Dietetic intervention trial in ILD feasible, helps stop weight loss
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Key takeaways:
- The research team achieved its 40-patient target aim in 7 months.
- Patients receiving the dietetic intervention had monthly weight gain, whereas patients receiving the dietary leaflet had monthly weight loss.
A 12-week dietetic intervention trial in patients with interstitial lung disease and malnutrition was feasible and helped patients stop losing weight, according to a poster at the European Respiratory Society International Congress.
“Malnutrition is a huge issue for our patients with ILD,” Rasleen Kahai, respiratory dietitian and the disability and wellness network co-chair at the Royal Brompton & Harefield Hospitals, said in a prerecorded poster presentation. “Data are quite sparse in this area, but we know that it can vary anywhere between 9% and 55% of patients with ILD who are malnourished.”
In this trial, Kahai and colleagues evaluated 40 patients with ILD who were malnourished or at risk for being malnourished to find out if a trial comparing receipt of a specialist dietetic intervention — consisting of individualized nutrition support advice — vs. a control (“poor appetite” dietary leaflet) for 12 weeks was feasible in this patient population.
Researchers also assessed changes in weight between the two groups.
Patients aged up to 75 years had to have a BMI of 20 kg/m2 or less, and patients aged older than 75 years had to have a BMI of 21 kg/m2 or less. Additionally, during the past year, included patients had either unintentional weight loss of 5% or greater of body weight or more than 2 kg if they had a normal BMI, according to the poster.
The research team achieved its 40-patient target aim in 7 months.
“However, during that time, we also had over 120 referrals showing that there is a significant unmet need for dietetic support in ILD,” Kahai said in the prerecorded presentation.
Within the total cohort, 19 patients (median age, 71 years; 47% women; median weight loss over past year, 7.9 kg; 68% treated with anti-fibrotic) received the specialist dietetic intervention, and the remaining 21 patients (median age, 76 years; 33% women; median weight loss over past year, 6.6 kg; 62% treated with anti-fibrotic) received a dietary leaflet.
Researchers reported that all 40 patients completed the trial.
Patients receiving the dietetic intervention experienced monthly weight gain (+0.14 kg), whereas patients receiving the dietary leaflet experienced monthly weight loss (–0.33 kg; between group difference, +0.47 kg per month; 95% CI, 0.12-0.83; P = .009).
In a model adjusted for age, sex, smoking, Charlson co-morbidity index, baseline BMI, anti-fibrotic drugs and composite physiological index, the difference between the dietetic intervention group and the dietary leaflet group was still significant, according to researchers.
Perspective
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These findings are significant in adding to the evidence supporting the importance of nutrition as a modifiable risk factor for respiratory health. The pilot study in ILD demonstrates that a dietary intervention is feasible to reverse weight loss, which has been shown to be associated with worse survival.
The Johns Hopkins BREATHE Center has conducted research and demonstrated that a Mediterranean-like diet, including components high in omega-3 fatty acids, is associated with improved respiratory health, particularly among individuals with asthma and COPD. We also postulate that a healthy diet may be protective against adverse exposures, such as air pollution. We have conducted dietary intervention trials in asthma and have an ongoing study of omega-3 fatty acid dietary supplements in COPD.
This study in ILD adds to the emerging evidence that dietary and other lifestyle interventions are promising components of a comprehensive care approach to our patients with chronic lung disease.
These findings support the value of future studies of dietary interventions in ILD, including those that investigate the effect of dietary interventions on health outcomes.
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Kahai R, et al. Late breaking abstract - Dietetic intervention in malnourished patients with interstitial lung disease (ILD): A pilot trial. Presented at: European Respiratory Society International Congress; Sept. 7-11, 2024; Vienna.
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