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Trial registered on ANZCTR
Registration number
ACTRN12624000009516
Ethics application status
Approved
Date submitted
21/11/2023
Date registered
9/01/2024
Date last updated
9/01/2024
Date data sharing statement initially provided
9/01/2024
Type of registration
Prospectively registered
Titles & IDs
Public title
Effects of Exclusive Enteral Nutrition (EEN) with fibre in healthy participants
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Scientific title
The impact of Exclusive Enteral Nutrition with fibre on intestinal physiology and microbiology in healthy controls
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Secondary ID [1]
311006
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Nil known
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
This is a follow up study from a previously performed study examining EEN (without fibre) in a similar protocol (ACTRN12621000568819)
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Health condition
Health condition(s) or problem(s) studied:
Crohn's disease
332113
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Condition category
Condition code
Inflammatory and Immune System
328840
328840
0
0
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Autoimmune diseases
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Diet and Nutrition
328841
328841
0
0
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Other diet and nutrition disorders
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Oral and Gastrointestinal
328842
328842
0
0
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Crohn's disease
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Exclusive enteral nutrition (EEN) involves the provision of specialised liquid nutrition formula, excluding all table foods and fluids with the exception of water, to patient's with Crohn's Disease to induce remission. In this study we will be giving EEN with fibre (Nutricia, Fortisip Multifibre) to healthy participants for a period of 3 weeks to assess changes this has on intestinal physiology and microbiology. Frequency of administration will be dependent on individual participant's estimated nutrition requirements, however likely to be 5-8 200ml bottles/day (spread across the day based on participant preference). Each 200ml bottle provides 1290kJ, 12g protein, 36.8g carbohydrate, 11.6g fat and 4.4g fibre)
The EEN regime will be prescribed by a dietitian with >10 years experience. Estimated nutrition requirements will be calculated (energy and protein) by the dietitian and amount of formula prescribed will meet these estimated requirements.
All formula will be provided to the participants at no cost.
Participants progress with EEN will be reviewed weekly by the dietitian (face to face or via phone) and adjusted accordingly based on tolerance, weight fluctuations and satiety
Adherence will be assessed by direct questioning, participant maintained diaries and amount of formula used.
Study visits whilst on EEN (to collect serum, urine and faecal samples) will occur at the Alfred Hospital, Monash University building, 55 Commercial Rd, Melbourne VIC
To safely induce intestinal stress in healthy subjects, participants will be administered a corticotrophin releasing hormone injection by a medical professional prior to commencing EEN and again after 3 weeks on EEN. Urine and blood samples will be taken following this injection.
Participants in this study will not be specifically be a follow up of the same participants enrolled in study ACTRN12621000568819, however if participants from the first study wish to participate in this study they are permitted to.
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Intervention code [1]
327443
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Treatment: Other
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Comparator / control treatment
No control group
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Control group
Uncontrolled
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Outcomes
Primary outcome [1]
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Intestinal permeability
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Assessment method [1]
336637
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Measured by dual sugar absorption test, lactulose rhamnose ratio
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Timepoint [1]
336637
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Prior to commencement of EEN and on completion of 3 weeks of EEN
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Secondary outcome [1]
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Intestinal epithelial integrity via biomarkers of bacterial translocation
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Assessment method [1]
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Serum LPS binding protein
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Timepoint [1]
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Prior to commencement of EEN and on completion of 3 weeks of EEN
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Secondary outcome [2]
429127
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Regional intestinal transit times
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Assessment method [2]
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Atmo gas sensing capsule
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Timepoint [2]
429127
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Prior to commencement of EEN and on completion of 3 weeks of EEN
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Secondary outcome [3]
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Faecal microbiota and mycobiota
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Assessment method [3]
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16S rRNA and shotgun metagenomic sequencing
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Timepoint [3]
429129
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Prior to commencement of EEN and on completion of 3 weeks of EEN
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Secondary outcome [4]
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Psychological status of the subjects
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Assessment method [4]
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Depression Anxiety and Stress Scale (DASS42)
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Timepoint [4]
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Prior to commencement of EEN and on completion of 3 weeks of EEN
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Secondary outcome [5]
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Intestinal epithelial integrity via biomarkers of epithelial injury
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Assessment method [5]
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Serum soluble CD14
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Timepoint [5]
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Prior to commencement of EEN and on completion of 3 weeks of EEN
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Secondary outcome [6]
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Intestinal integrity via intestinal inflammation
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Assessment method [6]
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Serum highly sensitive CRP
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Timepoint [6]
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Prior to commencement of EEN and on completion of 3 weeks of EEN
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Secondary outcome [7]
430120
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Intestinal intergrity via intestinal inflammation
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Assessment method [7]
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Faecal calprotectin
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Timepoint [7]
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Prior to commencement of EEN and on completion of 3 weeks of EEN
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Secondary outcome [8]
430121
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Colonic protein and carbohydrate fermentation
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Assessment method [8]
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Regional pH profile, Atmo Gas Capsule
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Timepoint [8]
430121
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Prior to commencement of EEN and on completion of 3 weeks of EEN
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Secondary outcome [9]
430122
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Colonic protein and carbohydrate fermentation
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Assessment method [9]
430122
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Short chain and branched chain fatty acids in faeces
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Timepoint [9]
430122
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Prior to commencement of EEN and on completion of 3 weeks of EEN
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Secondary outcome [10]
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Regional gas profiles through the gastrointestinal tract (hydrogen, CO2)
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Assessment method [10]
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Atmo Gas Capsule
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Timepoint [10]
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Prior to commencement of EEN and on completion of 3 weeks of EEN
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Secondary outcome [11]
430124
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Colonic carbohydrate and protein fermentation
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Assessment method [11]
430124
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Faecal volatile organic compounds in faeces
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Timepoint [11]
430124
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Prior to commencement of EEN and on completion of 3 weeks of EEN
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Secondary outcome [12]
430125
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Quality of life of the subjects
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Assessment method [12]
430125
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WHO Quality of Life Scale (WHOQOL-BREF)
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Timepoint [12]
430125
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Prior to commencement of EEN and on completion of 3 weeks of EEN
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Eligibility
Key inclusion criteria
18-60 years of age in good health
English speaking to provide informed consent
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Minimum age
18
Years
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Maximum age
60
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
• Use of antibiotics, probiotics or supplementary prebiotics in previous 2 weeks
• Family history of IBD
• History of gastrointestinal conditions
• History of eating disorder
• Recent weight changes (>5% within past 1 month)
• Body Mass Index (BMI) <18.5 or >30
• Restrictive diets with potential major alteration to nutrient balance (e.g., vegan, paleo)
• Current psychological illness
• Smoker
• Taking medication known to alter intestinal barrier function
• Pregnant or breast feeding
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Non-randomised trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Single group
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
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Statistical methods / analysis
Sample size
As this is a pilot study with no data upon which to power, an initial cohort of 10 subjects will be studied.
Data analysis plan
Data analysis will be undertaken using the Statistical Package for Social Sciences (SPSS), version 20, (SPSS, Chicago, Inc):
• Descriptive statistics
• Statistical significance will be taken as p < 0.05.
Both per-protocol and intention-to-treat data will applied to all endpoints. Descriptive statistics will describe the outcome variables and baseline data will compared with that after intervention using, for example, Wilcoxon rank sum test for continuous variables and Chi squared test for categorical variables.
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
1/02/2024
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Actual
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Date of last participant enrolment
Anticipated
30/06/2024
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Actual
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Date of last data collection
Anticipated
30/06/2024
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Actual
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Sample size
Target
10
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
VIC
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Recruitment postcode(s) [1]
41712
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3004 - Melbourne
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Funding & Sponsors
Funding source category [1]
315269
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University
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Name [1]
315269
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Monash University
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Address [1]
315269
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Wellington Rd, Clayton VIC 3800
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Country [1]
315269
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Australia
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Primary sponsor type
University
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Name
Monash University
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Address
Wellington Rd, Clayton VIC 3800
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Country
Australia
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Secondary sponsor category [1]
317303
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None
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Name [1]
317303
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Address [1]
317303
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Country [1]
317303
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
314189
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Alfred Health Ethics Commitee
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Ethics committee address [1]
314189
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55 Commercial Rd, Prahran VIC 3004
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Ethics committee country [1]
314189
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Australia
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Date submitted for ethics approval [1]
314189
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28/06/2023
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Approval date [1]
314189
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19/10/2023
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Ethics approval number [1]
314189
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Summary
Brief summary
Exclusive Enteral Nutrition (EEN) reduces inflammation and allows complete gut healing in up to 80% of people with Crohn’s Disease (CD). EEN involves removing all food and replacing it with a liquid containing all essential nutrients for 6-8 weeks. This treatment is superior to steroids in treating inflammation and is being increasingly used across Australasia as first-line therapy, particularly in children. Despite EEN having been shown to be effective in numerous studies, the ways in which it works to reduce inflammation is still unknown and this study seeks to address the hypotheses by assessing how EEN works. The best way to assess how a therapy works to treat disease is to examine its impact in a 'normal' gut with limited confounders.
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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
130726
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Dr Emma Halmos
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Address
130726
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Alfred Centre, Central Clinical School, Level 5 99 Commercial Rd, Melbourne VIC 3004
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Country
130726
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Australia
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Phone
130726
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+61407324779
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Fax
130726
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Email
130726
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[email protected]
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Contact person for public queries
Name
130727
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Sarah Melton
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Address
130727
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Alfred Centre, Central Clinical School, Level 5 99 Commercial Rd, Melbourne VIC 3004
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Country
130727
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Australia
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Phone
130727
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+61399030270
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Fax
130727
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Email
130727
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[email protected]
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Contact person for scientific queries
Name
130728
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Sarah Melton
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Address
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Alfred Centre, Central Clinical School, Level 5 99 Commercial Rd, Melbourne VIC 3004
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Country
130728
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Australia
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Phone
130728
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+61399030270
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Fax
130728
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Email
130728
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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
Individual participant data not to be shared publicly due to confidentially
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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.
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