Postprandial VLDL-triglycerid Metabolism in Type 2 Diabetes Patients With and Without NAFLD

Overview

Non-alcoholic fatty liver disease (NAFLD) covers a spectrum from simple reversible hepatic steatosis to inflammation and fibrosis termed steatohepatitis (NASH). The mechanisms behind why some subjects progress from NAFLD to NASH are not clear and the responsible mechanism for storage of excess amounts of liver fat in patients with NAFLD are poorly understood. Patients with type 2 diabetes mellitus (T2D) and abdominally obese subjects very often have accumulation of liver fat (NAFLD). T2D is also associated with abnormal lipid metabolism (dyslipidemia), including free fatty acids (FFA), hypertriglyceridemia and excessive postprandial hyperlipidemia which increases the risk of ischemic cardiovascular disease (CVD) and heart failure . In healthy, insulin sensitive subjects the postprandial increase in TG is primarily caused by meal derived chylomicrons, whereas endogenously produced TG (VLDL-TG) and decreased peripheral TG clearance only becomes quantitatively important in insulin resistant subjects .Thus, postprandial lipedemia in T2D results from both chylomicronemia as well as a reduction in both insulin mediated suppression of VLDL-TG secretion and lipoprotein lipase (LPL) mediated peripheral clearance . A recent study demonstrated that the ability of insulin to suppress hepatic VLDL-TG after a fat-enriched meal and the duration of the postprandial hyperlipidemia was similar in patients with T2D compared with age- and BMI matched individuals without T2D, indicating that the degree of insulin mediated VLDL-TG secretion and hyperlipidemia primarily depends on insulin sensitivity and not the presence of T2D diabetes per se. In these studies, we wants to examine the effect of a fat enriched mixed-meal on hepatic VLDL-TG handling and adipose storage capacity in patients with T2D with and without NAFLD. Investigators will address these questions using 14C triolein labeled VLDL-TG, MR spectroscopy of liver, muscle and fat biopsies in combination with state-of-the art muscle and adipose tissue enzyme kinetics, gene- and protein expression. The overarching goals are to define abnormalities and differences between patients with T2D with and without NAFLD in terms of hepatic lipid metabolism.

Full Title of Study: “Postprandial Hepatic Fatty Acid Metabolism During Oral High-fat Mixed-meal Challenge Test in Patients With Type 2 Diabetes With and Without NAFLD”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Non-Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Basic Science
    • Masking: None (Open Label)
  • Study Primary Completion Date: July 31, 2022

Interventions

  • Dietary Supplement: High-fat mixed-meal tolerance test (HF-MMT)
    • The test meal consists of a standardized HF-MMTT (791 cal) with 197 g cream (38 % fat) with 18 g sugar and 1 g vanilla sugar for taste (75 g fat, 25 g carbohydrate and 4 g protein)

Arms, Groups and Cohorts

  • Active Comparator: Type 2 Diabetes with NAFLD
    • Patients with Type 2 Diabetes with NAFLD MR spectroscopy verified steatosis
  • Active Comparator: Type 2 Diabetes without NAFLD
    • Patients with Type 2 Diabetes without NAFLD MR spectroscopy verified no steatosis

Clinical Trial Outcome Measures

Primary Measures

  • VLDL-triglyceride secretion – Ex vivo labeld VLDL – [14C]-triolein tracer technique.
    • Time Frame: 1 day
    • (μmol/min)
  • VLDL-triyglyceride uptake in muscle – Measurement of fatty acid concentration and specific activity in muscle biopsies
    • Time Frame: 1 day
    • (percent)
  • VLDL-triglyceride uptake in adiopose tissue – Measurement of fatty acid concentration and specific activity in adipose tissue biopsies
    • Time Frame: 1 day
    • (percent)

Secondary Measures

  • VLDL-triglyceride oxidation – Oxidation is measured by specific activity in exhaled air.
    • Time Frame: 1 day
    • (μmol/min)
  • Adipose cell size measurement
    • Time Frame: 1 day
    • (μl)
  • Insulin sensitivity
    • Time Frame: 1 day
    • (mg/kg/min)

Participating in This Clinical Trial

Inclusion Criteria

  • Subjects with Type 2 Diabetes with and without NAFLD (steatosis FF% > 5,6% on MR spectroscopy for NAFLD and NASH groups) Exclusion Criteria:

  • Active smoking – Comorbidity other than hypertension and hyperlipidemia – Fixed medical drug consumption (including insulin) except statins and anti-diabetic medications. However, statins must be paused 2 weeks before the examination date and other antidiabetic medication on examination date. – Patients with cancer or former cancer patients – Blood donation within the last 3 months prior to the study – Participation in experiments involving radioactive isotopes within the last 3 months – Alcohol abuse (over 21 items per week for men and over 14 for women) – Pregnancy

Gender Eligibility: All

Minimum Age: 30 Years

Maximum Age: 70 Years

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • University of Aarhus
  • Collaborator
    • Danish Diabetes Academy
  • Provider of Information About this Clinical Study
    • Sponsor
  • Overall Contact(s)
    • Indumathi Kumarathas, MD, +4530299715, indumathi@clin.au.dk

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