Sarcopenia in idiopathic pulmonary fibrosis: a prospective study exploring prevalence, associated factors and diagnostic approach

Abstract

Background Sarcopenia gained importance in the evaluation of patients with chronic respiratory diseases, including idiopathic pulmonary fibrosis (IPF), since it may impact negatively on clinical outcomes. Aim Aim of this study is to evaluate the prevalence and factors associated with sarcopenia, defined according to the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) 2019 definition, and to evaluate the prevalence of the single criteria that define the EWGSOP2 definition (muscle strength, muscle quantity and physical performance), in a cohort of consecutive patients with IPF prospectively followed up in 9 hospitals in Northern Italy between December 2018 and May 2021. Methods Enrolled patients underwent an extensive pulmonary and nutritional assessment, including bioelectrical impedance analysis, dynamometry and 4-m gait speed test, both at IPF diagnosis and at 6-month follow-up. Results Out of the 83 patients (81% males, mean age 72.5 years) with IPF at disease diagnosis enrolled in the study, 19 (22.9%) showed sarcopenia, including 2 (2.4%) with severe sarcopenia, 5 (6.0%) with confirmed sarcopenia and 12 (14.5%) with probable sarcopenia. Sarcopenia was associated with a significantly higher severity of the disease and sedentary lifestyle, while no differences were observed in regards to body mass index, history of weight loss and comorbidities between patients with and without sarcopenia. Out of the 64 patients without sarcopenia at baseline, 16 cases showed alteration of muscle quantity and/or physical performance. In the 51 patients with complete data at 6-month follow-up, there were no cases of severe sarcopenia, 1 case (2.0%) showed confirmed sarcopenia, while the prevalence of probable sarcopenia was 19.6% (10 cases). No differences in regards to antifibrotic treatment received and onset of gastrointestinal side effects were observed between patients with and without sarcopenia at follow-up. Conclusions The prevalence of sarcopenia in patients with IPF both at diagnosis and at 6-month follow-up was low but not negligible and was associated with higher severity of the disease and sedentary lifestyle. In IPF patients, a comprehensive diagnostic work-up including all the criteria defining the EWGSOP2 definition might be more useful than a series testing for prompt recognition of nutritional and physical performance abnormalities.

The interplay of physical and cognitive function in rehabilitation of interstitial lung disease patients: a narrative review

“…Only a few studies have provided evidence of sarcopenia in ILD patients ( Table 3 ). According to EWGSOP2 definition ( 82 ), sarcopenia was identified in 19 (22.9%) IPF patients, in a cohort of consecutive patients followed in 9 hospitals across Italy ( 14 ). Using the AWGS 2019 criteria ( 84 ), sarcopenia was identified in 32.1% ILD patients ( 13 ) and 39.3% in IPF patients ( 15 ) living in Japan.…”

Walking the path of treatable traits in interstitial lung diseases

“…This is the case of cachexia, frailty, and pulmonary hypertension (PH) among others. As an example, ILD patients frequently suffer from cachexia that often correlates with rapid clinical deterioration and early death [ 65 – 67 ]. Targeting cachexia in patients considered for lung transplant could have a substantial impact not only on body weight, but also on exercise tolerance, skeletal muscle strength, anxiety, and depression, thus potentially impacting the final decision on whether to proceed with transplantation [ 66 , 68 , 69 ].…”

Expression of Prostaglandin Genes and β-Catenin in Whole Blood as Potential Markers of Muscle Degeneration

“…Additionally, sarcopenia and frailty syndrome are associated with tissue fibrosis, particularly in the liver and lungs [ 13 , 14 ]. Evidence from several human diseases and data from animal models revealed that one of the pathological fibrosis pathways leads to Wnt/β-catenin signaling [ 15 ].…”