Sylvia Rinaldi1,2,3, Jason Gilliland4,5,6,7,8,9,10, Colleen O'Connor11,5, Jamie A Seabrook11,5,7,8,9,10, Marco Mura12, Janet Madill11. 1. School of Health Studies, Western University, London, Ontario, Canada, srinaldi@uwo.ca. 2. School of Food and Nutritional Sciences, Brescia University College at Western University, London, Ontario, Canada, srinaldi@uwo.ca. 3. Human Environments Analysis Laboratory, Western University, London, Ontario, Canada, srinaldi@uwo.ca. 4. School of Health Studies, Western University, London, Ontario, Canada. 5. Human Environments Analysis Laboratory, Western University, London, Ontario, Canada. 6. Department of Geography, Western University, London, Ontario, Canada. 7. Department of Paediatrics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada. 8. Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada. 9. Children's Health Research Institute and Lawson Health Research Institute, London, Ontario, Canada. 10. Lawson Health Research Institute, London, Ontario, Canada. 11. School of Food and Nutritional Sciences, Brescia University College at Western University, London, Ontario, Canada. 12. Division of Respirology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
Abstract
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.
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.
Authors: Felipe V C Machado; Ada E M Bloem; Tessa Schneeberger; Inga Jarosch; Rainer Gloeckl; Sandra Winterkamp; Frits M E Franssen; Andreas R Koczulla; Fabio Pitta; Martijn A Spruit; Klaus Kenn Journal: BMJ Open Respir Res Date: 2021-10