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Disturbances in brain insulin-sensitivity are not only observed in obesity and type 2 diabetes (T2D), but also during brain aging and in dementia. Ketone monoester supplements may improve brain insulin-sensitivity, which can be quantified by measuring the gray-matter cerebral blood flow (CBF) response to intranasally administered insulin. We hypothesize that acute ketone monoester supplementation increases (regional) brain vascular function and insulin-sensitivity thereby improving cognitive performance and appetite control. The primary objective is to evaluate in older men the acute effect of ketone monoester supplementation on (regional) brain vascular function and insulin-sensitivity, as quantified by the non-invasive gold standard magnetic resonance imaging (MRI)-perfusion method Arterial Spin Labelling (ASL). The CBF response to intranasal insulin is a robust and sensitive physiological marker of brain insulin-sensitivity. Secondary objectives are to investigate effects on cognitive performance as assessed with a neuropsychological test battery, and appetite control as quantified by functional MRI (fMRI) with visual food cues.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Experimental | Experimental | Ketone monoesters |
|
| Placebo | Placebo Comparator | Taste- and volume-matched placebo |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Ketone Monoester | Dietary Supplement | Ketone monoester supplement (395 mg/kg body mass) |
| |
| Measure | Description | Time Frame |
|---|---|---|
| Brain Vascular Function | Cerebral blood flow as quantified non-invasively by the MRI perfusion method Arterial Spin Labeling (ASL) | Change from placebo intervention at 30 minutes after supplement intake |
| Brain Insulin Sensitivity | Cerebral blood flow measurements before and after a nasal insulin spray as quantified non-invasively by the MRI perfusion method Arterial Spin Labeling (ASL) | Change from placebo intervention at 60 minutes after supplement intake |
| Measure | Description | Time Frame |
|---|---|---|
| Appetite-related brain reward activity | Blood oxygenation level-dependent (BOLD)-functional MRI (fMRI) response to food cues | Change from placebo intervention at 40 minutes after supplement intake |
| Cognitive Performance |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Peter J Joris, PhD | Maastricht University Medical Center | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Maastricht University Medical Center | Maastricht | Limburg | Netherlands |
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Study participants will receive in random order acutely 395 mg/kg body weight ketone monoesters or placebo, seperated by a wash-out period of at least 1 week.
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| Placebo |
| Dietary Supplement |
The placebo will be taste-matched to the active supplement for bitterness using denatonium benzoate and volume-matched with water |
|
Cambridge Neuropsychological Test Automated Battery (CANTAB)
| Change from placebo intervention at 120 minutes after supplement intake |
| Brain Perfusion | Transcranial Doppler (TCD) ultrasound will be used to assess the velocity of blood flow through the middle cerebral artery (MCA) | Change from placebo intervention at 120 minutes after supplement intake |
| Blood pressure | Office blood pressure and heart rate | Change from placebo intervention at 90 minutes after supplement intake |
| Ketone metabolism | Circulating beta-hydroxybutyrate concentrations | During 120 minutes following supplement intake |
| Glucose metabolism | Circulating glucose and insulin concentrations | During 120 minutes following supplement intake |
| Markers related to low-grade systemic inflammation | Circulating high-sensitive C-reactive protein concentrations | During 120 minutes following supplement intake |
| Appetite hormones | Circulating ghrelin concentrations | During 120 minutes following supplement intake |
| Perceived hunger and satiety | Visual analogue scale (VAS) questionnaires | During 120 minutes following supplement intake |
| Anthropometric measurements | Weight, length, waist and hip circumference | Before supplement intake |
| Food intake | Food Frequency Questionnaire to assess food intake over the past month | Once 120 minutes following supplement intake |