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Sanmartín-Sánchez A, Fernández-Jiménez R, Cabrera-César E, Espíldora-Hernández F, Vegas-Aguilar I, Amaya-Campos MDM, Palmas-Candia FX, Olivares-Alcolea J, Simón-Frapolli VJ, Cornejo-Pareja I, Sánchez-García A, Murri M, Guirado-Peláez P, Vidal-Suárez Á, Garrido-Sánchez L, Tinahones FJ, Velasco-Garrido JL, García-Almeida JM. The Nutritional Phenotyping of Idiopathic Pulmonary Fibrosis Through Morphofunctional Assessment: A Bicentric Cross-Sectional Case-Control Study. Life (Basel) 2025; 15:516. [PMID: 40283071 PMCID: PMC12029122 DOI: 10.3390/life15040516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2025] [Revised: 02/28/2025] [Accepted: 03/18/2025] [Indexed: 04/29/2025] Open
Abstract
There is increasing evidence supporting the use of morphofunctional assessment (MFA) as a tool for clinical characterization and decision-making in malnourished patients. MFA enables the diagnosis of malnutrition, sarcopenia, obesity, and cachexia, leading to a novel phenotype-based classification of nutritional disorders. Bioelectrical impedance analysis (BIVA), nutritional ultrasound® (NU) and computed tomography (CT) are included, along with functional tests like the Timed Up and Go test (TUG). Myoesteatosis, detectable via CT, can occur independently from nutritional phenotypes and has been identified as a significant mortality predictor in idiophatic pulmonary fibrosis (IPF). Our aim is to analyze the prevalence and overlap of nutritional phenotypes in IPF and evaluate the prognostic value of myoesteatosis. Our bicenter cross-sectional study included 82 IPF patients (84.1% male and with a medium age of 71.1 ± 7.35 years). MFA was performed using BIVA, NU, CT at the T12 level (CT-T12), the handgrip strength (HGS) test, and the TUG. CT-T12 BC parameters were analyzed using FocusedON® software, while statistical analyses were conducted with JAMOVI version 2.3.22. All four major nutritional phenotypes were represented in our cohort, with significant overlap. A total of 80.5% met the GLIM criteria for malnutrition, 14.6% had cachexia, 17% were sarcopenic, and 28% were obese. Of the obese patients, 70% were also malnourished, while 100% of sarcopenic obese patients (5.9% of total) had malnutrition. A total of 55% of sarcopenic patients with available CT also had myosteatosis, suggesting muscle quality deterioration as a potential driver of functional impairment. The presence of myosteatosis > 15% in T12-CT was an independent predictor of 12-month mortality (HR = 3.13; 95% CI: 1.01-9.70; p = 0.049), with survival rates of 78.1% vs. 96.6% in patients with vs. without myosteatosis, respectively. To conclude, this study underscores the relevance of MFA in the nutritional characterization of patients with IPF, demonstrating its potential to identify specific phenotypes associated with malnutrition, functional impairment, and the presence of myoesteatosis, thereby providing a valuable tool for clinical decision-making.
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Affiliation(s)
- Alicia Sanmartín-Sánchez
- Department of Endocrinology and Nutrition, Son Espases University Hospital, 07120 Mallorca, Spain; (A.S.-S.); (J.O.-A.)
| | - Rocío Fernández-Jiménez
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, 29010 Malaga, Spain; (I.V.-A.); (M.d.M.A.-C.); (I.C.-P.); (A.S.-G.); (M.M.); (P.G.-P.); (Á.V.-S.); (L.G.-S.); (F.J.T.); (J.M.G.-A.)
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29010 Malaga, Spain
- Department of Medicine and Dermatology, Málaga University, 29016 Malaga, Spain
- Department of Endocrinology and Nutrition, Quironsalud Málaga Hospital, Av. Imperio Argentina, 29004 Malaga, Spain
| | - Eva Cabrera-César
- Department of Neumology, Virgen de la Victoria University Hospital, 29010 Malaga, Spain; (E.C.-C.); (J.L.V.-G.)
| | | | - Isabel Vegas-Aguilar
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, 29010 Malaga, Spain; (I.V.-A.); (M.d.M.A.-C.); (I.C.-P.); (A.S.-G.); (M.M.); (P.G.-P.); (Á.V.-S.); (L.G.-S.); (F.J.T.); (J.M.G.-A.)
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29010 Malaga, Spain
| | - María del Mar Amaya-Campos
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, 29010 Malaga, Spain; (I.V.-A.); (M.d.M.A.-C.); (I.C.-P.); (A.S.-G.); (M.M.); (P.G.-P.); (Á.V.-S.); (L.G.-S.); (F.J.T.); (J.M.G.-A.)
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29010 Malaga, Spain
| | | | - Josefina Olivares-Alcolea
- Department of Endocrinology and Nutrition, Son Espases University Hospital, 07120 Mallorca, Spain; (A.S.-S.); (J.O.-A.)
| | - Víctor José Simón-Frapolli
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, 29010 Malaga, Spain; (I.V.-A.); (M.d.M.A.-C.); (I.C.-P.); (A.S.-G.); (M.M.); (P.G.-P.); (Á.V.-S.); (L.G.-S.); (F.J.T.); (J.M.G.-A.)
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29010 Malaga, Spain
- Department of Medicine and Dermatology, Málaga University, 29016 Malaga, Spain
| | - Isabel Cornejo-Pareja
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, 29010 Malaga, Spain; (I.V.-A.); (M.d.M.A.-C.); (I.C.-P.); (A.S.-G.); (M.M.); (P.G.-P.); (Á.V.-S.); (L.G.-S.); (F.J.T.); (J.M.G.-A.)
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29010 Malaga, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Carlos III Health Institute (ISCIII), Málaga University, 29010 Malaga, Spain
| | - Ana Sánchez-García
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, 29010 Malaga, Spain; (I.V.-A.); (M.d.M.A.-C.); (I.C.-P.); (A.S.-G.); (M.M.); (P.G.-P.); (Á.V.-S.); (L.G.-S.); (F.J.T.); (J.M.G.-A.)
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29010 Malaga, Spain
| | - Mora Murri
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, 29010 Malaga, Spain; (I.V.-A.); (M.d.M.A.-C.); (I.C.-P.); (A.S.-G.); (M.M.); (P.G.-P.); (Á.V.-S.); (L.G.-S.); (F.J.T.); (J.M.G.-A.)
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29010 Malaga, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Carlos III Health Institute (ISCIII), Málaga University, 29010 Malaga, Spain
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, Heart Area, Virgen de la Victoria University Hospital, 29010 Malaga, Spain
| | - Patricia Guirado-Peláez
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, 29010 Malaga, Spain; (I.V.-A.); (M.d.M.A.-C.); (I.C.-P.); (A.S.-G.); (M.M.); (P.G.-P.); (Á.V.-S.); (L.G.-S.); (F.J.T.); (J.M.G.-A.)
| | - Álvaro Vidal-Suárez
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, 29010 Malaga, Spain; (I.V.-A.); (M.d.M.A.-C.); (I.C.-P.); (A.S.-G.); (M.M.); (P.G.-P.); (Á.V.-S.); (L.G.-S.); (F.J.T.); (J.M.G.-A.)
| | - Lourdes Garrido-Sánchez
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, 29010 Malaga, Spain; (I.V.-A.); (M.d.M.A.-C.); (I.C.-P.); (A.S.-G.); (M.M.); (P.G.-P.); (Á.V.-S.); (L.G.-S.); (F.J.T.); (J.M.G.-A.)
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29010 Malaga, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Carlos III Health Institute (ISCIII), Málaga University, 29010 Malaga, Spain
| | - Francisco J. Tinahones
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, 29010 Malaga, Spain; (I.V.-A.); (M.d.M.A.-C.); (I.C.-P.); (A.S.-G.); (M.M.); (P.G.-P.); (Á.V.-S.); (L.G.-S.); (F.J.T.); (J.M.G.-A.)
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29010 Malaga, Spain
- Department of Medicine and Dermatology, Málaga University, 29016 Malaga, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Carlos III Health Institute (ISCIII), Málaga University, 29010 Malaga, Spain
| | - Jose Luis Velasco-Garrido
- Department of Neumology, Virgen de la Victoria University Hospital, 29010 Malaga, Spain; (E.C.-C.); (J.L.V.-G.)
| | - Jose Manuel García-Almeida
- Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital, 29010 Malaga, Spain; (I.V.-A.); (M.d.M.A.-C.); (I.C.-P.); (A.S.-G.); (M.M.); (P.G.-P.); (Á.V.-S.); (L.G.-S.); (F.J.T.); (J.M.G.-A.)
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29010 Malaga, Spain
- Department of Medicine and Dermatology, Málaga University, 29016 Malaga, Spain
- Department of Endocrinology and Nutrition, Quironsalud Málaga Hospital, Av. Imperio Argentina, 29004 Malaga, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Carlos III Health Institute (ISCIII), Málaga University, 29010 Malaga, Spain
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Sonaglioni A, Caminati A, Nicolosi GL, Muti-Schünemann GEU, Lombardo M, Harari S. Echocardiographic Assessment of Biventricular Mechanics in Patients with Mild-to-Moderate Idiopathic Pulmonary Fibrosis: A Systematic Review and Meta-Analysis. J Clin Med 2025; 14:714. [PMID: 39941384 PMCID: PMC11818070 DOI: 10.3390/jcm14030714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2024] [Revised: 01/18/2025] [Accepted: 01/21/2025] [Indexed: 02/16/2025] Open
Abstract
Background: Over the last few years, a few imaging studies have performed conventional transthoracic echocardiography (TTE) implemented with speckle tracking echocardiography (STE) for the assessment of biventricular mechanics in patients with non-advanced idiopathic pulmonary fibrosis (IPF). This systematic review and meta-analysis aimed at evaluating the overall effect of mild-to-moderate IPF on the main indices of biventricular systolic function assessed by TTE and STE. Methods: All imaging studies assessing right ventricular (RV)-global longitudinal strain (GLS), left ventricular (LV)-GLS, tricuspid annular plane systolic excursion (TAPSE), and left ventricular ejection fraction (LVEF) in IPF patients vs. healthy controls, selected from PubMed, Scopus, and EMBASE databases, were included. Continuous data (RV-GLS, LV-GLS, TAPSE, and LVEF) were pooled as standardized mean differences (SMDs) comparing the IPF group with healthy controls. The SMD of RV-GLS was calculated using the random-effect model, whereas the SMDs of LV-GLS, TAPSE, and LVEF were calculated using the fixed-effect model. Results: The full texts of 6 studies with 255 IPF patients and 195 healthy controls were analyzed. Despite preserved TAPSE and LVEF, both RV-GLS and LV-GLS were significantly, although modestly, reduced in the IPF patients vs. the controls. The SMD was large (-1.01, 95% CI -1.47, -0.54, p < 0.001) for RV-GLS, medium (-0.62, 95% CI -0.82, -0.42, p < 0.001) for LV-GLS, small (-0.42, 95% CI -0.61, -0.23, p < 0.001) for TAPSE, and small and not statistically significant (-0.20, 95% CI -0.42, 0.03, p = 0.09) for LVEF assessment. Between-study heterogeneity was high for the studies assessing RV-GLS (I2 = 80.5%), low-to-moderate for those evaluating LV-GLS (I2 = 41.7%), and low for those measuring TAPSE (I2 = 16.4%) and LVEF (I2 = 7.63%). The Egger's test yielded a p-value of 0.60, 0.11, 0.31, and 0.68 for the RV-GLS, LV-GLS, TAPSE, and LVEF assessment, respectively, indicating no publication bias. On meta-regression analysis, none of the moderators was significantly associated with effect modification for RV-GLS (all p > 0.05). The sensitivity analysis supported the robustness of the results. Conclusions: RV-GLS impairment is an early marker of subclinical myocardial dysfunction in mild-to-moderate IPF. STE should be considered for implementation in clinical practice for early detection of RV dysfunction in IPF patients without advanced lung disease.
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Affiliation(s)
| | - Antonella Caminati
- Semi-Intensive Care Unit, Division of Pneumology, IRCCS MultiMedica, 20123 Milan, Italy; (A.C.); (S.H.)
| | | | | | | | - Sergio Harari
- Semi-Intensive Care Unit, Division of Pneumology, IRCCS MultiMedica, 20123 Milan, Italy; (A.C.); (S.H.)
- Department of Clinical Sciences and Community Health, Università di Milano, 20122 Milan, Italy
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