascular disease on EKG
-
History of cardiovascular disease such as coronary artery disease, Coronary Artery Bypass Graft, valve replacement, Myocardial Infarction, stroke / Transient Ischemic attack.
-
History of macronutrient malabsorption
-
Current smoker. Stopped < 3 months ago.
-
Daily alcohol intake equal to 1.5 oz of 40 proof alcohol.
-
HIV positive
-
Any medical, psychological or social condition that, in the opinion of the Investigator, would jeopardize the health or well-being of the participant during any study procedures or the integrity of the data
-
Persons taking probiotics
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | The Rockefeller University | New York | New York | United States | 10065 |
Sponsors and Collaborators
- Rockefeller University
- Weill Medical College of Cornell University
- National Institutes of Health (NIH)
Investigators
- Principal Investigator: Peter Holt, MD, Rockefeller University
Study Documents (Full-Text)
More Information
Publications
- Boursier J, Mueller O, Barret M, Machado M, Fizanne L, Araujo-Perez F, Guy CD, Seed PC, Rawls JF, David LA, Hunault G, Oberti F, Calès P, Diehl AM. The severity of nonalcoholic fatty liver disease is associated with gut dysbiosis and shift in the metabolic function of the gut microbiota. Hepatology. 2016 Mar;63(3):764-75. doi: 10.1002/hep.28356. Epub 2016 Jan 13.
- Browning JD, Szczepaniak LS, Dobbins R, Nuremberg P, Horton JD, Cohen JC, Grundy SM, Hobbs HH. Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology. 2004 Dec;40(6):1387-95.
- Luther J, Garber JJ, Khalili H, Dave M, Bale SS, Jindal R, Motola DL, Luther S, Bohr S, Jeoung SW, Deshpande V, Singh G, Turner JR, Yarmush ML, Chung RT, Patel SJ. Hepatic Injury in Nonalcoholic Steatohepatitis Contributes to Altered Intestinal Permeability. Cell Mol Gastroenterol Hepatol. 2015 Mar;1(2):222-232.
- Stanhope KL, Schwarz JM, Keim NL, Griffen SC, Bremer AA, Graham JL, Hatcher B, Cox CL, Dyachenko A, Zhang W, McGahan JP, Seibert A, Krauss RM, Chiu S, Schaefer EJ, Ai M, Otokozawa S, Nakajima K, Nakano T, Beysen C, Hellerstein MK, Berglund L, Havel PJ. Consuming fructose-sweetened, not glucose-sweetened, beverages increases visceral adiposity and lipids and decreases insulin sensitivity in overweight/obese humans. J Clin Invest. 2009 May;119(5):1322-34. doi: 10.1172/JCI37385. Epub 2009 Apr 20.
- PHO-0956
Study Results
Participant Flow
| Recruitment Details | |
|---|---|
| Pre-assignment Detail |
| Arm/Group Title | Fructose, Then Glucose | Glucose, Then Fructose |
|---|---|---|
| Arm/Group Description | Participants first receive Fructose Solution (75 grams) from Day 3 through Day 16 of an inpatient stay with usual diet. After a 2-3 week washout period, they will then receive Glucose Solution (75 grams) from Day 3 through Day 16 on a second inpatient stay with usual diet. Fructose Solution (75 Grams): Fructose given in divided doses at breakfast and dinner. Glucose Solution (75 grams): Glucose given in divided doses at breakfast and dinner. | Participants first receive Glucose Solution (75 grams) from Day 3 through Day 16 of an inpatient stay with usual diet. After a 2-3 week washout period, they will then receive Fructose Solution (75 Grams) from Day 3 through Day 16 on a second inpatient stay with usual diet. Fructose Solution (75 Grams): Fructose given in divided doses at breakfast and dinner. Glucose Solution (75 grams): Glucose given in divided doses at breakfast and dinner. |
| Period Title: Overall Study | ||
| STARTED | 6 | 7 |
| COMPLETED | 4 | 6 |
| NOT COMPLETED | 2 | 1 |
Baseline Characteristics
| Arm/Group Title | Glucose, Then Fructose | Fructose, Then Glucose | Total |
|---|---|---|---|
| Arm/Group Description | Participants first receive Glucose Solution (75 grams) from Day 3 through Day 16 of an inpatient stay with usual diet. After a 2-3 week washout period, they will then receive Fructose Solution (75 Grams) from Day 3 through Day 16 on a second inpatient stay with usual diet. Fructose Solution (75 Grams): Fructose given in divided doses at breakfast and dinner. Glucose Solution (75 grams): Glucose given in divided doses at breakfast and dinner. | Participants first receive Fructose Solution (75 grams) from Day 3 through Day 16 of an inpatient stay with usual diet. After a 2-3 week washout period, they will then receive Glucose Solution (75 grams) from Day 3 through Day 16 on a second inpatient stay with usual diet. Fructose Solution (75 Grams): Fructose given in divided doses at breakfast and dinner. Glucose Solution (75 grams): Glucose given in divided doses at breakfast and dinner. | Total of all reporting groups |
| Overall Participants | 7 | 6 | 13 |
| Age (Count of Participants) | |||
| <=18 years |
0
0%
|
0
0%
|
0
0%
|
| Between 18 and 65 years |
6
85.7%
|
4
66.7%
|
10
76.9%
|
| >=65 years |
1
14.3%
|
2
33.3%
|
3
23.1%
|
| Age (years) [Mean (Full Range) ] | |||
| Mean (Full Range) [years] |
58
|
57
|
57.6
|
| Sex: Female, Male (Count of Participants) | |||
| Female |
3
42.9%
|
3
50%
|
6
46.2%
|
| Male |
4
57.1%
|
3
50%
|
7
53.8%
|
| Ethnicity (NIH/OMB) (Count of Participants) | |||
| Hispanic or Latino |
1
14.3%
|
1
16.7%
|
2
15.4%
|
| Not Hispanic or Latino |
6
85.7%
|
5
83.3%
|
11
84.6%
|
| Unknown or Not Reported |
0
0%
|
0
0%
|
0
0%
|
| Race (NIH/OMB) (Count of Participants) | |||
| American Indian or Alaska Native |
0
0%
|
0
0%
|
0
0%
|
| Asian |
0
0%
|
0
0%
|
0
0%
|
| Native Hawaiian or Other Pacific Islander |
0
0%
|
0
0%
|
0
0%
|
| Black or African American |
5
71.4%
|
4
66.7%
|
9
69.2%
|
| White |
2
28.6%
|
2
33.3%
|
4
30.8%
|
| More than one race |
0
0%
|
0
0%
|
0
0%
|
| Unknown or Not Reported |
0
0%
|
0
0%
|
0
0%
|
| Region of Enrollment (participants) [Number] | |||
| United States |
7
100%
|
6
100%
|
13
100%
|
Outcome Measures
| Title | Difference in the Distribution of Fecal Microbiota in Each Participant |
|---|---|
| Description | Difference in the distribution of fecal microbiota in each participant, between the fructose versus glucose supplemented diet arms of the study, as measured at the end of each intervention. |
| Time Frame | assessed at Day 16 of each intervention, up to 64 days |
Outcome Measure Data
| Analysis Population Description |
|---|
| Investigator has retired and access to results for each arm was not available for this outcome. Best efforts were made to obtain the data from the investigator; however, they were unsuccessful. |
| Arm/Group Title | Fructose, Then Glucose | Glucose, Then Fructose |
|---|---|---|
| Arm/Group Description | Participants first receive Fructose Solution (75 grams) from Day 3 through Day 16 of an inpatient stay with usual diet. After a 2-3 week washout period, they will then receive Glucose Solution (75 grams) from Day 3 through Day 16 on a second inpatient stay with usual diet. Fructose Solution (75 Grams): Fructose given in divided doses at breakfast and dinner. Glucose Solution (75 grams): Glucose given in divided doses at breakfast and dinner. | Participants first receive Glucose Solution (75 grams) from Day 3 through Day 16 of an inpatient stay with usual diet. After a 2-3 week washout period, they will then receive Fructose Solution (75 Grams) from Day 3 through Day 16 on a second inpatient stay with usual diet. Fructose Solution (75 Grams): Fructose given in divided doses at breakfast and dinner. Glucose Solution (75 grams): Glucose given in divided doses at breakfast and dinner. |
| Measure Participants | 0 | 0 |
Adverse Events
| Time Frame | 10 months | |||
|---|---|---|---|---|
| Adverse Event Reporting Description | Adverse event data are reported per arm/group. Adverse event per intervention are not available because the Investigator has retired. Best efforts were made to obtain and reexamine the adverse event data; however, they were unsuccessful. | |||
| Arm/Group Title | Fructose, Then Glucose | Glucose, Then Fructose | ||
| Arm/Group Description | Participants first receive Fructose Solution (75 grams) from Day 3 through Day 16 of an inpatient stay with usual diet. After a 2-3 week washout period, they will then receive Glucose Solution (75 grams) from Day 3 through Day 16 on a second inpatient stay with usual diet. Fructose Solution (75 Grams): Fructose given in divided doses at breakfast and dinner. Glucose Solution (75 grams): Glucose given in divided doses at breakfast and dinner. | Participants first receive Glucose Solution (75 grams) from Day 3 through Day 16 of an inpatient stay with usual diet. After a 2-3 week washout period, they will then receive Fructose Solution (75 Grams) from Day 3 through Day 16 on a second inpatient stay with usual diet. Fructose Solution (75 Grams): Fructose given in divided doses at breakfast and dinner. Glucose Solution (75 grams): Glucose given in divided doses at breakfast and dinner. | ||
All Cause Mortality |
||||
| Fructose, Then Glucose | Glucose, Then Fructose | |||
| Affected / at Risk (%) | # Events | Affected / at Risk (%) | # Events | |
| Total | 0/4 (0%) | 0/6 (0%) | ||
Serious Adverse Events |
||||
| Fructose, Then Glucose | Glucose, Then Fructose | |||
| Affected / at Risk (%) | # Events | Affected / at Risk (%) | # Events | |
| Total | 0/4 (0%) | 0/6 (0%) | ||
Other (Not Including Serious) Adverse Events |
||||
| Fructose, Then Glucose | Glucose, Then Fructose | |||
| Affected / at Risk (%) | # Events | Affected / at Risk (%) | # Events | |
| Total | 3/4 (75%) | 3/6 (50%) | ||
| Gastrointestinal disorders | ||||
| Bloating | 2/4 (50%) | 4 | 3/6 (50%) | 3 |
| nausea | 1/4 (25%) | 1 | 0/6 (0%) | 0 |
| Metabolism and nutrition disorders | ||||
| elevated blood glucose | 1/4 (25%) | 1 | 1/6 (16.7%) | 1 |
| Musculoskeletal and connective tissue disorders | ||||
| low back pain | 0/4 (0%) | 0 | 1/6 (16.7%) | 1 |
| Nervous system disorders | ||||
| lightheadedness | 1/4 (25%) | 1 | 0/6 (0%) | 0 |
Limitations/Caveats
More Information
Certain Agreements
All Principal Investigators ARE employed by the organization sponsoring the study.
There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.
Results Point of Contact
| Name/Title | Dr. Peter R Holt |
|---|---|
| Organization | The Rockefeller University |
| Phone | 212-327-7706 |
| holtp@rockefeller.edu |
- PHO-0956