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Trial registered on ANZCTR
Registration number
ACTRN12617000403336
Ethics application status
Approved
Date submitted
30/09/2015
Date registered
17/03/2017
Date last updated
20/01/2020
Date data sharing statement initially provided
23/01/2019
Type of registration
Prospectively registered
Titles & IDs
Public title
Effects of A1 versus A2 milk on cardiometabolic risk in overweight and obese Australians
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Scientific title
Overweight and obese Australians and the effects of A1 beta-casein versus A2 beta-casein on human cardiometabolic risk factors.
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Secondary ID [1]
287573
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None
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Universal Trial Number (UTN)
U1111-1194-2629
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Overweight and obesity
296359
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Cardiometabolic risk factors related to A1 beta-casein
296360
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Gastrointestinal symptoms related to A1 beta-casein
302488
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Condition category
Condition code
Cardiovascular
296633
296633
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0
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Diseases of the vasculature and circulation including the lymphatic system
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Diet and Nutrition
296634
296634
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0
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Obesity
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Inflammatory and Immune System
302047
302047
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0
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Other inflammatory or immune system disorders
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
All participants will undergo a washout period of 2 weeks during which they will replace all dairy with rice milk. Other dairy containing product consumption will be restricted.
Intervention 1: 250ml three times a day (750 ml/day) A1A2 beta-casein Milk for 12 weeks
Intervention 2: 250ml three times a day (750 ml/day) A2A2 beta-casein Milk for 12 weeks
Adherence will be monitored via a milk intake calendar
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Intervention code [1]
292975
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Treatment: Other
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Comparator / control treatment
Control: 250ml three times a day (750 ml/day) Rice Milk for 12 weeks
Adherence will be monitored via a milk intake calendar
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Control group
Active
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Outcomes
Primary outcome [1]
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Fasting serum cholesterol
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Assessment method [1]
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Timepoint [1]
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Pre-washout, baseline and 12 weeks.
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Primary outcome [2]
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Fasting serum triglyceride
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Assessment method [2]
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Timepoint [2]
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Pre-washout, baseline and 12 weeks.
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Primary outcome [3]
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Antibodies to oxidised LDL measured by ELISA
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Assessment method [3]
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Timepoint [3]
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Pre-washout, baseline and 12 weeks.
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Secondary outcome [1]
317985
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Fasting serum inflammatory markers (Glutathione, MPO, IL-4, IL-6, IL-8, CRP, TNF-alpha, IFN-gamma and TGF-beta1
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Assessment method [1]
317985
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Timepoint [1]
317985
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Pre-washout, baseline and 12 weeks.
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Secondary outcome [2]
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Fasting serum insulin
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Assessment method [2]
317986
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Timepoint [2]
317986
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Pre-washout, baseline and 12 weeks.
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Secondary outcome [3]
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Blood pressure measured by automated, calibrated sphygmomanometer
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Assessment method [3]
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Timepoint [3]
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Pre-washout, baseline and 12 weeks
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Secondary outcome [4]
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Fasting serum leptin
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Assessment method [4]
317988
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Timepoint [4]
317988
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Pre-washout, baseline and 12 weeks.
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Secondary outcome [5]
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Body composition measured by dual-energy X-ray absorptiometry (DXA)
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Assessment method [5]
317989
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Timepoint [5]
317989
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Baseline and 12 weeks
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Secondary outcome [6]
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Gut permeability measured by dual sugar test (Lactulose/Mannitol)
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Assessment method [6]
317990
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Timepoint [6]
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Baseline and 12 weeks
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Secondary outcome [7]
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Gut inflammation measured by assesing faecal calprotectin with a single step enzyme linked immunosorbant assay (ELISA)
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Assessment method [7]
317991
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Timepoint [7]
317991
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Baseline and 12 weeks
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Secondary outcome [8]
317992
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A1A2, A2A2 and Rice milk tolerance measured by GI symptom report diary
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Assessment method [8]
317992
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Timepoint [8]
317992
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Baseline, 6 weeks and 12 weeks
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Secondary outcome [9]
317993
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Body weight will be recorded in light clothing without shoes with a Body Composition Monitor (Omron Healthcare, Kyoto, Japan)
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Assessment method [9]
317993
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Timepoint [9]
317993
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Pre-washout, baseline and 12 weeks
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Secondary outcome [10]
332800
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Fasting serum glucose
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Assessment method [10]
332800
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Timepoint [10]
332800
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Pre-washout, baseline and 12 weeks.
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Secondary outcome [11]
332801
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Fasting whole blood Hba1C
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Assessment method [11]
332801
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Timepoint [11]
332801
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Pre-washout, baseline and 12 weeks.
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Secondary outcome [12]
332802
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Arterial stiffness assessed by pulse contour analysis using the Pulse Trace PCA 2 (Carefusion, NSW, Australia)
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Assessment method [12]
332802
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Timepoint [12]
332802
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Pre-washout, baseline and 12 weeks
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Secondary outcome [13]
332803
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Satiety will be assessed by 100 mm Visual Analogue Scale (VAS) questionnaires
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Assessment method [13]
332803
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Timepoint [13]
332803
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Baseline and 12 weeks
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Secondary outcome [14]
332804
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Waist circumference will be measured in the standing position at the narrowest area between the lateral lower rib and the iliac crest with a tape measure.
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Assessment method [14]
332804
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Timepoint [14]
332804
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Pre-washout, baseline and 12 weeks
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Secondary outcome [15]
332805
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Hip circumference will be taken at the largest circumference of the lower abdomen with a tape measure.
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Assessment method [15]
332805
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Timepoint [15]
332805
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Pre-washout, baseline and 12 weeks
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Secondary outcome [16]
332806
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Plasma BCM-7 will be assessed by ELISA and cross-checked with HPLC MS
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Assessment method [16]
332806
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Timepoint [16]
332806
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Pre-washout, baseline and 12 weeks.
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Secondary outcome [17]
332807
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Fasting serum Non-Esterified Fatty Acids (NEFA)
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Assessment method [17]
332807
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Timepoint [17]
332807
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Pre-washout, baseline and 12 weeks.
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Secondary outcome [18]
332808
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Fasting serum Dipeptidyl Peptidase-IV (DPPIV) activity
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Assessment method [18]
332808
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Timepoint [18]
332808
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Pre-washout, baseline and 12 weeks.
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Secondary outcome [19]
332809
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Psychological health (quality of life, psychological well-being, self-rated health, and anxiety and depression) will be measured using previously-validated self-report psychometric inventories.
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Assessment method [19]
332809
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Timepoint [19]
332809
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Baseline and 12 weeks
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Secondary outcome [20]
332810
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Executive Functioning will be assessed by the Subtle Cognitive Impairment Test (SCIT)
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Assessment method [20]
332810
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Timepoint [20]
332810
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Baseline and 12 weeks
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Secondary outcome [21]
332822
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Short Chain Fatty Acids (SCFA) in faecal samples will be analysed
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Assessment method [21]
332822
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Timepoint [21]
332822
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Baseline and 12 weeks
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Secondary outcome [22]
332823
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Gut microbiome will be analysed from faecal samples
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Assessment method [22]
332823
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Timepoint [22]
332823
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Baseline and 12 weeks
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Eligibility
Key inclusion criteria
overweight or obese (BMI: 25-40 kg/m2)
willing to consume 750 ml of milk/day
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Minimum age
18
Years
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Maximum age
70
Years
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Sex
Both males and females
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Can healthy volunteers participate?
Yes
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Key exclusion criteria
Milk allergy, pregnancy and lactation, diabetes, current habitual opioid consumption and smokers
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Eligible participants will be assigned an ID as they are recruited. Allocation will involve contacting the holder of the allocation schedule who will be off-site.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
The randomisation scheme will be created using www.randomization.com with 3 treatments.
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people receiving the treatment/s
The people administering the treatment/s
The people assessing the outcomes
The people analysing the results/data
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Intervention assignment
Parallel
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
A sample size of 32 participants/group is predicted to provide sufficient power (80%) to detect a large effect size (7% difference) between groups at the p < 0.05 level. Recruiting 46 participants/group will accommodate for 30% dropout rate. A total of 140 participants will be recruited for the 3 groups. Calculations are based on standard deviation of 10% within a group observed in our previous studies examining changes in cardiometabolic risk factors in overweight and obese participants. Statistical analysis will be undertaken using SPSS 22 for Windows (SPSS Inc., Chicago, IL). Data will be expressed as mean (+/-SEM) and assessed for normality to ensure that the assumptions of the analysis are met. The data will be analysed using General Linear Models with baseline value covariates. If significant between groups effects are present, post hoc comparisons between the treatment groups will be made using the Least Significant Difference (LSD) method. Statistical significance will be considered at p<0.05.
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Recruitment
Recruitment status
Recruiting
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Date of first participant enrolment
Anticipated
4/02/2019
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Actual
25/02/2019
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Date of last participant enrolment
Anticipated
7/09/2020
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Actual
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Date of last data collection
Anticipated
14/12/2020
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Actual
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Sample size
Target
140
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Accrual to date
127
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Final
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Recruitment in Australia
Recruitment state(s)
WA
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Funding & Sponsors
Funding source category [1]
292144
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Commercial sector/Industry
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Name [1]
292144
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The a2 milk Company
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Address [1]
292144
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PO Box 1564 North Sydney
NSW 2059
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Country [1]
292144
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Australia
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Primary sponsor type
University
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Name
Curtin University
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Address
GPO Box U1987 Perth
WA 6845
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Country
Australia
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Secondary sponsor category [1]
290819
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None
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Name [1]
290819
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Address [1]
290819
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Country [1]
290819
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
293621
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Curtin Human Research Ethics Committee
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Ethics committee address [1]
293621
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GPO Box U1987, Perth Western Australia, 6845
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Ethics committee country [1]
293621
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Australia
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Date submitted for ethics approval [1]
293621
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24/03/2017
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Approval date [1]
293621
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26/07/2017
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Ethics approval number [1]
293621
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HRE2017-0490
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Summary
Brief summary
Obesity significantly increases the risk of developing metabolic syndrome (MS), which is associated with increased cardiovascular morbidity/mortality. Presently, there is fierce debate surrounding the effects of the A1 beta-casein protein variant (A1) in bovine milk compared to the progenitor A2 variant (A2) with respect to their relative impact on MS risk factors. Most milk and milk products available commercially in Australia contain the A1 protein from dairy cows which carry the A1 gene. The A1 variant in Australian dairy cattle is the result of a mutation from the A2 gene in European herds ~5,000 years ago. Alternatively, milk produced by cows specially selected and then bred to produce only the original A2 beta-casein type is also available in Australia, but it is a specialty milk brand. Ample evidence now suggests that A1 milk beta-casein can affect features of MS and so has important public health implications. Given the Australian Dietary Guidelines recommend 2.5-4 dairy serves/day, the effect of milk variety on MS warrants investigation. A1 and A2 protein have differences in bioactivity on digestion, due to the release of the 7-amino acid opioid peptide beta-casomorphin-7 (BCM-7), from the digestion of A1 but not A2. In vitro and animal studies have demonstrated that BCM-7 oxidises low density lipoprotein (LDL)-cholesterol and increases levels of the inflammatory marker myeloperoxidase, both of which are implicated in the development of heart disease. A1 beta-casein and BCM-7 also stimulate inflammatory markers and so may contribute to the overall inflammatory milieu in MS. We have also shown in our recent randomised cross-over study that A1 milk stimulates differences in gastrointestinal inflammatory responses compared to A2 milk. The aim of the current proposed project is to investigate the difference between A1 and A2 beta-casein protein containing milk on cardiovascular and metabolic risk factors in overweight/obese individuals. Simple and affordable nutrition interventions that can positively affect modifiable risk factors for heart disease and T2D in Australian adults are needed. If the predicted differences between A1 and A2 beta-casein containing milk on cardiometabolic risk outcomes are found, it will have important ramification for public health and the prevention of chronic illness like cardiovascular disease. Dairy farmers would be advised to choose A2 semen for their dairy breeding programs to change to the A2 milk type for Australian consumers. We hypothesise that A1, but not A2 beta-casein containing milk, will correspond to shifts in cardiometabolic risk factors mediated via BCM-7 in blood. In contrast, we propose that A2 beta-casein containing milk will have a neutral, rather than beneficial, effect on metabolic syndrome factors. Thus, the hypothesis implies that A2 will do no harm, while the mutated A1 variant may increase the risk of chronic disease at a population health level.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
60706
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A/Prof Sebely Pal
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Address
60706
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Curtin University
School of Public Health
Kent Street, Bentley, Perth
Western Australia 6102
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Country
60706
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Australia
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Phone
60706
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+61 8 9266 4755
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Fax
60706
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Email
60706
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[email protected]
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Contact person for public queries
Name
60707
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Suleen Ho
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Address
60707
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Curtin University
School of Public Health
Kent Street, Bentley, Perth
Western Australia 6102
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Country
60707
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Australia
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Phone
60707
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+61 422238198
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Fax
60707
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Email
60707
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[email protected]
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Contact person for scientific queries
Name
60708
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Suleen Ho
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Address
60708
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Curtin University
School of Public Health
Kent Street, Bentley, Perth
Western Australia 6102
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Country
60708
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Australia
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Phone
60708
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+61 422238198
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Fax
60708
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Email
60708
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[email protected]
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Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
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No/undecided IPD sharing reason/comment
IPD availability was not discussed during planning for this study.
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
Download to PDF