Abstract
BMI/nutritional assessment should be part of the evaluation of IPF patients, since it has an impact on prognosis http://ow.ly/BBe930ocgx5
To the Editor:
The publication by Torrisi et al. [1] in the European Respiratory Journal evaluated the ability of comorbidities to improve the prediction of survival of idiopathic pulmonary fibrosis (IPF) patients. These variables are in addition to those in the best validated Gender-Age-Physiology (GAP) multivariable prediction model for mortality in IPF. The authors have added to the four parameters (age, sex, forced vital capacity per cent predicted and diffusing capacity of the lung for carbon monoxide per cent predicted) of the GAP model [2] comorbidities such as gastro-oesophageal reflux, pulmonary hypertension, lung cancer, valvular heart disease and atrial arrhythmias, which were found to have a significant impact on survival. They showed that the inclusion of comorbidities in TORVAN models significantly improved the prediction of the risk of death.
However, we were surprised that there was no mention of nutritional status despite growing evidence that IPF patients frequently suffer from malnutrition [3]. We now have evidence that malnutrition is also a prognostic factor (S. Jouneau and co-workers, unpublished results; see also [4, 5]) and is suspected of involvement in several chronic diseases. For example, the body mass index (BMI) [6] or body fat-free mass [7] can be strong, independent predictors in chronic obstructive pulmonary disease (COPD) patients. It is conceivable that the negative effect of malnutrition on survival might be reversed by pulmonary rehabilitation in malnourished patients as demonstrated in COPD [8], in contrast to some of the significant variables (pulmonary hypertension, atrial arrhythmias or lung cancer) identified by Torrisi et al. [1].
We, therefore, suggest that BMI or another nutrition variable should be included in the present study, if they are available, and in future work on predictive models for IPF patients.
Footnotes
Conflict of interest: S. Jouneau reports current work on malnutrition and IPF funded by Boehringer Ingelheim and Roche/Genentech, during the conduct of the study; grants for research, personal fees and non-financial support for congress attendance, registration, travel and accommodation, personal fees for advisory board work and consultancy from Actelion, AIRB, AstraZeneca, BMS, Boehringer, Chiesi, Gilead, GSK, LVL, Mundipharma, Novartis, Pfizer, Roche and Savara-Serendex, outside the submitted work.
Conflict of interest: M. Lederlin reports current work on malnutrition and IPF funded by Boehringer Ingelheim and Roche/Genentech, during the conduct of the study; personal fees from Boehringer Ingelheim, outside the submitted work.
Conflict of interest: L. Vernhet reports current work on malnutrition and IPF funded by Boehringer Ingelheim and Roche/Genentech, during the conduct of the study.
Conflict of interest: R. Thibault reports current work on malnutrition and IPF funded by Boehringer Ingelheim and Roche/Genentech, during the conduct of the study; and received royalties from Knoë, Le Kremlin Bicêtre, France for designing the Simplified Evaluation of Food Intake (SEFI) tool.
- Received February 27, 2019.
- Accepted March 1, 2019.
- Copyright ©ERS 2019
