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Sarcopenia and probable sarcopenia are associated with loss of muscle strength, functional impairment, frailty, and an increased risk of adverse outcomes in older adults. In short-term interventions, structural or functional changes may be modest, whereas certain serum biomarkers of metabolic-nutritional response may be more sensitive. In this protocol version, serum transthyretin (TTR) has been selected as the primary outcome, without assuming that it represents, by itself, a direct measure of muscle mass or overall clinical efficacy.
Sarcopenia is a progressive skeletal muscle disorder associated with aging and an increased risk of disability, hospitalization, dependency, and mortality. Contemporary consensus definitions identify low muscle strength as the primary characteristic of the condition, while muscle quantity or quality and physical performance are used to support the diagnosis and determine its severity.
In older adults, anabolic resistance reduces the muscle's responsiveness to habitual dietary protein intake. Leucine has been proposed as an amino acid capable of stimulating key anabolic pathways and therefore represents a plausible candidate for short-term nutritional interventions. In turn, Durvillaea incurvata flour provides bioactive compounds and dietary fiber with potential antioxidant and anti-inflammatory properties, although clinical evidence supporting its use in sarcopenia remains limited.
From a methodological perspective, a 28-day follow-up period may be sufficient to detect early metabolic and nutritional responses, but it may be insufficient to demonstrate robust clinical changes in muscle strength, muscle mass, or physical performance. For this reason, serum TTR has been selected as the primary short-term response outcome in the present protocol.
The selection of serum TTR as the primary outcome requires careful interpretation. Serum TTR levels may be influenced by protein-energy intake, liver function, inflammatory status, and intercurrent clinical conditions. Accordingly, in this protocol, serum TTR will not be interpreted as a direct surrogate of muscle mass or as a stand-alone measure of clinical efficacy. Rather, it will be considered a serum marker of early metabolic and nutritional response, whose interpretation will be complemented by functional, body composition, inflammatory, and safety-related outcomes.
This study is therefore designed as an exploratory, randomized proof-of-concept trial to determine whether the combination of leucine and seaweed flour improves serum TTR and whether this response is accompanied by consistent secondary changes in muscle strength, mobility, body composition, and the metabolic-inflammatory profile.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Control chocolate cake | Placebo Comparator | One daily serving of standard chocolate-flavored cake without added leucine or seaweed flour for 28 consecutive days |
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| Leucine-enriched chocolate cake | Active Comparator | One daily serving of standard chocolate-flavored cake supplemented with 3 g of leucine for 28 consecutive days |
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| Leucine and Durvillaea incurvata Flour-Enriched Chocolate Cake | Experimental | One daily serving of standard chocolate-flavored cake supplemented with 3 g of leucine and 3 g of Durvillaea incurvata flour for 28 consecutive days. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Standard chocolate-flavored cake | Dietary Supplement | Participants will consume one standard chocolate-flavored cake serving daily for 28 days, without added leucine or seaweed flour. |
| Measure | Description | Time Frame |
|---|---|---|
| Change from baseline in fasting serum transthyretin concentration at day 28. | Fasting serum transthyretin (TTR; prealbumin) concentration (mg/dL) measured using Human Transthyretin/Prealbumin ELISA Kit (NBP2-60516, Bio-Techne, Novus Biologicals). The outcome is the change from Day 0 to Day 28 according to the Statistical Analysis Plan. | 28 days |
| Measure | Description | Time Frame |
|---|---|---|
| Change from baseline in handgrip strength at day 28. | Handgrip strength (kg) measured by dynamometry under standardized conditions. The operational measure, such as the best of three valid attempts. | 28 days |
| Change from baseline in 4-meter gait speed at day 28. |
| Measure | Description | Time Frame |
|---|---|---|
| Number of participants with any adverse event. | Number of participants with at least one adverse event recorded from through the day 28 visit, regardless of relationship to the intervention. | 28 days |
| Number of participants with serious adverse events. |
Inclusion Criteria
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| MarÃa S Mariotti Celis, Ph D | Contact | +56 9 82332421 | mmariotti@uft.cl |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Universidad Finis Terrae | Santiago | 8010000 | Chile |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 26675566 | Background | Calvani R, Marini F, Cesari M, Tosato M, Anker SD, von Haehling S, Miller RR, Bernabei R, Landi F, Marzetti E; SPRINTT consortium. Biomarkers for physical frailty and sarcopenia: state of the science and future developments. J Cachexia Sarcopenia Muscle. 2015 Dec;6(4):278-86. doi: 10.1002/jcsm.12051. Epub 2015 Jul 7. | |
| 17138848 |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Jul 1, 2026 |
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Randomized, single-center, double-blind, controlled, three-arm parallel clinical trial with a 1:1:1 allocation ratio and a 28-day follow-up period. The study is designed as an exploratory proof-of-concept trial focused on early efficacy and safety.
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Participants, outcome assessors, clinical personnel, investigators responsible for data collection, and the statistician will remain blinded to treatment allocation throughout the trial.
Study products will be packaged identically and presented with the same external appearance and coded labeling. The individual responsible for packaging and maintaining the code-treatment correspondence will not participate in clinical assessments or statistical analyses.
Unblinding will only be permitted in the event of a medical emergency or when knowledge of treatment allocation is essential for participant management. Any unblinding event will be documented, including the date, time, reason, requesting individual, and authorizing individual.
|
| Leucine-Enriched Chocolate Cake | Dietary Supplement | Participants will consume one chocolate-flavored cake serving supplemented with 3 g of leucine daily for 28 days. |
|
|
| Leucine Plus Seaweed Flour-Enriched Chocolate Cake | Dietary Supplement | Participants will consume one chocolate-flavored cake serving supplemented with 3 g of leucine and 3 g of Durvillaea incurvata flour daily for 28 days. |
|
|
Usual gain speed (m/s) calculated from the 4-meter walk test under standardized condition. |
| 28 days |
| Change from baseline in appendicular muscle mass index at day 28. | Appendicular skeletal muscle mass index (kg/m2) measured calculated as appendicular skeletal muscle mass divided by height squared | 28 days |
| Percentage (%) of prescribed study product serving consumed during the intervention. | Adherence calculated from returned product counts and participant self-report as number of consumed servings divided by the number of prescribed servings. | 28 days |
| Number of participants with adequate adherence during the intervention. | Participants who consume at least 80% of prescribed study product serving during the 28-day intervention. | 28 days |
Number of participants with at least one serious adverse event, as defined by applicable ethical and regulatory criteria
| 28 days |
| Number of participants with treatment-related adverse events | Number of participants with at least one adverse event assessed by the investigator as possibly, probably, or definitely related to the assigned study product. | 28 days |
| Number of participants with gastrointestinal intolerance symptoms. | Number of participants reporting gastrointestinal symptoms such as nausea, abdominal pain, bloating, diarrhea, constipation, vomiting, or other symptoms recorded in the tolerability form. | 28 days |
| Number of participants who discontinue the study product due to an adverse event. | Number of participants who permanently stop consuming the assigned study product because of an adverse event. | 28 days |
| Change from baseline in serum TNF-alpha concentration at day 28. | Fasting serum TNF-alpha concentration (pg/mL) measured using Human TNF-alpha ELISA Kit. | 28 days |
| Change from baseline in serum OX-SR1 concentration | Fasting serum OX-SR1 concentration (pg/mL) measured using Human Oxidative Stress Responsive (OXSR1) ELISA Kit | 28 days |
| Change from baseline in fasting insulin concentration at day 28. | Fasting serum insulin (uUI/mL) measure using the validated assay. | 28 days |
| Change from baseline in total cholesterol concentration at day 28 | Fasting serum total cholesterol concentration (mg/dL) measured using the laboratory method. | 28 days |
| Change from baseline in LDL cholesterol concentration at day 28. | Fasting serum LDL cholesterol concentration (mg/dL) measured using the laboratory method. | 28 days |
| Change from baseline in HDL cholesterol concentration at day 28. | Fasting serum HDL cholesterol concentration (mg/dL) measured using the laboratory method. | 28 days |
| Change from baseline in triglyceride concentration at day 28. | Fasting serum triglyceride concentration (mg/dL) measured using the laboratory method. | 28 days |
| Change from baseline in serum glucose concentration at day 28. | Fasting serum glucose concentration (mg/dL) measured using the laboratory method | 28 days |
| Change from baseline in serum total protein concentration at day 28. | Fasting serum total protein concentration (mg/dL) measured using the laboratory method. | 28 days |
| Change from baseline in serum total bilirubin concentration at day 28. | Fasting serum total bilirubin concentration (U/L) measured using the laboratory method. | 28 days |
| Change from baseline in serum albumin concentration at day 28. | Fasting serum albumin concentration (g/dL) measured using the laboratory method. | 28 days |
| Change from baseline in serum globulin concentration at day 28. | Fasting serum globulin concentration (g/dL) measured using the laboratory method. | 28 days |
| Shenkin A. Serum prealbumin: Is it a marker of nutritional status or of risk of malnutrition? Clin Chem. 2006 Dec;52(12):2177-9. doi: 10.1373/clinchem.2006.077412. No abstract available. |
| 40120052 | Background | Beaudart C, Alcazar J, Aprahamian I, Batsis JA, Yamada Y, Prado CM, Reginster JY, Sanchez-Rodriguez D, Lim WS, Sim M, von Haehling S, Woo J, Duque G; Global Leadership Initiative in Sarcopenia (GLIS) group. Health outcomes of sarcopenia: a consensus report by the outcome working group of the Global Leadership Initiative in Sarcopenia (GLIS). Aging Clin Exp Res. 2025 Mar 22;37(1):100. doi: 10.1007/s40520-025-02995-9. |
| 32033882 | Background | Chen LK, Woo J, Assantachai P, Auyeung TW, Chou MY, Iijima K, Jang HC, Kang L, Kim M, Kim S, Kojima T, Kuzuya M, Lee JSW, Lee SY, Lee WJ, Lee Y, Liang CK, Lim JY, Lim WS, Peng LN, Sugimoto K, Tanaka T, Won CW, Yamada M, Zhang T, Akishita M, Arai H. Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment. J Am Med Dir Assoc. 2020 Mar;21(3):300-307.e2. doi: 10.1016/j.jamda.2019.12.012. Epub 2020 Feb 4. |
| 30312372 | Background | Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyere O, Cederholm T, Cooper C, Landi F, Rolland Y, Sayer AA, Schneider SM, Sieber CC, Topinkova E, Vandewoude M, Visser M, Zamboni M; Writing Group for the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), and the Extended Group for EWGSOP2. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019 Jan 1;48(1):16-31. doi: 10.1093/ageing/afy169. |
| Jul 1, 2026 |
| Prot_SAP_000.pdf |
| ID | Term |
|---|---|
| D055948 | Sarcopenia |
| ID | Term |
|---|---|
| D009133 | Muscular Atrophy |
| D020879 | Neuromuscular Manifestations |
| D009461 | Neurologic Manifestations |
| D009422 | Nervous System Diseases |
| D001284 | Atrophy |
| D020763 | Pathological Conditions, Anatomical |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D012816 | Signs and Symptoms |
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| ID | Term |
|---|---|
| D007930 | Leucine |
| ID | Term |
|---|---|
| D000597 | Amino Acids, Branched-Chain |
| D000596 | Amino Acids |
| D000602 | Amino Acids, Peptides, and Proteins |
| D000601 | Amino Acids, Essential |
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