The study will be conducted as a 26-week double-blinded randomized placebo-controlled trial of Appethyl® vs placebo in 100 overweight/obese (BMI ≥25.0-35.9 kg/m\^2) men and women between 18-65 years with prediabetes (fasting plasma glucose of 5.6 mmol/L to \<7.0 mmol/L). At initiation, all subjects will receive healthy life style instructions in accordance to the guidelines described in the Nordic Nutrition Recommendations. The study aim to investigate the effect over time (26-weeks) of daily Appethyl® treatment compared to placebo on change in fasting glucose (primary endpoint) and several other health markers (secondary endpoint). The hypothesis to be tested is whether the null hypothesis (no difference between Appethyl® and placebo with regard to endpoint data) can be rejected.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
TRIPLE
Enrollment
82
Spinach extract, capsules, 5g/day, 26 weeks.
Pea protein, capsules, 5g/day, 26 weeks.
University of Copenhagen
Frederiksberg, DK, Denmark
Fasting blood glucose
To investigate the effect over time of daily Appethyl® treatment compared to placebo on change in fasting glucose.
Time frame: Change from baseline (week 0) to end of intervention (week 26)
Change in bodyweight
Body weight will be measured at baseline (week 0), week 12 and after end of intervention (week 26) in a fasting state. Body weight will be measured wearing only underwear or light clothing as well as no shoes and stockings. Body weight will be measured on a calibrated scale and subjects will be instructed to stand in the middle of the platform of the scale with straight neck and eyes looking straight ahead, whilst distributing their weight evenly on body feet after having emptied their bladder. Two measurements are made when the scale has stabilized and both results are recorded to the nearest 0.1 kg and the average of the two measurements is used for further analysis.
Time frame: Change from baseline (week 0) to end of intervention (week 26)
Change in fasting Insulin
Venous blood samples will be collected at baseline (week 0), week 12 and after end of intervention (week 26) by a vein puncture in the antecubital vein after an overnight fast from at least 10 pm the night before. HOMA-IR and HOMA-IS will be calculated from fasting blood glucose and insulin concentrations.
Time frame: Change from baseline (week 0) to end of intervention (week 26)
Change in hbA1c
Venous blood samples will be collected at baseline (week 0), week 12 and after end of intervention (week 26) by a vein puncture in the antecubital vein after an overnight fast from at least 10 pm the night before.
Time frame: Change from baseline (week 0) to end of intervention (week 26)
Change in anthropometrics
Waist- and hip circumference will be measured at baseline (week 0), week 12 and after end of intervention (week 26) in a fasting state. The measurements of waist- and hip circumference will be performed with an empty bladder and performed with a non-elastic tape measuring. Waist circumference is measured mid-way between the lower rib and iliac crest (top of the hip bone) at the end of expiration with the subject in a standing position with their weight distributed evenly on both feet. Hip circumference is measures at the widest point between the hips and buttocks observed from the front at the end of expiration with the subject in a standing position with their weight distributed evenly on both feet. Two measurements of waist- and hip circumference will be made and both results will be recorded to the nearest 0.5 cm and the average of the two measurements is used in further analysis
Time frame: Change from baseline (week 0) to end of intervention (week 26)
Change in body composition
Body composition will be assessed by a whole body DXA scan at baseline (week 0), week 12 and after end of intervention (week 26) assessing lean mass (kg), fat mass (kg), abdominal fat (kg), visceral fat (kg) and bone mineral density (g/cm\^2). The DXA scan will be performed in a fasting condition with the subjects only wearing light clothing and after emptying the bladder.
Time frame: Change from baseline (week 0) to end of intervention (week 26)
Change in inflammation
Venous blood samples will be collected at baseline (week 0), week 12 and after end of intervention (week 26) by a vein puncture in the antecubital vein after an overnight fast from at least 10 pm the night before. Leptin (pg/ml), adiponectin (ng/ml), IL-6 (pg/ml), TNF-alfa (pg/ml) and hsCRP (mg/L) will be assessed.
Time frame: Change from baseline (week 0) to end of intervention (week 26)
Change in blood lipids
Venous blood samples will be collected at baseline (week 0), week 12 and after end of intervention (week 26) by a vein puncture in the antecubital vein after an overnight fast from at least 10 pm the night before. Blood lipids: LDL and TG
Time frame: Change from baseline (week 0) to end of intervention (week 26)
Change in blood pressure
Systolic and diastolic blood pressure (mmHg) will be measured at baseline (week 0), week 12 and after end of intervention (week 26) using a validated automatic device. The blood pressure will be measured on the right arm with an appropriate arm cuff after 5-10 min rest in a resting position. The measurement will be performed three times approximately two minutes apart, and the reading is recorded to the nearest 1 mmHg for blood pressure. A mean value of the three readings will be used in further analysis.
Time frame: Change from baseline (week 0) to end of intervention (week 26)
Change in pulse
Pulse (beats per minute) will be measured at baseline (week 0), week 12 and after end of intervention (week 26) using a validated automatic device. The pulse will be measured on the right arm with an appropriate arm cuff after 5-10 min rest in a resting position. The measurement will be performed three times approximately two minutes apart, and the reading is recorded to the nearest 1 beats per minute for pulse. A mean value of the three readings will be used in further analysis.
Time frame: Change from baseline (week 0) to end of intervention (week 26)
Change in the proportion of participants converting to normoglycemia
Number of participants converting from prediabetes to normal glucose levels
Time frame: Change from baseline (week 0) to end of intervention (week 26)
Change in subjective assessment of dietary preferences
Subjective measurements of hunger, satiety, taste for sweet, fat and salt will be assessed by Visual Analogue Scales (VAS) (0-10 cm, where 10 being the highest ranking). The participants will be asked to complete the VAS at baseline (week 0) and at every visit from week 0 to 26 (week 4, 8, 12, 16, 20 and 24). Moreover, every fourth week from week 2 to week 22 (week 2, 6, 10, 14, 18, and 22) participants will be asked to complete the questionnaire regarding subjective assessment of dietary preferences at home. The questionnaire will be handed out prior to completion.
Time frame: Change from baseline (week 0) to end of intervention (week 26)
Change in subjective assessment of investigational product
Participants will be asked to answer a questionnaire (on a scale from 1-5 going from very tolerable to very intolerable) regarding their experience of the investigational product at baseline (week 0) and at every visit from week 0 to 26 (week 4, 8, 12, 16, 20 and 24). Moreover, every fourth week from week 2 to 22 (week 2, 6, 10, 14, 18, and 22) participants will be asked to complete the questionnaire regarding subjective assessment of the investigational product at home. The questionnaire will be handed out prior to completion.
Time frame: Change from baseline (week 0) to end of intervention (week 26)
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