Probiotics have been recognized as functional foods with beneficial effects against obesity and cardiometabolic diseases, such as dyslipidemia, type 2 diabetes and the reduction of visceral fat mass, body weight and waist circumference. In previous studies, it was shown that capsule/powder probiotic or postbiotic supplementation containing a single strain probiotic, could reduce anthropometric parameters, including the visceral fat area, and contribute to type 2 diabetes management in subjects with abdominal obesity. Similar findings were found when this single strain probiotic was delivered through enriched seafood sticks. Results showed that enriched seafood sticks significantly reduced insulin concentrations and HOMA-IR, pulse pressure, waist circumference, body weight and triglycerides. These findings suggest that this specific single strain probiotic as a probiotic or postbiotic, could be a complementary strategy in the management of cardiometabolic disease risk factors. Probiotics have mostly been studied incorporated in dairy food matrix. Other food matrices, such as chewing gum, have scarcely been exploited by the food industry. Chewing gum as a novel vehicle for probiotics presents the ability to release active ingredients into the oral cavity with a steady and rapid action. Furthermore, it has a high acceptance amongst adults and children and present few side effects. No previous randomized controlled trials have examined the effect of a probiotic chewing gum on anthropometric adiposity biomarkers and glucose homeostasis in abdominally obese individuals. The main objective of the present study is to evaluate the efficacy of single strain probiotic in the reduction of waist circumference in abdominally obese individuals. The specific objectives: * To evaluate the efficacy of single strain probiotic in the improvement of other anthropometric biomarkers (waist-hip-ratio, body weight, BMI, total fat mass, visceral fat index, free fat mass, lean body mass, conicity index, visceral adipose tissue and subcutaneous fat). * To evaluate the efficacy of single strain probiotic in the management of glucose homeostasis. * To evaluate the efficacy of single strain probiotic in the management of serum lipid levels. * To evaluate the efficacy of single strain probiotic in the reduction of blood pressure and pulse pressure. * To asses Quality of life after single strain probiotic supplementation. * To identify changes in caloric intake and subjective satiety after single strain probiotic supplementation. * To identify changes in gastrointestinal health after single strain probiotic supplementation. * To identify changes in the oral microbiome after single strain probiotic supplementation. * To identify changes in the gastrointestinal microbiome after single strain probiotic supplementation.
A total of 180 adult volunteers will be included in the intervention (90 in each arm of the intervention). During the CHOICE study, there will be 6 visits in total. Of these visits, 3 will be face-to-face and 3 by telephone. The study visits will be the following: screening visit (V0, face-to-face): to check inclusion/exclusion criteria and, in case of satisfying the inclusion criteria; basal visit (V1, face-to- face); visits during the intervention (V2, V3 and V4 via telephone); final study visit (V5, face-to-face). In visits V0, V1 and V5 volunteers must present themselves in fasting conditions of 8 hours to obtain blood samples. In visits V1 and V5 volunteers must bring saliva and faeces samples. In order to measure the changes in visceral adipose tissue, up to five days prior to the visit V1 and approximately up to 3 days prior after the V5, volunteers must have a Nuclear Magnetic Resonance (NMR) for measuring visceral fat. CHOICE Study Visit 0 (V0, week -1): Recruitment and selection * Information to the volunteer and signature of the informed consent. * Revision of the inclusion/exclusion criteria. * Elaboration of study clinical history. * Vital signs (blood pressure/resting heart rate). * Checking the concomitant medication. * Anthropometry (waist circumference; hip; body weight and composition; height). * Blood sample extraction. * Delivery of the 3-day dietary record and the material for feaces and saliva sample recollection for V1. * Schedule the first visit and instructions (fasting). Visit 1 (V1, week 0): Basal visit * NMR (±5 days V1). * Revision of study clinical history. * Vital signs (blood pressure/resting heart rate). * Checking the concomitant medication. * Anthropometry (waist circumference; hip; body weight and composition). * Blood sample extraction. * Abdominal fat Ultrasound. * Checking the 3-day dietary record. * Checking the Three Factor Eating Questionnaire (TFEQ). * Checking the Bing Eating Scale (BES). * Checking the satiety scale (VAS) and gastrointestinal health information. * Collection of feaces samples. * Collection of saliva samples. * Delivery of the 3-day dietary record and the material for saliva and feaces sample for V5. * Schedule the next telephone visit and also the final visit and instructions (fasting). Visit 2 (V2, week 3): Follow-up during the intervention * Checking the concomitant medication. * Record adverse effects. * Checking adherence to product consumption (treatment compliance) * Checking the satiety scale. * Checking the gastrointestinal health. * Schedule the next visit and instructions. Visit 3 (V3, week 6): Follow-up during the intervention * Checking the concomitant medication. * Record adverse effects. * Checking adherence to product consumption (treatment compliance) * Checking the satiety scale. * Checking the gastrointestinal health. * Schedule the next visit and instructions. Visit 4 (V4, week 9): Follow-up during the intervention * Checking the concomitant medication. * Record adverse effects. * Checking adherence to product consumption (treatment compliance) * Checking the satiety scale. * Checking the gastrointestinal health. * Schedule the next visit and instructions (fasting). Visit 5 (V2, week 12): Final visit * NMR (±3 days before V5). * Revision of study clinical history. * Vital signs (blood pressure/resting heart rate). * Anthropometry (waist circumference; hip; body weight and composition) * Checking the concomitant medication. * Blood sample extraction. * Abdominal fat Ultrasound. * Checking the 3-day dietary record. * Checking the TFEQ. * Checking the BES. * Record of adverse effects. * Checking the treatment compliance * Checking the satiety scale. (VAS) * Collection of feaces samples. * Collection of saliva samples.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
180
Sugar-free chewing gum with single strain probiotic and zinc. The dosage will be 2 chewing a day, served at the same time and chewed for 6 minutes outside meals (for example 2h after breakfast or lunch).
Sugar-free chewing gum. The dosage will be 2 chewing a day, served at the same time and chewed for 6 minutes outside meals (for example 2h after breakfast or lunch).
Universitat Rovira i Virgili
Reus, Tarragona, Spain
RECRUITINGChange in waist circumference
Difference in waist circumference (cm) measured at the umbilicus using a 150-cm anthropometric steel measuring tape from week 0 to week 12
Time frame: From week 0 to Week 12
Change in hip circumference
Differences in hip circumference (cm) measured at the widest portion of the buttocks using a 150-cm anthropometric steel measuring tape from week 0 to week 12
Time frame: From week 0 to Week 12
Change in waist-hip-ratio
Differences in waist-hip-ratio (cm) measured as waist circumference/hip circumference from week 0 to week 12
Time frame: From week 0 to Week 12
Change in Body weight
Differences in body weight (kg) measured using a Tanita MC 780-MA; Tanita Corp., Barcelona, Spain, from week 0 to week 12
Time frame: From week 0 to Week 12
Change in Body mass index
Differences in body mass index (kg/m2) calculated as weight (kg) divided to height (m2), from week 0 to week 12
Time frame: From week 0 to Week 12
Change in Total fat mass
Differences in total fat mass (% kg) measured using a Tanita MC 780-MA; Tanita Corp., Barcelona, Spain, from week 0 to week 12
Time frame: From week 0 to Week 12
Change in Free fat mass
Differences in free fat mass (%, kg) measured using a Tanita MC 780-MA; Tanita Corp., Barcelona, Spain, from week 0 to week 12
Time frame: From week 0 to Week 12
Change in Lean body mass
Differences in Lean body mass (%, kg) measured using a Tanita MC 780-MA; Tanita Corp., Barcelona, Spain, from week 0 to week 12
Time frame: From week 0 to Week 12
Change in Visceral fat index
Differences in visceral fat index obtained using a Tanita MC 780-MA; Tanita Corp., Barcelona, Spain, from week 0 to week 12
Time frame: From week 0 to Week 12
Change in Conicity index
Differences in Conicity index calculated as waist circumference (cm)/0.109 x square root of weight (kg)/height (m) from week 0 to week 12
Time frame: From week 0 to Week 12
Change in Visceral adipose tissue
Differences in Visceral adipose tissue (cm2) measured by MRI (transverse body scan in one axial slice 5cm over L5-S1) from week 0 to week 12
Time frame: From week 0 to Week 12
Change in Subcutaneous fat
Differences in Subcutaneous fat (cm2) measured by MRI, transverse body scan in one axial slice 5cm over L5-S1 from week 0 to week 12
Time frame: From week 0 to Week 12
Changes in Fasting blood glucose
Differences in Fasting blood glucose (mmol/L) measured by Standardized methods in an automated analyzer from week 0 to week 12
Time frame: From week 0 to Week 12
Changes in Fasting insulin
Differences in Fasting insulin (IU/mL) measured by Standardized methods in an automated analyzer from week 0 to week 12
Time frame: From week 0 to Week 12
Changes in HOMA index
Differences in HOMA index measured with the formula insulin x glucose/405 from week 0 to week 12
Time frame: From week 0 to Week 12
Changes in glycosylated hemoglobin (HbA1c)
Differences in glycosylated hemoglobin (%) measured by Standardized methods in an automated analyzer from week 0 to week 12
Time frame: From week 0 to Week 12
Changes in Total cholesterol
Differences in Total cholesterol (mmol/L) measured by Standardized methods in an automated analyzer from week 0 to week 12
Time frame: From week 0 to Week 12
Changes in HDLc
Differences in HDLc (mmol/L) measured by Standardized methods in an automated analyzer from week 0 to week 12
Time frame: From week 0 to Week 12
Changes in LDLc
Differences in LDLc (mmol/L) measured by Standardized methods in an automated analyzer from week 0 to week 12
Time frame: From week 0 to Week 12
Changes in Total Triglycerides
Differences inTotal Triglycerides (mmol/L) measured by Standardized methods in an automated analyzer from week 0 to week 12
Time frame: From week 0 to Week 12
Changes in Systolic blood pressure
Differences in Systolic blood pressure (mmHg) measured by an automatic phygmomanometer (OMRON HEM-907; Peroxfarma, Barcelona, Spain) measured twice after adult respite 2-5 min seated, with a 1-min interval in between from week 0 to week 12
Time frame: From week 0 to Week 12
Changes in Diastolic blood pressure
Differences in Diastolic blood pressure (mmHg) measured by an automatic hygmomanometer (OMRON HEM-907; Peroxfarma, Barcelona, Spain) measured twice after adult respite 2-5 min seated, with a 1-min interval in between from week 0 to week 12
Time frame: From week 0 to Week 12
Changes in Pulse Pressure
Differences in Pulse pressure (mmHg), calculated as the difference between the upper and lower numbers of blood pressure, from week 0 to week 12
Time frame: From week 0 to Week 12
Changes in Three Factor Eating Questionnaire (TFEQ; Spanish edition)
Differences in TFEQ score from week 0 to week 12. The minimum score is 0 and maximum score is 100, and higher score means a worse outcome.
Time frame: From week 0 to Week 12
Changes in Bing Eating Scale (BES; Spanish edition)
Differences in BES score from week 0 to week 12. The minimum score is 0 and maximum score is 46, and higher score means a worse outcome.maximum score is 100, and higher score means a worse outcome.
Time frame: From week 0 to Week 12
Changes in dietary intake
Differences in dietary intake assessed by a 3-day dietary record from week 0 to week 12
Time frame: From week 0 to week 12
Changes in Satiety
Differences in satiety, assessed by a Visual Annual Scale (VAS), from week 0 to week 3, week 6, week 9 and week 12. The minimum score is -100 mm and maximum score is 100 mm, and higher score means a better outcome.
Time frame: From week 0 to week 3, week 6, week 9 and week 12
Changes in bowel habit
Differences in bowel habit, assessed by bristol scale, from week 0 to week 3, week 6, week 9 and week 12. In this scale there are 7 descriptive points, the minimum score is "severe constipation" and maximum score is "severe diarrhea". The better outcome is in the middle of the 7 descriptive points (points 3 and 4): "normal".
Time frame: From week 0 to week 3, week 6, week 9 and week 12
Changes in flatulences
Differences in the presence of flatulence (yes or not), from week 0 to week 3, week 6, week 9 and week 12
Time frame: From week 0 to week 3, week 6, week 9 and week 12
Changes in nausea
Differences in the presence of nausea (yes or not), from week 0 to week 3, week 6, week 9 and week 12
Time frame: From week 0 to week 3, week 6, week 9 and week 12
Changes in reflux
Differences in the presence of reflux (yes or not), from week 0 to week 3, week 6, week 9 and week 12
Time frame: From week 0 to week 3, week 6, week 9 and week 12
Changes in abdominal distension
Differences in the presence of abdominal distension (yes or not), from week 0 to week 3, week 6, week 9 and week 12
Time frame: From week 0 to week 3, week 6, week 9 and week 12
Changes in diarrhea
Differences in the presence of diarrhea (yes or not), from week 0 to week 3, week 6, week 9 and week 12
Time frame: From week 0 to week 3, week 6, week 9 and week 12
Changes in gut microbiota
Differences in Phyla composition, assessed by metagenomics, from week 0 to week 12
Time frame: From week 0 to week 12
Changes in oral microbiota
Differences in Phyla composition, assessed by metagenomics, from week 0 to week 12
Time frame: From week 0 to week 12
Change in Visceral adipose tissue
Differences in Visceral adipose tissue (mm) measured by ultrasound (xipho-umbilical axis, 1-5 cm above navel) from week 0 to week 12
Time frame: From week 0 to week 12
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