What are the best indicators to assess malnutrition in idiopathic pulmonary fibrosis patients? A cross-sectional study in a referral center

Jouneau, S.; Kerjouan, M.; Rousseau, Chloé; Léderlin, Mathieu; Llamas-Guttierez, Francisco; Latour, B. de; Guillot, Samuel; Vernhet, Laurent; Desrues, B.; Thibault, Ronan

doi:10.1016/j.nut.2018.12.008

Cited by 44 publications

(42 citation statements)

References 31 publications

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“…Of the existing research, malnutrition prevalence varies greatly and is often identified by a single measure. Jouneau et al [35] found that 28% of patients were malnourished using FFM, 4% were malnourished using BMI, and 5% were malnourished using midarm circumference. A conference abstract by Autore et al [36] reported that 26% of patients were at risk of malnutrition using the Mini Nutritional Assessment Short Form, a validated screening tool designed for populations >65 years.…”

Section: Discussion/conclusionmentioning

confidence: 99%

Fat-Free Mass Index Controlled for Age and Sex and Malnutrition Are Predictors of Survival in Interstitial Lung Disease

et al. 2021

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Background: Literature focusing on nutritional variables and survival in interstitial lung disease (ILD) is limited by its focus on weight and BMI and has not considered body composition. Objectives: The primary objective of this study was to examine whether body composition measures, specifically fat-free mass index z-score (z-FFMI) and body fat mass index z-score (z-BFMI), were predictors of survival in fibrotic ILD patients. The second objective was to examine if nutrition status was a predictor of survival. Method: Seventy-eight outpatients diagnosed with fibrotic ILD were recruited in this cross-sectional study. Body composition data using dual frequency bioelectrical impedance analysis (BodyStat 1500MD; UK) and nutrition status using the subjective global assessment (SGA) were determined. To control for age and sex, z-FFMI and z-BFMI were calculated using population means. Participant charts were reviewed for diagnosis, age, disease severity, and exercise capacity. Results: Age (HR 1.08, 95% CI [1.03–1.13], p < 0.01), BMI (HR 0.90, 95% CI [0.84–0.97], p < 0.01]), z-FFMI (HR 0.70, 95% CI [0.56–0.87], p = 0.02), z-BFMI (HR 0.74, 95% CI [0.57–0.96], p < 0.01), 6-min walk distance (6MWD) (HR 0.99, 95% CI [0.99–1.00], p < 0.01), percent predicted diffusing capacity for carbon monoxide (%DLco) (HR 0.93, 95% CI [0.89–0.97], p < 0.01), and severe malnutrition (SGA-C) (HR 6.98, 95% CI [2.00–24.27], p < 0.01) were significant predictors of survival. When controlled for exercise capacity and disease severity, z-FFMI and severe malnutrition were significant predictors of survival independent of %DLco. Conclusion: z-FFMI and severe malnutrition were significant predictors of survival in fibrotic ILD patients independent of disease severity.

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Section: Discussion/conclusionmentioning

confidence: 99%

Fat-Free Mass Index Controlled for Age and Sex and Malnutrition Are Predictors of Survival in Interstitial Lung Disease

et al. 2021

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“…A weight loss of 5% is often used to define significant unintentional weight loss and is included in the definition of cachexia [18,19] and in criteria for the diagnosis of malnutrition proposed by a global consensus group [20]. Low BMI and low fat-free mass are common in patients with IPF [21]. Weight loss in patients with IPF may occur due to physical inactivity [22], which leads to loss of muscle mass, or to loss of appetite due to factors such as symptoms, medications, malnutrition, or depression [23].…”

Section: Discussionmentioning

confidence: 99%

Analysis of body mass index, weight loss and progression of idiopathic pulmonary fibrosis

et al. 2020

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Background Nintedanib is an approved therapy for idiopathic pulmonary fibrosis (IPF). Some patients treated with nintedanib experience weight loss. Exploratory data suggest that low body mass index or weight loss are associated with worse outcomes in patients with IPF. We investigated whether BMI at baseline or weight loss over 52 weeks was associated with FVC decline, or influenced the effect of nintedanib, in patients with IPF. Methods Using pooled data from the two INPULSIS trials, we analysed the rate of decline in FVC (mL/yr) over 52 weeks in patients treated with nintedanib and placebo in subgroups by baseline BMI (< 25; ≥25 to < 30; ≥30 kg/m2) and by weight loss over 52 weeks (≤5; > 5%) using random coefficient regression. Results In the placebo group, the mean rate of FVC decline over 52 weeks was numerically greater in patients with lower baseline BMI (− 283.3 [SE 22.4], − 207.9 [20.9] and − 104.5 [21.4] in patients with BMI < 25 kg/m2, ≥25 to < 30 kg/m2 and ≥ 30 kg/m2, respectively). Nintedanib reduced the rate of FVC decline versus placebo in all subgroups by BMI, with a consistent treatment effect across subgroups (interaction p = 0.31). In the placebo group, the mean rate of FVC decline was numerically greater in patients with > 5% than ≤5% weight loss over 52 weeks (− 312.7 [SE 32.2] versus − 199.5 [SE 14.4] mL/year). Nintedanib reduced the rate of FVC decline versus placebo in both subgroups by weight loss, with a greater treatment effect in patients with > 5% weight loss (interaction p = 0.0008). The adverse event profile of nintedanib was similar across subgroups. Conclusions In patients with IPF, lower BMI and weight loss may be associated with faster decline in FVC. Nintedanib reduces the rate of FVC decline both in patients who lose weight on treatment and those who do not. Trial registration ClinicalTrials.gov; Nos. NCT01335464 and NCT01335477; URL: www.clinicaltrials.gov.

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“…However, muscle wasting occurs systemically in older people as a physiological response to fasting, malnutrition, or inactivity. Malnutrition has been identified in nearly one-third of IPF patients (Jouneau et al 2019). IPF patients have also been reported as significantly inactive compared with age-matched healthy individuals (Nishiyama et al 2018).…”

Section: Discussionmentioning

confidence: 99%

Appendicular Skeletal Muscle Mass Correlates with Patient-Reported Outcomes and Physical Performance in Patients with Idiopathic Pulmonary Fibrosis

Ebihara

Iwanami

Yamasaki

et al. 2021

Tohoku J. Exp. Med.

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Idiopathic pulmonary fibrosis (IPF), an incurable lung disease of unknown cause, often presents with losses of skeletal muscle mass. IPF requires comprehensive care, but it has not been investigated which skeletal muscle mass index reflects holistic management factors: pulmonary function, patient-reported outcomes (PROs), and physical performance. We compared three representative indices of skeletal muscle mass with holistic management factors in IPF patients. Twenty-seven mild to severe IPF patients (21 male) with the mean age of 76.1 ± 5.9 years were enrolled. The three indices were appendicular skeletal muscle mass index (ASMI), cross-sectional area of pectoralis major (PM CSA), and cross-sectional area of erector spinae muscles (ESM CSA). ASMI is considered as a gold standard for sarcopenia assessment, while PM CSA and ESM CSA are frequently used in IPF. As PROs, we assessed breathlessness with the modified Medical Research Council dyspnea scale (mMRC), symptoms with the chronic obstructive pulmonary disease assessment test (CAT), and health-related quality of life with St. George's Respiratory Questionnaire (SGRQ). For physical performance, peripheral muscle strength and 6-min walk distance (6MWD) were investigated. In this cross-sectional study, ASMI showed the greatest number of significantly correlated indices, such as pulmonary function, peripheral muscle strength, 6MWD, mMRC, and SGRQ. PM CSA showed the next greatest number of correlations, with peripheral muscle strength, 6MWD, and mMRC, whereas ESM CSA showed no significant correlations with any index. Thus, ASMI correlated with both PROs and physical performance, and PM CSA correlated mainly with physical performance. In conclusion, assessing ASMI is helpful for the comprehensive care of patients with IPF.

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What are the best indicators to assess malnutrition in idiopathic pulmonary fibrosis patients? A cross-sectional study in a referral center

Cited by 44 publications

References 31 publications

Fat-Free Mass Index Controlled for Age and Sex and Malnutrition Are Predictors of Survival in Interstitial Lung Disease

Fat-Free Mass Index Controlled for Age and Sex and Malnutrition Are Predictors of Survival in Interstitial Lung Disease

Analysis of body mass index, weight loss and progression of idiopathic pulmonary fibrosis

Appendicular Skeletal Muscle Mass Correlates with Patient-Reported Outcomes and Physical Performance in Patients with Idiopathic Pulmonary Fibrosis

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