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Non-Alcoholic Fatty Liver DiseaseTikTacNCT05987748

The Clock Thickens: Morning or Evening Training for the Treatment of NAFLD?

A study testing Exercise training in people with Non-Alcoholic Fatty Liver Disease, run by Leiden University Medical Center at 1 site in Netherlands.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

The goal of this clinical trial is to investigate the different effect of morning and evening exercise training in individuals with non-alcoholic fatty liver disease (NAFLD). The main question it aims to answer is: Is morning or evening exercise better for the treatment of NAFLD? Participants will follow a supervised… Read more about this study

Who is it for?
Ages 45 to 75 years
Conditions the study is for
Non-Alcoholic Fatty Liver Disease
What is being tested?
Exercise training
Could I receive a placebo?
No, everyone receives an active treatment
How many people
40 participants
Where
1 siteNetherlands
Study dates
1 Sep 2023to 1 Sep 2024
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 45 to 75 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Age ≥ 45 years and ≤ 75
  • Obese (BMI > 27 kg/m2)
  • Males and postmenopausal females
  • Caucasian
  • Hepatic steatosis defined as increased hyperechogenicity of the liver on abdominal ultrasound, CAP score on Fibroscan > 280, and/or histological signs of steatosis
  • Sedentary lifestyle (maximum of 20 minutes of moderate-to-vigorous physical activity per day on less than three days per week)
  • Written informed consent

Who cannot join

  • Exclusion criteria for MRI (claustrophobia, pacemaker, metal implants, etc.)
  • Any other liver disease than NAFLD/NASH
  • Present excessive alcohol use defined as > 2 units/day
  • Recent use (< 3 months) of antibiotics
  • Recent changes in dosages of regular medication (< 3 months)
  • Recent (< 3 months) weight change (>5%)
Show all 12Show fewer
  • Recent (< 3 months) substantial diet changes
  • Cardiovascular co-morbidity defined as heart failure, coronary insufficiency and hypertension in past history
  • Comorbidity that contraindicates exercise training and exercise testing or that affects exercise response and exercise capacity
  • Ongoing or recent use of glucocorticoids, oral/transdermal hormonal substitution, paclitaxel, theofyllin, amiodarone, myelosuppresive agents
  • A psychiatric, addictive or any other disorder that compromises the subjects ability to understand the study content and to give written informed consent for participation in the study
  • Working night or alternating shifts, known sleeping disorders such as narcolepsy or insomnia

Trial locations and contacts

1 site in 1 country.

Milena Schönke, PhD contact

+31715268188

m.schoenke@lumc.nl

Maarten E Tushuizen, MD PhD contact

m.e.tushuizen@lumc.nl

Netherlands1 site
  • Leiden University Medical Center

    Leiden, South Holland, 2333 ZA

    Milena Schönke, PhD, +31715268188, m.schoenke@lumc.nl

    Maarten E Tushuizen, MD PhD, m.e.tushuizen@lumc.nl

Other trials in Netherlands

About this study

Official title: The Clock Thickens: Morning or Evening Training for the Treatment of NAFLD? (TikTac Study)

The goal of this clinical trial is to investigate the different effect of morning and evening exercise training in individuals with non-alcoholic fatty liver disease (NAFLD). The main question it aims to answer is:

  • Is morning or evening exercise better for the treatment of NAFLD?

Participants will follow a supervised exercise training program for three months with either morning or evening training and the effect on liver health will be assessed. Researchers will compare the morning to the evening exercise group to see if one training timepoint is more effective than the other in reducing the amount of fat in the liver and improving liver health.

Read the detailed description

The aim of the study is to identify the effect of exercise timing on NAFLD. Additionally, we aim to increase the understanding of the exercise-related modulation of the metabolic and inflammatory processes causing NAFLD, including insulin resistance and dysbiosis of the gut microbiota. Forty obese patients with NAFLD will be enrolled by randomization to participate in an exercise training program over 12 weeks, either in the morning (n=20) or evening (n=20). Blood and stool samples will be collected before, during and after the intervention to monitor diagnostic markers such as liver enzymes (AST, ALT, GGT, etc.) and changes of the gut microbiota with exercise, respectively. Moreover, mixed meal tolerance tests will be performed before and after the intervention to monitor insulin sensitivity and hepatic fat content and cardiovascular parameters (e.g. arterial stiffness) will be monitored via MRI. Throughout the study, physical fitness will be assessed and monitored using steep ramp tests. Patients will be randomized for a supervised, standardized 50 min morning or evening training, with both progressive endurance and strength elements, in a frequency of 3 times a week for 12 weeks.

Being tested
Exercise training
Keywords
Exercise, Circadian rhythms
Medical subject headings
Non-alcoholic Fatty Liver Disease, Motor Activity

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Exercise trainingBehavioural

    Mixed exercise training containing strength and endurance elements carried out under supervision

Study groups in NCT05987748
Study groupRoleWhat they receive
Morning exerciseExperimentalIndividuals will exercise train at 8 AM three times per week for 12 weeks.
Receives: Behavioral: Exercise training
Evening exerciseExperimentalIndividuals will exercise train at 8 PM three times per week for 12 weeks.
Receives: Behavioral: Exercise training

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Liver fat content

    Liver fat content (in %) will be measured by MRI LiverMultiScan

    Measured: 12 weeks

Secondary outcomes (13)
  1. Hepatic fibrosis

    Hepatic stiffness (in kPa) will be measured as a proxy for liver fibrosis by Fibroscan (transient elastography)

    Measured: 12 weeks

  2. Body mass index (BMI)

    Body weight (in kg) and height (in m) will be combined to report BMI in kg/m^2

    Measured: 12 weeks

  3. Fecal microbiota

    Fecal microbiota composition assessed via microbial sequencing

    Measured: 12 weeks

  4. Cardiorespiratory fitness

    Peak workload (Wpeak) will be assessed with a the Steep Ramp Test (SRT) on a cycle ergometer

    Measured: 12 weeks

  5. Waist circumference

    Waist circumference (in cm) will be measured with a measuring tape

    Measured: 12 weeks

  6. Blood pressure

    Blood pressure (mmHg) will be measured using an arm cuff

    Measured: 12 weeks

  7. Plasma levels of liver enzymes

    Plasma levels of aspartate transaminase (ASAT), alanine aminotransferase (ALAT), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP) (all in units/L) and bilirubin (in umol/L) will be quantified in the laboratory

    Measured: 12 weeks

  8. Plasma insulin levels

    Plasma insulin (in pmol/L) will be measured during a mixed meal test after 0, 10, 20, 30, 40, 60, 90, 120 and 180 minutes of the ingestion of a mixed meal

    Measured: 12 weeks

  9. Plasma glucose levels

    Plasma glucose (in mmol/L) will be measured during a mixed meal test after 0, 10, 20, 30, 40, 60, 90, 120 and 180 minutes of the ingestion of a mixed meal

    Measured: 12 weeks

  10. Blood lipid levels

    Blood triglyceride, LDL-cholesterol and HDL-cholesterol levels (all in mmol/L) will be quantified in the laboratory

    Measured: 12 weeks

  11. Physical activity

    Self-reported physical activity (minutes of moderate-intensity activity per week) will be assessed with the International Physical Activity Questionnaire (IPAQ)

    Measured: 12 weeks

  12. Sleep

    Sleeping habits (bedtime, time of falling asleep, time of waking up, sleep duration) will be assessed via the Munich Chronotype Questionnaire (MCTQs 5.0).

    Measured: 12 weeks

  13. Food intake

    Self-reported food intake (type of food, quantity, time of intake) will be assessed with 3-day food diaries

    Measured: 12 weeks

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted14 Aug 2023
  2. Study start1 Sep 2023 (estimated)
  3. Primary completion1 Sep 2024 (estimated)
  4. Study completion1 Sep 2024 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
40 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05987748
Sponsor's protocol ID
NL83431.058.22
Acronym
TikTac
Status last verified
Aug 2023
First submitted
28 Jul 2023
Last updated
14 Aug 2023
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: All IPD that underlie results in a publication

Publications

  • Younossi ZM, Koenig AB, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016 Jul;64(1):73-84. doi: 10.1002/hep.28431. Epub 2016 Feb 22.

    PubMed 26707365
  • Estes C, Razavi H, Loomba R, Younossi Z, Sanyal AJ. Modeling the epidemic of nonalcoholic fatty liver disease demonstrates an exponential increase in burden of disease. Hepatology. 2018 Jan;67(1):123-133. doi: 10.1002/hep.29466. Epub 2017 Dec 1.

    PubMed 28802062
  • Stols-Goncalves D, Hovingh GK, Nieuwdorp M, Holleboom AG. NAFLD and Atherosclerosis: Two Sides of the Same Dysmetabolic Coin? Trends Endocrinol Metab. 2019 Dec;30(12):891-902. doi: 10.1016/j.tem.2019.08.008. Epub 2019 Oct 17.

    PubMed 31630897
  • Younossi Z, Anstee QM, Marietti M, Hardy T, Henry L, Eslam M, George J, Bugianesi E. Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention. Nat Rev Gastroenterol Hepatol. 2018 Jan;15(1):11-20. doi: 10.1038/nrgastro.2017.109. Epub 2017 Sep 20.

    PubMed 28930295
  • Ruissen MM, Mak AL, Beuers U, Tushuizen ME, Holleboom AG. Non-alcoholic fatty liver disease: a multidisciplinary approach towards a cardiometabolic liver disease. Eur J Endocrinol. 2020 Sep;183(3):R57-R73. doi: 10.1530/EJE-20-0065.

    PubMed 32508312
  • Sato S, Basse AL, Schonke M, Chen S, Samad M, Altintas A, Laker RC, Dalbram E, Barres R, Baldi P, Treebak JT, Zierath JR, Sassone-Corsi P. Time of Exercise Specifies the Impact on Muscle Metabolic Pathways and Systemic Energy Homeostasis. Cell Metab. 2019 Jul 2;30(1):92-110.e4. doi: 10.1016/j.cmet.2019.03.013. Epub 2019 Apr 18.

    PubMed 31006592
  • Savikj M, Gabriel BM, Alm PS, Smith J, Caidahl K, Bjornholm M, Fritz T, Krook A, Zierath JR, Wallberg-Henriksson H. Afternoon exercise is more efficacious than morning exercise at improving blood glucose levels in individuals with type 2 diabetes: a randomised crossover trial. Diabetologia. 2019 Feb;62(2):233-237. doi: 10.1007/s00125-018-4767-z. Epub 2018 Nov 13.

    PubMed 30426166
  • Dalbram E, Basse AL, Zierath JR, Treebak JT. Voluntary wheel running in the late dark phase ameliorates diet-induced obesity in mice without altering insulin action. J Appl Physiol (1985). 2019 Apr 1;126(4):993-1005. doi: 10.1152/japplphysiol.00737.2018. Epub 2019 Feb 7.

    PubMed 30730814
  • Andersson A, Kelly M, Imajo K, Nakajima A, Fallowfield JA, Hirschfield G, Pavlides M, Sanyal AJ, Noureddin M, Banerjee R, Dennis A, Harrison S. Clinical Utility of Magnetic Resonance Imaging Biomarkers for Identifying Nonalcoholic Steatohepatitis Patients at High Risk of Progression: A Multicenter Pooled Data and Meta-Analysis. Clin Gastroenterol Hepatol. 2022 Nov;20(11):2451-2461.e3. doi: 10.1016/j.cgh.2021.09.041. Epub 2021 Oct 7.

    PubMed 34626833
  • Schaapman JJ, Tushuizen ME, Coenraad MJ, Lamb HJ. Multiparametric MRI in Patients With Nonalcoholic Fatty Liver Disease. J Magn Reson Imaging. 2021 Jun;53(6):1623-1631. doi: 10.1002/jmri.27292. Epub 2020 Aug 21.

    PubMed 32822095
  • Oeda S, Tanaka K, Oshima A, Matsumoto Y, Sueoka E, Takahashi H. Diagnostic Accuracy of FibroScan and Factors Affecting Measurements. Diagnostics (Basel). 2020 Nov 12;10(11):940. doi: 10.3390/diagnostics10110940.

    PubMed 33198092
  • Mikolasevic I, Orlic L, Franjic N, Hauser G, Stimac D, Milic S. Transient elastography (FibroScan((R))) with controlled attenuation parameter in the assessment of liver steatosis and fibrosis in patients with nonalcoholic fatty liver disease - Where do we stand? World J Gastroenterol. 2016 Aug 28;22(32):7236-51. doi: 10.3748/wjg.v22.i32.7236.

    PubMed 27621571
  • van Lingen E, Tushuizen ME, Steenhuis MEJ, van Deynen T, Martens J, Morales DD, van der Meulen-de Jong AE, Molendijk I, van der Marel S, Maljaars PWJ. Disease activity in inflammatory bowel disease patients is associated with increased liver fat content and liver fibrosis during follow-up. Int J Colorectal Dis. 2022 Feb;37(2):349-356. doi: 10.1007/s00384-021-04065-8. Epub 2021 Nov 17.

    PubMed 34791524
  • Beyer C, Hutton C, Andersson A, Imajo K, Nakajima A, Kiker D, Banerjee R, Dennis A. Comparison between magnetic resonance and ultrasound-derived indicators of hepatic steatosis in a pooled NAFLD cohort. PLoS One. 2021 Apr 1;16(4):e0249491. doi: 10.1371/journal.pone.0249491. eCollection 2021.

    PubMed 33793651
  • Dennis A, Mouchti S, Kelly M, Fallowfield JA, Hirschfield G, Pavlides M, Banerjee R. A composite biomarker using multiparametric magnetic resonance imaging and blood analytes accurately identifies patients with non-alcoholic steatohepatitis and significant fibrosis. Sci Rep. 2020 Sep 17;10(1):15308. doi: 10.1038/s41598-020-71995-8.

    PubMed 32943694

Questions about this trial

What is this clinical trial studying?

A study testing Exercise training in people with Non-Alcoholic Fatty Liver Disease, run by Leiden University Medical Center at 1 site in Netherlands.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 7 inclusion and 12 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 14 Aug 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Netherlands. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact Milena Schönke, PhD (+31715268188, m.schoenke@lumc.nl), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Liver fat content (time frame: 12 weeks). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05987748, which also lists 29 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 14 Aug 2023.

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