A Gender and Culturally Specific Approach to Reduce NAFLD in Mexican-American Men

University of Arizona15 enrolled

Overview

Using a small Randomized Controlled Trial (RCT) study design, PNPLA3 risk allele carriers (CG/GG genotype) with NAFLD, will be assigned 2:1 to a tailored NAFLD-specific weight loss intervention compared to a wait-list control group.

The Mexican-American population accounts for 64.3% of the U.S. Hispanic population and is the fastest growing Hispanic subgroup. Non-alcoholic fatty liver disease (NAFLD) is a chronic disease associated with obesity that is highest in the nation for Mexican-American men. NAFLD consists of a spectrum of conditions, ranging from fatty liver to cirrhosis and liver cancer. Lack of physical activity and sugar-sweetened beverage consumption are risk factors for NAFLD and are highly evident in the Mexican-American male population. Additionally, Mexican-American men are at increased risk of NAFLD and liver cancer if they are carriers of a version of a gene (PNPLA3) found to increase risk and severity of NAFLD. In the absence of prescription medications, weight loss due to changes in diet and physical activity is recommended for the prevention and treatment of NAFLD. Changes in lifestyle that result in \>5% body weight loss have been shown to improve levels of liver fat and even reverse the condition. Despite the clear need to develop effective intervention strategies for Mexican-American men, no studies to date have explored the use of health risk assessment strategies, including genetic risk, to motivate behavior change to reduce the risk of NAFLD in Mexican-American men. Consequently, this will be the first weight loss intervention for Mexican-American men to incorporate genetic predisposition and lifestyle risk factors of NAFLD (e.g., dietary sugar consumption), as a strategy to improve engagement in weight loss and weight maintenance behaviors.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

Conditions

NAFLD

Interventions

NAFLD-specific weight loss interventionBEHAVIORAL

This is a 12-month NAFLD-specific weight loss intervention that is explicitly tailored for Mexican-American men. It will include recommendations for diet, physical activity, and will utilize risk for NAFLD as a mechanism to engage men in lifestyle modification.

Wait-list controlOTHER

Participants in this condition will not receive treatment for 12-months until study comparisons have been made. After 12-months, participants will receive the 12-month NAFLD-specific weight loss intervention.

Eligibility

Sex: MALEMin age: 18 YearsMax age: 64 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Self-identify as a Mexican or Mexican-American man * 18-64 years of age * BMI between 30 to 50.0 kg/m² * Have a CAP score ≥248 at screening * Be identified as PNPLA3 risk allele carriers (CG/GG genotype) at screening * Be able to provide informed consent * Speak, read, and write either English and/or Spanish. Exclusion Criteria: * Have active, chronic gastrointestinal disorder (e.g. inflammatory bowel disease, ulcerative colitis, Chron's disease, celiac disease) * Been previously diagnosed with viral hepatitis, liver disease or liver cancer * Have a history of bariatric surgery * Report medical condition or treatment for a medical condition that could affect body weight or ability to engage in structured physical activity that is consistent with the intervention for this study * Have current congestive heart failure, angina, uncontrolled arrhythmia, or other symptoms indicative of an increased acute risk for a cardiovascular event * Have a resting systolic blood pressure of ≥150 mmHg or resting diastolic blood pressure of ≥100 mmHg * Have an eating disorders that would contraindicate weight loss or physical activity * Report significant alcohol consumption (e.g., drinking ≥ 21 standard drinks/week, binge drinkers, or those with previous heavy alcohol consumption) identified by the Alcohol Use Disorders Identification Test * Currently treated for psychological issues (e.g., depression, bipolar disorder, etc.), taking psychotropic medications with the previous 12 months, or hospitalized for depression within the previous 5 years * Report exercise on ≥3 days per week for ≥ 20 minutes per day over the past 3 months * Report weight loss of ≥5% or participating in a weight reduction diet program in the past 3 months * Taking any medication or supplement known to affect body composition or history of exposure to hepatotoxic drugs * Report plans to relocate to a location that limits their access to the study site or having employment, personal, or travel commitments that prohibit attendance to all of the scheduled assessments.

Locations (1)

University of Arizona Collaboratory for Metabolic Disease Prevention and Treatment

Tucson, Arizona, United States

Outcomes

Primary Outcomes

Study Recruitment: Interest in Participation at Baseline

The number of Mexican-American men who express interest in participation.

Time frame: Baseline

Study Recruitment: Screened for Eligibility at Baseline

The number of Mexican-American men screened for eligibility.

Time frame: Baseline

Study Recruitment: Eligibility at Baseline

The number of Mexican-American men eligible/ineligible for study inclusion and reason for ineligibility.

Time frame: Baseline

Study Recruitment: Enrollment at Baseline

The number of Mexican-American men enrolled in the study.

Time frame: Baseline

Retention at 6-months

Retention will be measured as the number of participants who remain in the study at 6-months, divided by the number enrolled.

Time frame: 6-months

Retention at 12-months

Retention will be measured as the number of participants who remain in the study at 12-months, divided by the number enrolled.

Time frame: 12-months

Attendance at weekly counseling sessions at 6-months

The investigators will use descriptive analyses to examine attendance at weekly counseling sessions (% sessions attended) at 6-months.

Time frame: 6-months

Attendance at weekly counseling sessions at 12-months

The investigators will use descriptive analyses to examine attendance at weekly counseling sessions (% sessions attended) at 12-months.

Data from ClinicalTrials.gov

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Secondary Outcomes

Change in body weight at 6-months

Body weight (kg) will be measured on a digital scale to assess change in body weight at 6-months over the intervention period.

Time frame: 6-months

Change in body weight at 12-months

Body weight (kg) will be measured on a digital scale to assess change in body weight at 12-months over the intervention period.

Time frame: 12-months

Change in waist circumference at 6-months

Waist circumference (cm) will be assessed using a standardized protocol at 6-months.

Time frame: 6-months

Change in waist circumference at 12-months

Waist circumference (cm) will be assessed using a standardized protocol at 12-months.

Time frame: 12-months

Change in liver steatosis at 6-months

A non-invasive transient elastography (FibroScan®, TE) will be used to measure the amount of fat (steatosis) present in the liver at 6-months based on controlled attenuation parameters (CAP).

Time frame: 6-months

Change in liver steatosis at 12-months

A non-invasive transient elastography (FibroScan®, TE) will be used to measure the amount of fat (steatosis) present in the liver at 12-months based on controlled attenuation parameters (CAP).

Time frame: 12-months

Change in liver fibrosis at 6-months

A non-invasive transient elastography (FibroScan®, TE) will be used to measure the amount of liver fibrosis (scaring) present in the liver at 6-months based on kilopascals (kPa).

Time frame: 6-months

Change in liver fibrosis at 12-months

A non-invasive transient elastography (FibroScan®, TE) will be used to measure the amount of liver fibrosis (scaring) present in the liver at 12-months based on kilopascals (kPa).

Time frame: 12-months

Change in alanine aminotransferase (ALT) at 6-months

Fasting blood samples will be collected to examine changes in alanine aminotransferase (ALT) in Units/Liter (U/L) at 6-months.

Time frame: 6-months

Change in alanine aminotransferase (ALT) at 12-months

Fasting blood samples will be collected to examine changes in alanine aminotransferase (ALT) in Units/Liter (U/L) at 12-months.

Time frame: 12-months

Change in aspartate aminotransferase (AST) at 6-months

Fasting blood samples will be collected to examine changes in aspartate aminotransferase (AST) in Units/Liter (U/L) at 6-months.

Time frame: 6-months

Change in aspartate aminotransferase (AST) at 12-months

Fasting blood samples will be collected to examine changes in aspartate aminotransferase (AST) in Units/Liter (U/L) at 12-months.

Time frame: 12-months

Change in physical activity at 6-months

An Actigraph will be used to objectively measure and quantify energy expenditure from physical activity at 6-months.

Time frame: 6-months

Change in physical activity at 12-months

An Actigraph will be used to objectively measure and quantify energy expenditure from physical activity at 12-months.

Time frame: 12-months

Change in dietary intake at 6-months

24-hr recalls will be used to assess self reported food intake (kcal/day) at 6-months. This will be used to estimate calories, dietary fat, protein, and carbohydrates consumed.

Time frame: 6-months

Change in dietary intake at 12-months

24-hr recalls will be used to assess self reported food intake (kcal/day) at 12-months. This will be used to estimate calories, dietary fat, protein, and carbohydrates consumed.

Time frame: 12-months

Change in weight loss self-efficacy at 6-months: questionnaire

Change in weight loss self-efficacy at 6-months will be measured using a reliable and validated self reported questionnaire (Weight Efficacy Lifestyle Questionnaire; 10-point Likert scale from 0 (not confident) to 9 (very confident)).

Time frame: 6-months

Change in weight loss self-efficacy at 12-months: questionnaire

Change in weight loss self-efficacy at 12-months will be measured using a reliable and validated self reported questionnaire (Weight Efficacy Lifestyle Questionnaire; 10-point Likert scale from 0 (not confident) to 9 (very confident)).

Time frame: 12-months