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Trial registered on ANZCTR
Registration number
ACTRN12616000599471
Ethics application status
Approved
Date submitted
6/05/2016
Date registered
10/05/2016
Date last updated
10/05/2016
Type of registration
Retrospectively registered
Titles & IDs
Public title
Effect of varying dietary protein concentration with carbohydrate versus fat on energy intake in healthy adults
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Scientific title
Interactions between protein leverage and dietary carbohydrate and fat content in the control of energy intake in humans
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Secondary ID [1]
289146
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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
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Health condition
Health condition(s) or problem(s) studied:
obesity
298660
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Condition category
Condition code
Diet and Nutrition
298721
298721
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0
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Obesity
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Each participant attended four, 4-day periods of in-house dietary manipulation. Participants will be given ad libitum access to diets containing varying protein content (10% and 25%), and the nutrient used to adjust dietary protein concentrations (carbohydrate or fat). The 4 diet treatments will be matched for palatability and energy density. The 4 diet composition will be as follows:
Fixed fat, variable carbohydrate
Diet 1: 10% protein, 30% fat and 60% carbohydrate
Diet 2: 25% protein, 30% fat, 45% carbohydrate
Fixed carbohydrate and variable fat
Diet 3: 10% protein, 40% fat and 50% carbohydrate
Diet 4: 25% protein, 25% fat and 50% carbohydrate
Participants will be given ad libitum access to study food with no access to other foods during each intervention period. Participants will have free access to a variety of foods all day and can initiate their own meal times. Participants will be asked to leave any uneaten foods and/or empty packages in a designated bag.
Food intake will be measured by recording the weight of food before and after serving, to the nearest gram. Energy intake will be calculated using the nutritional information for each recipe. The trial will be a randomised cross-over trial, each participant completed each of the four 4-day interventions with at least a one week washout period between interventions.
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Intervention code [1]
294663
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Lifestyle
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Intervention code [2]
294678
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Prevention
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Comparator / control treatment
The trial was a randomised crossover trial, each participant was their own control. None of the four diets will act as the comparator/control.
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Control group
Active
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Outcomes
Primary outcome [1]
298198
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Energy intake (MJ): Participants will be given ad libitum access to study food with no access to other foods during each intervention period. Participants will have free access to a variety of foods all day and could initiate their own meal times. Participants will be asked to leave any uneaten foods and/or empty packages in a designated bag. Food intake will be measured by recording the weight of the food before and after serving to the nearest gram. Total energy intake will then be calculated using the nutritional information for each recipe.
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Assessment method [1]
298198
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Timepoint [1]
298198
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Provided foods will be weighed at the beginning of each day and food intake will be monitored and weighed by the study coordinator every 1-2 hours from 7am until 7pm. Any leftover or empty packages from foods consumed overnight (7pm-7am) will be weighed at 7am the next day.
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Secondary outcome [1]
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Fasted serum levels of glucose
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Assessment method [1]
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Timepoint [1]
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Measured on the morning of day 1 prior to and on the morning of day 5 following each of the four 4-day interventions.
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Secondary outcome [2]
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Fasted serum levels of triglycerides
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Assessment method [2]
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Timepoint [2]
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Measured on the morning of day 1 prior to and on the morning of day 5 following each of the four 4-day interventions.
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Secondary outcome [3]
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Fasted serum levels of total cholesterol
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Assessment method [3]
323463
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Timepoint [3]
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Measured on the morning of day 1 prior to and on the morning of day 5 following each of the four 4-day interventions.
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Secondary outcome [4]
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Fasted serum levels of HDL cholesterol
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Assessment method [4]
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Timepoint [4]
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Measured on the morning of day 1 prior to and on the morning of day 5 following each of the four 4-day interventions.
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Secondary outcome [5]
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Fasted serum levels of urea
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Assessment method [5]
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Timepoint [5]
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Measured on the morning of day 1 prior to and on the morning of day 5 following each of the four 4-day interventions.
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Secondary outcome [6]
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Fasted serum levels of protein
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Assessment method [6]
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Timepoint [6]
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Measured on the morning of day 1 prior to and on the morning of day 5 following each of the four 4-day interventions.
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Secondary outcome [7]
323467
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Fasted serum levels of albumin
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Assessment method [7]
323467
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Timepoint [7]
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Measured on the morning of day 1 prior to and on the morning of day 5 following each of the four 4-day interventions.
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Secondary outcome [8]
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Fasted plasma levels of fibroblast growth factor-21
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Assessment method [8]
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Timepoint [8]
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Measured on the morning of day 1 prior to and on the morning of day 5 following each of the four 4-day interventions.
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Secondary outcome [9]
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24 hour levels of urinary urea
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Assessment method [9]
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Timepoint [9]
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Measured the day prior to and on day 4 of the four interventions.
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Secondary outcome [10]
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Glucose control measured by continuous Glucose Monitoring System
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Assessment method [10]
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Timepoint [10]
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Measured throughout each of the four 4-day interventions.
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Secondary outcome [11]
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Sleep duration measured by Actiwatch
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Assessment method [11]
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Timepoint [11]
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Measured throughout each of the four 4-day interventions.
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Secondary outcome [12]
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Levels of activity measured by Actiwatch
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Assessment method [12]
323472
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Timepoint [12]
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Measured throughout each of the four 4-day interventions.
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Secondary outcome [13]
323473
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Appetite rating using visual analogue scales
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Assessment method [13]
323473
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Timepoint [13]
323473
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Appetite questionnaires were administered hourly from before breakfast until 22:00 on day 4
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Secondary outcome [14]
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Food palatability ratings using visual analogue scales
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Assessment method [14]
323474
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Timepoint [14]
323474
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Palatability questionnaires were administered for each food consumed on day 4
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Secondary outcome [15]
323475
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Blood pressure was measured by Omron Standard Blood Pressure Monitor
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Assessment method [15]
323475
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Timepoint [15]
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Measured on the morning of day 1 prior to and on the morning of day 5 following each of the four 4-day interventions.
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Secondary outcome [16]
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Body weight using a digital scale
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Assessment method [16]
323476
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Timepoint [16]
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Measured on the morning of day 1 prior to and on the morning of day 5 following each of the four 4-day interventions.
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Secondary outcome [17]
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Waist circumference using a tape measure
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Assessment method [17]
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Timepoint [17]
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Measured on the morning of day 1 prior to and on the morning of day 5 following each of the four 4-day interventions.
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Secondary outcome [18]
323478
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Body height using a fixed stadiometer.
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Assessment method [18]
323478
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Timepoint [18]
323478
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Measured on day 1 of the first of the four dietary interventions.
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Eligibility
Key inclusion criteria
Lean (BMI < 25 kg/m2), healthy male and female participants
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Minimum age
18
Years
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Maximum age
65
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
Pregnancy or planning pregnancy, breastfeeding, known diabetes, known unstable or untreated elevated blood pressure or cholesterol, cardiovascular disease, chronic inflammatory conditions, medications that interfere with glucose metabolism, smoking, alcohol consumption above current NHMRC dietary guidelines, allergy or intolerance to any of the intervention foods, irregular eating patterns or eating disorder, following a weight reducing diet. Vegetarians and Vegans will be excluded to aid preparation of covertly manipulated foods.
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Study design
Purpose of the study
Prevention
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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)
Each subject was screened to determine eligibility for the study. At this point the trial coordinator was unaware of the sequence of interventions the subject would be allocated. Once it was determined that the participant was eligible to be included in the trial the participant was then randomly allocated an order of intervention. Allocation of order was concealed by randomly selecting a sequence from an envelope.
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
All possible sequences of interventions were printed the same number of times and placed in an envelope prior to the start of the study. The total number of sequences printed exceeded the number of participants that would be required to complete the trial. A sequence was randomly selected from the envelope for each participant.
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people receiving the treatment/s
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Intervention assignment
Crossover
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Other design features
Within subject design, each participant completed each of the interventions.
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Phase
Not Applicable
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Type of endpoint/s
Efficacy
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Statistical methods / analysis
The study aims to recruit 30 lean subjects, comprising equal numbers of males and females. The sample size calculation was based on a previous ad libitum study where a 4.5MJ change in energy intake was measured in response to a reduction in percent dietary protein from 15% to 8% with a standard deviation of differences within pairs of approximately 1.2MJ. In order to detect a difference of 0.8MJ with a power of 80%, a significance of <0.05 using a within subjects design, a sample size of 20 will be required. Recruitment of 30 subjects would allow for a dropout of 30%.
Mixed model linear regression will be used to test for significant effects of the interventions and for differences in the change from baseline between each intervention for measurements taken prior to and following each intervention. Data will be presented as means and standard errors, an a p value of < 0.05 will be accepted as significant. Estimates from the mixed model linear regression will also be presented alongside confidence intervals.
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Recruitment
Recruitment status
Completed
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Date of first participant enrolment
Anticipated
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Actual
4/11/2011
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Date of last participant enrolment
Anticipated
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Actual
14/08/2013
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Date of last data collection
Anticipated
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Actual
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Sample size
Target
30
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Accrual to date
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Final
13
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Recruitment in Australia
Recruitment state(s)
NSW
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Recruitment hospital [1]
5744
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Royal Prince Alfred Hospital - Camperdown
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Recruitment postcode(s) [1]
13213
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2050 - Camperdown
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Funding & Sponsors
Funding source category [1]
293525
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Government body
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Name [1]
293525
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National Health and Medical Research Council
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Address [1]
293525
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Level 1, 16 Marcus Clarke Street, Canberra, ACT 2601
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Country [1]
293525
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Australia
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Primary sponsor type
University
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Name
The University of Sydney
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Address
The University of Sydney, NSW 2006
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Country
Australia
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Secondary sponsor category [1]
292345
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Individual
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Name [1]
292345
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Alison Gosby
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Address [1]
292345
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The University of Sydney, NSW 2006
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Country [1]
292345
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Australia
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
294963
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Sydney Local Health District
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Ethics committee address [1]
294963
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Research Development Office Level 11, KGV Building Missenden Road Royal Prince Alfred Hospital Camperdown, NSW 2050
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Ethics committee country [1]
294963
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Australia
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Date submitted for ethics approval [1]
294963
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11/05/2011
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Approval date [1]
294963
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02/06/2011
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Ethics approval number [1]
294963
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X11-0139 & HREC/11/RPAH/194
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Summary
Brief summary
Protein intake has remained relatively stable through the development of the obesity epidemic. The protein leverage hypothesis proposes that a separate and dominant appetite for protein drives excess energy intake when dietary protein is diluted by fat and carbohydrate. We have provided convincing evidence that when the percent protein of the diet is reduced from 25% to 10% by increasing percent carbohydrate and keeping fat constant at 30% lean humans respond by increasing total energy intake. Recent data from a rodent dietary model suggests that intake of protein and carbohydrate is regulated (with protein dominating) but intake of fat is not. If dietary fat is not regulated in humans we would predict that the protein leverage effect will be even stronger if protein and fat co-vary in experimental diets and carbohydrate is kept constant at an adequate level. The aim of the study is to test whether converse changes in fat rather than carbohydrate will accentuate the protein leverage effect in covert trials. To do this we will manipulate the protein to energy ratio of the diet by increasing or decreasing the protein content whilst respectively decreasing or increasing the carbohydrate or fat content on 4 occasions for 4-days.
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Trial website
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Trial related presentations / publications
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Public notes
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Attachments [1]
867
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/AnzctrAttachments/370646-X11-0139 approval.pdf
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Contacts
Principal investigator
Name
65642
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Prof Stephen Simpson
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Address
65642
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Charles Perkins Centre, Bldg D17, The University of Sydney, NSW 2006
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Country
65642
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Australia
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Phone
65642
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+61 2 8627 1613
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Fax
65642
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Email
65642
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[email protected]
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Contact person for public queries
Name
65643
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Alison Gosby
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Address
65643
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Charles Perkins Centre, Bldg D17, The University of Sydney, NSW 2006
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Country
65643
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Australia
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Phone
65643
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+61 2 8627 1689
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Fax
65643
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Email
65643
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[email protected]
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Contact person for scientific queries
Name
65644
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Alison Gosby
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Address
65644
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Charles Perkins Centre, Bldg D17, The University of Sydney, NSW 2006
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Country
65644
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Australia
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Phone
65644
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+61 2 8627 1689
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Fax
65644
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Email
65644
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[email protected]
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No information has been provided regarding IPD availability
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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