Skip to main content
Log in

Designing phase II B trials in sarcopenia: The best target population

  • JNHA: Frailty and Cognitive Decline
  • Published:
The journal of nutrition, health & aging

Abstract

Despite the existing limitations and controversies regarding the definition of sarcopenia and its clinical consequences, the current scientific evidence strongly suggests that muscle decline is a primary determinant of the disabling process (and likely of other major health-related events). In fact, the muscle loss (in terms of mass as well as strength) occurring with aging has been growingly associated with mobility impairment and disability in older persons. Unfortunately, current evidence is mainly from observational studies. Times are mature to begin testing interventions aimed at modifying the sarcopenia process through the design and development of specific clinical trials. Considering the emergence of many promising interventions towards this age-related condition (e.g., physical exercise [in particular, resistance training], testosterone, antioxidant supplementations), the need for Phase II trial designs is high. In the present report, we discuss which are the major issues related to the design of Phase II clinical trials on sarcopenia with particular focus on the participant’s characteristics to be considered as possible inclusion and exclusion criteria.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Rosenberg IH. Sarcopenia origins and clinical relevance. JNutr. 1997;127(5 Suppl):990S.

    CAS  Google Scholar 

  2. Abellan van Kan G, Andre E, Bischoff Ferrari HA, Boirie Y, Onder G, Pahor M et al. Carla Task Force on Sarcopenia propositions for clinical trials. J Nutr Health Aging. 2009;13(8):700.

    Article  PubMed  CAS  Google Scholar 

  3. Cesari M, Ferrini A Zamboni V, Pahor M. Sarcopenia current clinical and research issues. Open Geriatr Med J. 2008; 1:14.

    Article  Google Scholar 

  4. Janssen I, Baumgartner RN, Ross R, Rosenberg IH, Roubenoff R. Skeletal muscle cutpoints associated with elevated physical disability risk in older men and women. Am J Epidemiol. 2004;159(4):413.

    Article  PubMed  Google Scholar 

  5. Visser M, Kritchevsky SB, Goodpaster BH, Newman AB, Nevitt M, Stamm E et al. Leg muscle mass and composition in relation to lower extremity performance in men and women aged 70 to 79: the health aging and body composition study. J Am Geriatr Soc. 2002;50(5):897.

    Article  PubMed  Google Scholar 

  6. Janssen I, Heymsfield SB, Ross R. Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability. J Am Geriatr Soc. 2002;50(5):889.

    Article  PubMed  Google Scholar 

  7. Cesari M, Pahor M, Lauretani F, Zamboni V, Bandinelli S, Bernabei R et al. Skeletal Muscle and Mortality Results From the InCHLANTi Study. J Gerontol A Biol Sci Med Sci. 2009

  8. Goodpaster BH, Park SW, Harris TB, Kritchevsky SB, Nevitt M, Schwartz AV et al. The loss of skeletal muscle strength, mass, and quality in older adults: the health, aging and body composition study. J Gerontol A Biol Sci Med Sci. 2006;61(10):1059.

    Article  PubMed  Google Scholar 

  9. Newman AB, Kupelian V, Visser M, Simonsick EM, Goodpaster BH, Kritchevsky SB et al. Strength, but not muscle mass, is associated with mortality in the health, aging and body composition study cohort. J Gerontol A Biol Sci Med Sci. 2006;61(1):72.

    Article  PubMed  Google Scholar 

  10. Cesari M, Pahor M. Target population for clinical trials on sarcopenia. J Nutr Health Aging. 2008;12(7):470.

    Article  PubMed  CAS  Google Scholar 

  11. Studenski S. Target population for clinical trials. J Nutr Health Aging. 2009;13(8):729.

    Article  PubMed  CAS  Google Scholar 

  12. Cruz-Jentoft AT, Baeyeas JP, Bauer JM, Boirie Y, Cederholm T, Landi F et al. Sarcopenia European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age and Ageing. 2010;39(4):412.

    Article  PubMed  Google Scholar 

  13. Clark BC, Manini TM. Sarcopenia =/= dynapenia. J Gerontol A Biol Sci Med Sci. 2008;63(8):829.

    Article  PubMed  Google Scholar 

  14. Morley JE, Baumgartner RN, Roubenoff R, Mayer J, Nair KS. Sarcopenia. J Lab Clin Med. 2001;137(4):231.

    Article  PubMed  CAS  Google Scholar 

  15. Stenholm S, Harris TB, Rantanen T, Visser M, Kritchevsky SB, Ferrucci L. Sarcopenic obesity: definition, cause and consequences. Curr Opin Clin Nutr Metab Care. 2008;11(6):693.

    Article  PubMed  Google Scholar 

  16. Zamboni M, Mazzali G, Fantin F, Rossi A, Di Francesco V. Sarcopenic obesity: a new category of obesity in the elderfy. Nutr Metab Cardiovasc Dis. 2008; 18(5):388.

    Article  PubMed  CAS  Google Scholar 

  17. Cesari M, Kritchevsky SB, Baumgartner RN, Atkinson HH, Penniax BW, Lenchik L et al. Sarcopenia, obesity, and inflammation-results from the Trial of Angiotensin Converting Enzyme Inhibition and Novel Cardiovascular Risk Factors study. Am J Clin Nutr. 2005;82(2):428.

    PubMed  CAS  Google Scholar 

  18. Newman AB, Kupelian V, Visser M, Simoasick E, Goodpaster B, Nevitt M et al. Sarcopenia alternative definitions and associations with lower extremity function. J Am Geriatr Soc. 2003;51(11): 1602.

    Article  PubMed  Google Scholar 

  19. Leeuwenburgh C. Role of apoptosis in sarcopenia. J Gerontol A Biol Sci Med Sci. 2003;58(11):999.

    Article  PubMed  Google Scholar 

  20. Dirks AJ, Hofer T, Marzetti E, Pahor M, Leeuwenburgh C. Mitochondrial DNA mutations, energy metabolism and apoptosis in aging muscle. Ageing Res Rev. 2006;5(2):179.

    Article  PubMed  CAS  Google Scholar 

  21. Roubenoff R. Physical activity, inflammation, and muscle loss. Nutr Rev. 2007;65(12 Pt 2):S208.

    Article  PubMed  Google Scholar 

  22. Srikanthan P, Hevener AL, Karlamangla AS. Sarcopenia exacerbates obesity-associated insulin-resistance and dysglycemia findings from the National Health and Nutrition Examination Survey HI. PLoS One. 2010;5(5)el0805.

    Article  Google Scholar 

  23. Thall PF, Simon R. Practical Bayesian guidelines for phase ECB clinical trials. Biometrics. 1994;50(2):337.

    Article  PubMed  CAS  Google Scholar 

  24. Gray R, Manola J, Saxman S, Wright J, Dutcher J, Atkins M et al Phase II clinical trial design: methods in translational research from the Genitourinary Committee at the Eastern Cooperative Oncology Group. Clin Cancer Res. 2006;12(7 Pt 1):1966.

    Article  PubMed  CAS  Google Scholar 

  25. Case LD, Morgan TM. Design of Phase II cancer trials evaluating survival probabilities. BMC Med Res Methodol. 2003;3:6.

    Article  PubMed  Google Scholar 

  26. Fleming TR, DeMets DL. Surrogate end points in clinical trials: are we being misled? Ann Intern Med. 1996;125(7):605.

    PubMed  CAS  Google Scholar 

  27. Beenakker KG, Ling CH, Meskers CG, de Craen AJ, Stijnen T, Westendorp RG et al. Patterns of muscle strength loss with age in the general population and patients with a chronic inflammatory state. Ageing Res Rev. 2010

  28. Walsmith J, Roubenoff R. Cachexia in rheumatoid arthritis. Int J Cardiol. 2002;85(1):89.

    Article  PubMed  Google Scholar 

  29. Giles JT, Ling SM, Ferrucci L, Bartlett SJ, Andersen RE, Towns M et al. Abnormal body composition phenotypes in older rheumatoid arthritis patients: association with disease characteristics and pharmacotherapies. Arthritis Rheum. 2008;59(6):807.

    Article  PubMed  Google Scholar 

  30. Roubenoff R. Sarcopenic obesity: does muscle loss cause fat gain? Lessons from rheumatoid arthritis and osteoarthritis. Ann NY Acad Sci. 2000:904:553.

    Article  PubMed  CAS  Google Scholar 

  31. Cesari M, Kritchevsky SB, Penniax BW, Nicklas BJ, Simonsick EM, Newman AB et al. Prognostic value of usual gait speed in well-functioning older people-results from the Health, Aging and Body Composition Study. J Am Geriatr Soc. 2005;53(10): 1675.

    Article  PubMed  Google Scholar 

  32. Manini TM, Visser M, Won-Park S, Patel KV, Strotmeyer ES, Chen H et al. Knee extension strength cutpoints for maintaining mobility. J Am Geriatr Soc. 2007;55(3):451.

    Article  PubMed  Google Scholar 

  33. Guralnik JM, Ferrucci L, Pieper CF, Leveille SG, Markides KS, Ostir GV et al. Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. J Gerontol ABiol SciMed Sci. 2000;55(4):M221.

    Article  CAS  Google Scholar 

  34. Guralnik JM, Ferrucci L, Simonsick EM, Salive ME, Wallace RB. Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med. 1995;332(9):556.

    Article  PubMed  CAS  Google Scholar 

  35. Manini TM, Visser M, Won-Park S, Patel KV, Strotmeyer ES, Chen H, Goodpaster B, De Rekeneire N, Newman AB, Simonsick EM, Kritchevsky SB, Ryder K, Schwartz AV, Harris TB. Knee extension strength cutpoints for maintaining mobility. J Am Geriatr Soc 2007;55(3):451.

    Article  PubMed  Google Scholar 

  36. Bortz WMn. A conceptual framework of frailty: a review. J Gerontol A Biol Sci Med Sci. 2002;57(5):M283.

    Article  PubMed  Google Scholar 

  37. Baumgartner RN, Koehler KM, Gallagher D, Romero L, Heymsfield SB, Ross RR et al. Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol. 1998;147(8):755.

    PubMed  CAS  Google Scholar 

  38. Melton L Jr, Khosla S, Crowson CS, O’Connor MK, O’Fallon WM, Riggs BL. Epidemiology of sarcopenia, J Am Geriatr Soc. 2000;48(6):625.

    PubMed  Google Scholar 

  39. Castaneda C, Janssen I. Ethnic comparisons of sarcopenia and obesity in diabetes. Ethn Dis.2005;15(4):664.

    PubMed  Google Scholar 

  40. Wang Z, Heo M, Lee RC, Kotier DP, Withers RT, Heymsfield SB. Muscularity in adult humans: proportion of adipose tissue-free body mass as skeletal muscle. Am J Hum Biol 2001;13(5):612.

    Article  PubMed  CAS  Google Scholar 

  41. Gallagher D, Heymsfield SB, Heo M, Jebb SA, Murgatroyd PR, Sakamoto Y. Healthy percentage body fat ranges: an approach for developing guidelines based on body mass index. Am J Clin Nutr. 2000;72(3):694.

    PubMed  CAS  Google Scholar 

  42. Goodpaster BH, Carlson CL, Visser M, Kelley DE, Scherzinger A, Harris TB et al. Attenuation of skeletal muscle and strength in the elderly: The Health ABC Study. J AppI Physiol 2001;90(6):2157.

    CAS  Google Scholar 

  43. Garcia-Martinez C, Lopez-Soriano FJ, Argiles JM. Acute treatment with tumour necrosis factor-alpha induces changes in protein metabolism in rat skeletal muscle. Mol Cell Biochem. 1993;125(1): 11.

    Article  PubMed  CAS  Google Scholar 

  44. Charters Y, Grimble RF. Effect of recombinant human tumour necrosis factor alpha on protein synthesis in liver, skeletal muscle and skin of rats. Biochem J. 1989;258(2):493.

    PubMed  CAS  Google Scholar 

  45. Schaap LA, Pluijm SM, Deeg DJ, Harris TB, Kritchevsky SB, Newman AB et al. Higher inflammatory marker levels in older persons: associations with 5-year change in muscle mass and muscle strength. J Gerontol A Biol Sci Med Sci. 2009;64(11): 1183.

    Article  PubMed  Google Scholar 

  46. Roubenoff R. Catabolism of aging: is it an inflammatory process? Curr Opin Clin Nutr Metab Care. 2003;6(3):295.

    PubMed  Google Scholar 

  47. Eisenstaedt R, Penniax BW, Woodman RC. Anemia in the elderly: current understanding and emerging concepts. Blood Rev. 2006;20(4):213.

    Article  PubMed  Google Scholar 

  48. Tipton KD, Ferrando AA. Improving muscle mass: response of muscle metabolism to exercise, nutrition and anabolic agents. Essays Biochem. 2008;44:85.

    Article  PubMed  CAS  Google Scholar 

  49. Herbst KL, Bhasia S. Testosterone action on skeletal muscle. Curr Opin Clian Nutr Metab Care. 2004;7(3):271.

    Article  CAS  Google Scholar 

  50. Perrini S, Laviola L, Carreira MC, Cignarelli A, Natalicchio A, Giorgiao F. The GHIGF1 axis and signaling pathways in the muscle and bone: mechanisms underlying age-related skeletal muscle wasting and osteoporosis. J Endocrinol. 2010;205(3):201.

    Article  PubMed  CAS  Google Scholar 

  51. Cesari M, Kritchevsky SB, Leeuwenburgh C, Pahor M. Oxidative damage and platelet activation as new predictors of mobility disability and mortality in elders. Antioxid Redox Signal 2006;8(3–4):609.

    Article  PubMed  CAS  Google Scholar 

  52. Azuma K, Heilbrona LK, Albu JB, Smith SR, Ravussin E, Kelley DE. Adipose tissue distribution in relation to insulin resistance in type 2 diabetes mellitus. Am J Physiol Endocrinol Metab. 2007;293(1):E435.

    Article  PubMed  CAS  Google Scholar 

  53. Pradhan AD, Maason JE, Rifai N, Buring JE, Ridker PM. C-reactive protein, interleukin6, and risk of developing type 2 diabetes mellitus. JAMA 2001;286(3):327.

    Article  PubMed  CAS  Google Scholar 

  54. Anker SD, Sharma R. Thesyndrome of cardiac cachexia. Int J Cardiol. 2002;85(1):51.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Matteo Cesari.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pahor, M., Cesari, M. Designing phase II B trials in sarcopenia: The best target population. J Nutr Health Aging 15, 725–730 (2011). https://doi.org/10.1007/s12603-011-0058-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12603-011-0058-9

Key words

Navigation