Rinaldi Sylvia, Gilliland Jason, O'Connor Colleen, Seabrook Jamie A, Mura Marco, Madill Janet
School of Health Studies, Western University, London, Ontario, Canada,
School of Food and Nutritional Sciences, Brescia University College at Western University, London, Ontario, Canada,
Respiration. 2021;100(5):379-386. doi: 10.1159/000512732. Epub 2021 Mar 15.
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.
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.
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.
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.
z-FFMI and severe malnutrition were significant predictors of survival in fibrotic ILD patients independent of disease severity.
关注间质性肺疾病（ILD）营养变量与生存情况的文献，因侧重于体重和体重指数（BMI）而受限，且未考虑身体成分。
本研究的主要目的是检验身体成分指标，特别是去脂体重指数z评分（z-FFMI）和体脂肪量指数z评分（z-BFMI）是否为纤维化ILD患者生存情况的预测指标。第二个目的是检验营养状况是否为生存情况的预测指标。
本横断面研究招募了78例诊断为纤维化ILD的门诊患者。采用双频生物电阻抗分析（BodyStat 1500MD；英国）测定身体成分数据，采用主观全面评定法（SGA）评估营养状况。为控制年龄和性别因素，使用总体均值计算z-FFMI和z-BFMI。查阅参与者病历以获取诊断、年龄、疾病严重程度和运动能力等信息。
年龄（风险比[HR] 1.08，95%置信区间[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分钟步行距离（6MWD）（HR 0.99，95% CI [0.99 - 1.00]，p < 0.01）、预测的一氧化碳弥散量百分比（%DLco）（HR 0.93，95% CI [0.89 - 0.97]，p < 0.01）以及重度营养不良（SGA-C）（HR 6.98，95% CI [2.00 - 24.27]，p < 0.01）是生存情况的显著预测指标。在控制运动能力和疾病严重程度后，z-FFMI和重度营养不良是独立于%DLco的生存情况显著预测指标。
z-FFMI和重度营养不良是纤维化ILD患者生存情况的显著预测指标，与疾病严重程度无关。
