Background: The value of the phase angle (PhA), measured via bioelectrical impedance analysis (BIA), could be considered a good marker of the cell mass and the cell damage of a patient; however, there are new techniques, such as muscle ultrasonography, that allow the quantity and quality of muscle to be assessed in a minimally invasive way. The aim of this study is to determine the prognostic value of morphofunctional techniques in the prognosis of mortality in patients with idiopathic pulmonary fibrosis (IPF). Methods: This multicenter, cross-sectional study included 86 patients with idiopathic pulmonary fibrosis with a mean age of 71 years, 82.7% of whom were male. The nutritional risk of the patients was assessed by means of questionnaires, such as the Subjective Global Assessment (SGA), and non-invasive functional techniques, including BIA, nutritional ultrasound, and hand grip strength (HGS). Statistical analysis of the sample was performed using JAMOVI version 2.3.22. Results: Correlations were made between the RF-CSA techniques with PhA (r = 0.48, p < 0.001), BCM (r = 0.70, p < 0.001), SMI (r = 0.64, p < 0.001), and HGS (r = 0.54, p < 0.001). The cut-off points for 12-month mortality were PhA = 4.5° (AUC = 0.722, sensitivity of 72.7% and specificity of 66.6%), BCM = 28.8 kg (AUC = 0.609, sensitivity of 32.4% and specificity of 100.0%), RF-CSA = 3.00 cm² (AUC = 0.857, sensitivity of 64.4% and specificity of 100.0%), 6MMW = 420 m (AUC = 0.830, sensitivity of 63.27% and specificity of 100.0%), and TUG = 7.2 s (AUC = 0.771, sensitivity of 100.0% and specificity of 56.67%). In addition, a multivariate analysis was performed with RF-CSA, HR = 8.11 (1.39–47.16, p = 0.020), and PhA of 6.35 (1.29–31.15, p = 0.023), taking into account age, sex, and BMI to determine mortality. Finally, a Kaplan–Meier survival analysis was conducted with low or normal values for classical parameters (GAP and T6MM) and new parameters (PhA, BCM, RF-CSA, and TUG). Conclusion: RF-CSA and PhA were shown to be good prognostic markers of 12-month mortality and could, therefore, be useful screening tools to complement the nutritional assessment of IPF patients.

Introduction: Idiopathic pulmonaryy fibrosis (IPF) is a progressive interstitial lung disease with a poor prognosis. While comorbidities like pulmonary hypertension and lung cancer have been studied extensively, less attention has been paid to the implications of malnutrition and sarcopenia in patients with IPF. This study aimed to assess the prevalence of malnutrition, sarcopenia, and the combined malnutrition-sarcopenia syndrome in patients with IPF using the latest diagnostic criteria from the Global Leadership Initiative on Malnutrition (GLIM) and the European Working Group on Sarcopenia in Older People 2 (EWGSOP2). Methods: A prospective, observational, multicenter study was conducted, focusing on patients with idiopathic pulmonary fibrosis (IPF). All participants provided informed consent, and the study followed ethical guidelines. Malnutrition was diagnosed based on the GLIM criteria, requiring one phenotypic and one etiological criterion, with muscle mass assessed via bioelectrical impedance analysis (BIA). Sarcopenia was screened following the EWGSOP2 recommendations. The statistical analysis was performed using JAMOVI version 2.3.22, with significance set at p < 0.05. Results: The findings revealed that 77.65% of the participants were malnourished, and 20% had sarcopenia. The malnourished patients had significantly lower body weight, height, and muscle mass compared to the non-malnourished patients. Furthermore, the patients with malnutrition exhibited poorer health-related quality of life scores. This study also identified the malnutrition-sarcopenia syndrome in 8.23% of the participants. Conclusions: Malnutrition, based on the GLIM criteria was identified in three out of four patients with IPF, while sarcopenia according to the EWGSOP2 was present in one out of five. This study underscores the necessity for routine screening for malnutrition and sarcopenia in patients with IPF.

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.

Background: Body composition (BC) techniques, including bioelectrical impedance analysis (BIVA), nutritional ultrasound^® (NU), and computed tomography (CT), can detect nutritional diagnoses such as sarcopenia (Sc). Sc in idiopathic pulmonary fibrosis (IPF) is associated with greater severity and lower survival. Our aim was to explore the correlation of BIVA, NU and functional parameters with BC at T12 level CT scans in patients with IPF but also its relationship with degree of Sc, malnutrition and mortality. Methods: This bicentric cross-sectional study included 60 IPF patients (85.2% male, 70.9 ± 7.8 years). Morphofunctional assessment (MFA) techniques included BIVA, NU, CT at T12 level (T12-CT), handgrip strength, and timed up and go. CT data were obtained using FocusedON^®. Statistical analysis was conducted using JAMOVI version 2.3.22 to determine the cutoff points for Sc in T12-CT and to analyze correlations with other MFA techniques. Results: the cutoff for muscle area in T12-CT was ≤77.44 cm² (area under the curve (AUC) = 0.734, sensitivity = 41.7%, specificity = 100%). The skeletal muscle index (SMI_T12CT) cutoff was ≤24.5 cm²/m² (AUC = 0.689, sensitivity = 66.7%, specificity = 66.7%). Low SMI_T12CT exhibited significantly reduced median survival and higher risk of mortality compared to those with normal muscle mass (SMI cut off ≥ 28.8 cm/m²). SMI_T12CT was highly correlated with body cell mass from BIVA (r = 0.681) and rectus femoris cross-sectional area (RF-CSA) from NU (r = 0.599). Cronbach’s α for muscle parameters across different MFA techniques and CT was 0.735, confirming their validity for evaluating muscle composition. Conclusions: T12-CT scan is a reliable technique for measuring low muscle mass in patients with IPF, specifically when the L3 vertebrae are not captured. An SMI value of <28.8 is a good predictor of low lean mass and 12-month mortality in IPF patients.

Background: Triple therapy significantly enhances both clinical and functional outcomes in patients with uncontrolled chronic obstructive pulmonary disease (COPD), even when they are already receiving treatment. However, it is often prescribed with multiple inhalers, which can affect adherence to treatment. The evidence on the effectiveness of extrafine single inhaler triple therapy (efSITT) compared to multiple inhalers triple therapy (MITT) in patients with moderate-to-severe COPD in the real-world setting is limited. Methods: TRIPOLI was a unicentric retrospective observational study that compared one year of efSITT with beclomethasone dipropionate, formoterol fumarate dihydrate, and glycopyrronium with one year of MITT in terms of exacerbations, use of rescue medication, adherence, and lung function in patients with COPD. Results: A total of 71 patients were analyzed. The mean number of total and moderate exacerbations showed a significant reduction of 27.56% (p = 0.0043) and 29.56% (p = 0.0008), respectively, after efSITT. The percentage of patients with poor adherence decreased from 30.2% to 9.9% with efSITT and the proportion of patients with complete adherence increased from 55.8% to 81.7%. An improvement of 2.29% was described in mean forced expiratory volume in the first second (% pred). No differences were observed in the rate of pneumonia between the treatment with efSITT and MITT. Conclusion: The TRIPOLI study suggests that switching from MITT to efSITT might reduce exacerbations in patients with moderate-to-severe COPD, likely attributable to improved adherence in real-world settings.

Background/Objetives: Idiopathic pulmonary fibrosis (IPF) is a progressive interstitial lung disease with poor prognosis. Nutritional disorders, particularly cachexia, significantly impact morbidity and mortality in IPF but remain under-investigated. This study aimed to characterize cachexia phenotypes in IPF through morphofunctional assessment (MFA) and to evaluate their prognostic relevance, including the role of mitochondrial biomarkers. Methods: In this prospective bicenter study, 85 IPF patients underwent MFA including bioelectrical impedance vector analysis (BIVA), nutritional ultrasound (NU), and T12-level computed tomography (T12-CT) for body composition. Functional and strength assessments included timed up and go test (TUG) and handgrip strength (HGS), respectively. Cachexia was defined by Evans’ criteria, Martin’s CT-based criteria, and our IPF-specific proposed definition. Serum GDF-15 and PGC-1α levels were also measured. Results: Cachexia prevalence varied by definition: 24.71% (Evans), 29.5% (Martin) and 42.4% (IPF Cachexia Syndrome). Cachectic patients showed significantly lower muscle mass, function, and quality (measured by reduced muscle attenuation at T12-CT), along with higher GDF-15 and lower PGC-1α levels. The presence of IPF Cachexia syndrome (HR 2.56; 95% CI, 1.08–6.07; p = 0.033), GDF-15 > 4412.0 pg/mL (HR 3.21; 95% CI, 1.04–9.90; p = 0.042) and impaired TUG (>8 s) (HR 3.77; 95% CI, 1.63–8.71; 0.002) were all independently associated with increased 24-month mortality. Conclusions: Cachexia is prevalent in IPF and showed strong concordance between the three diagnostic criteria. The IPF Cachexia syndrome, based on comprehensive morphofunctional phenotyping, demonstrated superior discriminatory capacity. The addition of mitochondrial biomarkers may improve early detection and support personalized interventions to improve patient outcomes.