Developmental ORIgins of Healthy and Unhealthy AgeiNg: the Role of Maternal Obesity (DORIAN)

Turku University Hospital (TYKS)

Status: Completed

Conditions: Insulin Resistance; Muscle Weakness; Maternal-Fetal Relations

Treatments: Behavioral: Exercise Training

Study type: Interventional

Funder types: Other

Identifiers

NCT01931540

T55/2012b

EC-FP7-278603 (Other Grant/Funding Number)

Details and patient eligibility

About

The prevalence of obesity in the developed world has increased markedly over the last 20 years. Considering the prevalence of obese and overweight adult subjects, and the fact that pregnancy itself induces a state of insulin resistance and inflammation, maternal obesity may be the most common health risk for the developing fetus. It is well established that what we eat has a major impact on our health. However, there is growing evidence to suggest that diet during pregnancy and lactation may be particularly important as not only does it influence the health of the mother, it may have a permanent effect on the health of her children and even her grandchildren. The concept that environmental factors, such as nutrition during early development, influence both our health span and lifespan has been termed the developmental origins of health and disease hypothesis.

The objective of the study are:

• to compare subjects with frailty (condition developed with ageing) with controls and characterize the unhealthy aged condition with the measurements described below
• to examine if signs of frailty can be reversed by lifestyle induced modifications (exercise training programme) of its primary components (IR, sarcopenia, psychological profile) in offspring of overweight/obese (OOM) vs lean mothers (OLM).

The study consists of 37 frail old subjects, age ≥ 65 sub-grouped in 17 OOM, and 20 OLM and 11 non frail controls. These subjects will be studied with positron emission tomography (PET), computed tomography (CT), magnetic resonance imaging (MRI) and spectroscopy (MRS) and ultra sounds (US). In addition functional MRI (fMRI) will be performed. Adipose tissue biopsies will be taken.

Subjects will undergo characterization of biohumoral markers, a 75 g oral glucose tolerance test, imaging biomarkers (PET/CT, US, fMRI-MRS), genetic biomarkers (DNA and telomere damage) and inflammatory biomarkers (macrophage infiltration) before and after the 4-month lifestyle intervention period (physical exercise). By PET/CT it will be measured tissue-specific IR in skeletal muscle, adipose tissue, liver, myocardium and targeted brain regions. MRS will be used to measure organ steatosis in the skeletal muscle and liver, MRI will be used to measure fat masses in abdominal areas, and fMRI will be performed to assess activation in brain regions regulating cognition and appetite/energy control. US will be used to assess cardiovascular markers (IMT, strain and function).

Enrollment: 48 patients

Sex: Female

Volunteers: No Healthy Volunteers

Inclusion criteria

• Subjects must be already participating the Helsinki Birth Cohort Study

Frailty Groups Inclusion Criteria:

• (Frailty) with lowest half of adult grip strength (measured 2001-2004)
• Group OM: (Offspring of Obese mothers) Highest quartile of maternal BMI
• Group LM: (Offspring of Normal weight/Lean mothers) Lowest two quartiles of maternal BMI

Control group Inclusion Criteria:

• (no Frailty) with highest half of adult grip strength (measured 2001-2004)
• Offspring of normal weight mothers

Exclusion criteria

• Subjects whose mothers were pre-eclamptic during pregnancy
• Oral corticosteroid or Warfarin therapy
• Recent myocardial infarction
• Severe chronic disorder that can prevent to participate the intervention
• Chronic atrial fibrillation and pacemaker
• Cancer less than 5 years ago
• Current smoking
• Diabetes requiring insulin treatment or fasting glucose more than 7 mmol/l
• Weight more than 170 kg and Waist circumference > 150 cm
• Inner ear implants
• Metal objects in body including metallic prostheses, artificial valve prostheses, surgical clips, braces, foreign fragments or tattoo

Trial design

Primary purpose: Treatment

Allocation: Non-Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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48 participants in 3 patient groups

Exercise Training - 17 offspring of OM

Experimental group

Description:

4 months exercise training, OM: Obese mothers

Treatment:

Behavioral: Exercise Training

11 non-frail controls (9 LM)

No Intervention group

Description:

Studied only at baseline

Exercise Training - 20 offspring of LM

Experimental group

Description:

4 months exercise training, LM:Lean/Normal Mothers

Treatment:

Behavioral: Exercise Training