To the moment, only limited data are present on the efficacy of changes in diet composition of patients with non-alcoholic fatty liver disease (NAFLD). The national database search in the federal registry of specialized products revealed no registered products for medical nutrition for patients with NAFLD. We developed the composition of specialized food products, produced their experimental batches, and performed laboratory studies of their safety, including tests on toxicology and microbiology (which revealed no concerns). Organoleptic studies of the products showed acceptable results. The aim of the present study is to assess safety and tolerability of newly developed specialized products for medical nutrition of patients with non-alcoholic fatty liver diseases in a prospective randomized placebo-controlled trial.
Development of specialized medical products is actual due to the high prevalence of non-alcoholic fatty liver disease (NAFLD), which accounts for 20-30% of the world's population, while non-alcoholic steatohepatitis (NASH) accounts for about 20% of all cases of NAFLD and affects all age groups, including children. Currently, there are no generally accepted and efficient methods to treat the disease. Recommended measures include changes in lifestyle, i.e., weight loss and dietary modifications together with increased physical activity. Pragmatic approaches combining dietary restriction and a progressive increase in aerobic exercise / resistance training are preferable and should be individually tailored. Only general principles of diet modification are strongly recommended, though the evidence of their efficacy is far from excellent. According to EASL 2016 guidelines on NAFLD, there is a need for energy restriction, exclusion of NAFLD-promoting components (processed food, and food and beverages high in added fructose; the macronutrient composition should be adjusted according to the Mediterranean diet) and avoidance of excessive alcohol intake. Only limited data are available on the change of diet composition, including the intake of products with low glycaemic index, containing larger amounts of components with known antioxidant capacity (including vitamins and minerals) and dietary fibre. Still, the use of mentioned components is promising in the regard of their potential to trigger metabolic changes, decrease insulin resistance, inflammatory processes in the liver tissue and excessive lipid accumulation in the liver in patients with NAFLD. The database search in the federal registry of specialized products revealed no specialized products for medical nutrition for patients with NAFLD. Despite some similarities in the pathogenesis of the diseases, specialized medical products for patients with diabetes mellitus are not optimal for patients with fatty liver disease. Based on the published data, medical and biological requirements for specialized product of medical nutrition were formulated. According to them, at an earlier stage of the present work we developed the composition of specialized food products, produced their experimental batches, and performed laboratory studies of their safety, including tests on toxicology and microbiology (which revealed no concerns). Organoleptic studies of the products showed acceptable results. The aim of the present study is to assess safety and tolerability of newly developed specialized products for medical nutrition of patients with non-alcoholic fatty liver diseases in a prospective randomized placebo-controlled trial.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
45
Patients randomly allocated to this group will use specialized product for medical nutrition (SPP-1). This product contains: soy protein, whey protein concentrate, microcapsulated rapeseed oil, maltodextrin, inulin, Polydextrose, soy lecithin, potassium citrate, magnesium lactate, ω-3 PUFA (docosahexaenoic acid), sweetener mixture (stevia extract, erythritol), natural flavor "Yogurt-vanilla", calcium carbonate, betaine hydrochloride, natural flavor "raspberry", vitamin premix (vitamins a, e, C, D3, B1, B2, B6, B12, PP, folic acid, Pantothenic acid, K1, Biotin), beet juice concentrate, carrageenan, mineral premix (iron, zinc, copper, manganese, iodine, selenium, molybdenum, chromium), alpha-lipoic acid. The product is packed in approved by sanitary rules bags by 30 g. The instant drink obtained by the mixture of the bag content with warm (30-60C) water should be used immediately after being prepared. The daily dose is 1 pack TID
All the patients enrolled to the study will be provided with recommendations on diet. Individualized requirements will be calculated based on the results of indirect calorimetry (resting energy expenditures) and measurements of urea in daily urine
Gastroenterology and Hepatology, FRC Nutrition and Biotechnology
Moscow, Russia
RECRUITINGWeight change
Assessment of weight before the start of treatment and on the 14th day of treatment. Change will be calculated as a difference from the subtraction of the second measurement from the first.
Time frame: 14 days
Change of satiety level
Assessment of satiety will be performed before the start of treatment and on the 14th day of treatment. Change will be calculated as a difference from the subtraction of the second measurement from the first.
Time frame: 14 days
Change of hunger level
Assessment of hunger will be performed with the use of the hunger scale before the start of treatment and on the 14th day of treatment. Change will be calculated as a difference from the subtraction of the second measurement from the first.
Time frame: 14 days
Presence of adverse events
Assessment of adverse events will be performed before the start of treatment and along the period of treatment.
Time frame: 14 days
Change of proportion of fat in body composition
Percent of fat in body composition will be assessed with bioelectrical impedance analysis (bioimpedance, BIA). The change will be calculated as a difference from the subtraction of the second measurement from the first.
Time frame: 14 days
Change of proportion of water in body composition
Percent of water in body composition will be assessed with BIA. The change will be calculated as a difference from the subtraction of the second measurement from the first.
Time frame: 14 days
Change of lean body weight
Lean weight in body composition will be assessed with BIA. The change will be calculated as a difference from the subtraction of the second measurement from the first.
Time frame: 14 days
Change in blood docosahexaenoic acid concentration
High performance liquid chromatography with mass spectrometry analysis of blood samples will be performed to evaluate docosahexaenoic acid concentration before the start of medical food product intake and on the last (14th) day of treatment. The change will be calculated as a difference from the subtraction of the second measurement from the first.
Time frame: 14 days
Change in blood hydroxyeycosatetraenoic acid concentration
High performance liquid chromatography with mass spectrometry analysis of blood samples will be performed to evaluate hydroxyeycosatetraenoic acid concentration before the start of medical food product/placebo intake and on the last (14th) day of treatment. The change will be calculated as a difference from the subtraction of the second measurement from the first.
Time frame: 14 days
Change of serum glucose concentration
Blood chemistry will be performed before the start of medical food product/placebo intake and on the last (14th) day of treatment. The change will be calculated as a difference from the subtraction of the second measurement from the first.
Time frame: 14 days
Change of serum insulin concentration
Blood chemistry will be performed before the start of medical food product/placebo intake and on the last (14th) day of treatment. The change will be calculated as a difference from the subtraction of the second measurement from the first.
Time frame: 14 days
Change of serum triglycerides concentration
Blood chemistry will be performed before the start of medical food product/placebo intake and on the last (14th) day of treatment. The change will be calculated as a difference from the subtraction of the second measurement from the first.
Time frame: 14 days
Change of serum high-density lipoprotein concentration
Blood chemistry will be performed before the start of medical food product/placebo intake and on the last (14th) day of treatment. The change will be calculated as a difference from the subtraction of the second measurement from the first.
Time frame: 14 days
Change of serum low-density lipoprotein concentration
Blood chemistry will be performed before the start of medical food product/placebo intake and on the last (14th) day of treatment. The change will be calculated as a difference from the subtraction of the second measurement from the first.
Time frame: 14 days
Change of serum cholesterol concentration
Blood chemistry will be performed before the start of medical food product/placebo intake and on the last (14th) day of treatment. The change will be calculated as a difference from the subtraction of the second measurement from the first.
Time frame: 14 days
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Change of serum gamma-glutamine transpeptidase (GGT) activity level
Blood chemistry will be performed before the start of medical food product/placebo intake and on the last (14th) day of treatment. The change will be calculated as a difference from the subtraction of the second measurement from the first.
Time frame: 14 days
Change of serum alanine amino-transferase (AST) activity level
Blood chemistry will be performed before the start of medical food product/placebo intake and on the last (14th) day of treatment. The change will be calculated as a difference from the subtraction of the second measurement from the first.
Time frame: 14 days
Change of serum alanine amino-transferase (ALT) activity
Blood (serum) ALT level will be measured before the start of the product/placebo intake and on the last (14th) day of treatment by blood chemistry. The change will be calculated as a difference from the subtraction of the second measurement from the first.
Time frame: 14 days