The goal of this clinical trial is to improve the treatment of hepatic steatosis associated with obesity with pharmacological and nutritionnal approaches. The main question it aims to answer is: Does an individualized nutritionnal approach with a dietician combined with medication targeting obesity is the most efficient way to treat hepatic steatosis associated with obesity? Participants will either participate in one of three groups: * Nutrition: Participant will only have a regular follow-up with a registered dietician; * Nutrition + Semaglutide: Participants will start a new medication targeting obesity and will have a regular follow-up with a registered dietician; * Semaglutide: Participants will start a new medication targeting obesity.
Participants in each group will be followed during a year for 4 timepoints (0, 3, 6 and 12 months). Blood and feces samples, anthropometric measures, transient elastography measurements and health questionnaires will be assessed at each timepoint. The nutritionnal intervention targeting hepatic steastosis associated with obesity will use conclusions from a systematic review we conducted on nutritionnal approaches to treat liver steatosis.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
120
Participants receiving this intervention will be starting with a dose of semaglutide 0.25 mg. Physicians will follow Wegovy® Dosing Schedule guidelines, ending with a final dose of 2.4 mg at the fifth month. Type 2 diabetes participants wishing to stop at 1.0 mg will be allowed.
Participants receiving this intervention will be seeing a registered dietician at each visit. The individualized approach will be based on recent literature (mostly hypocaloric) by using different methods.
Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval
Québec, Quebec, Canada
Liver Steatosis
Transient elastography is an ultrasound-based modality that is non-invasive and measures the degree of steatosis with the controlled attenuation parameter (CAP; dB/m) and liver stiffness (kPa).This method will be used at each visit to follow the progression and the efficiency of the interventions. The following ranges will be use to classify hepatic steatosis based on CAP (dB/m) (specific to FibroScan®): S0 (\< 302), S1 (302-331), S2 (331-337) and S3 (\>337).
Time frame: From enrollment to the end of the clinical trial at 12 months (for 4 visits)
Liver Stiffness
Transient elastography is an ultrasound-based modality that is non-invasive and measures the degree of steatosis with the controlled attenuation parameter (CAP; dB/m) and liver stiffness (kPa).This method will be used at each visit to follow the progression and the efficiency of the interventions. The following ranges will be use to classify hepatic fibrosis based on liver stiffness (kPa) (specific to FibroScan®): F0-F1 (\< 8.0), F2 (8.9-9.7), F3 (9.7-13.6) and F4 (\>13.6).
Time frame: From enrollment to the end of the clinical trial at 12 months (for 4 visits)
Liver function (biochemistry)
Blood samples will be drawn at each visit to assess the following measures: liver enzymes (aspartate aminotransferase \[AST\], alanine aminotransferase \[ALT\], gamma-glutamyl transferase \[GGT\], alkaline phosphatase \[ALP\]), total bilirubin and albumin. Liver scores will also be calculated: fatty liver index (FLI) and fibrosis-4 index (FIB-4) The following normal ranges will be used: * AST : \[8-33\] U/L; * ALT : \[10-40\] U/L; * GGT : \[2-30\] U/L; * ALP : \[30-120\] U/L; * Total bilirubin : \[5-21\] umol/L; * Albumin : \[35-30\] g/L. * FLI : \<30 : Low risk of hepatic steatosis ; \>60 : High risk of hepatic steatosis. * FIB-4 : \>3.48 : High risk of cirrhosis
Time frame: From enrollment to the end of the clinical trial at 12 months (for 4 visits)
Lipid panel
Blood samples will be drawn at each visit to assess the lipid panel. The following ranges will be used: * triglycerides: \< 1.5 mmol/L; * total cholesterol: \< 5.20 mmol/L; * LDL-cholesterol: \< 2.59 mmol/L; * HDL-cholesterol: \> 1.55 mmol/L;
Time frame: From enrollment to the end of the clinical trial at 12 months (for 4 visits)
Change from Baseline in the gut microbiota diversity
The composition of the gut microbiota will be measured at each visit with the participants' stool samples. The difference between the concentration of gut microbiota diversity (bacteria, families, phyllum, etc.) will be analyzed.
Time frame: From enrollment to the end of the clinical trial at 12 months (for 4 visits)
Change from Baseline in blood lipids and metabolites
We will perform lipidomic and metabolomic measures with blood samples of each visit with liquid chromatography coupled with mass spectrometry (LC-MS/MS).
Time frame: From enrollment to the end of the clinical trial at 12 months (for 4 visits)
Glucose
Blood samples will be drawn at each visit to assess the glucose. The following range will be used: \- glucose: \< 5.6 mmol/L;
Time frame: From enrollment to the end of the clinical trial at 12 months (for 4 visits)
Insulin
Blood samples will be drawn at each visit to assess insulin The following range will be used: \- insuline: \[20-60\] pmol/L;
Time frame: From enrollment to the end of the clinical trial at 12 months (for 4 visits)
Glycated hemoglobin
Blood samples will be drawn at each visit to assess HbA1c The following range will be used: \- HbA1c: \< 6.5 %;
Time frame: From enrollment to the end of the clinical trial at 12 months (for 4 visits)
C-reactive protein
Blood samples will be drawn at each visit to assess the c-reactive protein The following range will be used: \- CRP: \< 10 mg/L.
Time frame: From enrollment to the end of the clinical trial at 12 months (for 4 visits)
Liver enzymes
Blood samples will be drawn at each visit to assess the following measures: liver enzymes (aspartate aminotransferase \[AST\], alanine aminotransferase \[ALT\], gamma-glutamyl transferase \[GGT\] and alkaline phosphatase \[ALP\]), The following normal ranges will be used: * AST : \[8-33\] U/L; * ALT : \[10-40\] U/L; * GGT : \[2-30\] U/L; * ALP : \[30-120\] U/L.
Time frame: From enrollment to the end of the clinical trial at 12 months (for 4 visits)
Fatty liver index (FLI)
The Fatty liver index (FLI) is a non-invasive score to calculate liver steatosis (using BMI, WC, TG and GGT). The following ranges will be used: * \<30 : Low risk of hepatic steatosis ; * \>60 : High risk of hepatic steatosis.
Time frame: From enrollment to the end of the clinical trial at 12 months (for 4 visits)
Fibrosis-4 index (FIB-4)
The fibrosis-4 index (FIB-4) is a non-invasive score to calculate liver fibrosis (using Age, AST, ALT and Platelet count). The following normal range will be used: \- \<30 : Low risk of hepatic steatosis ; \>60 : High risk of hepatic steatosis. fatty liver index (FLI) and The following range will be used: \- FIB-4 : \>3.48 : High risk of cirrhosis
Time frame: From enrollment to the end of the clinical trial at 12 months (for 4 visits)
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