Body composition and trauma
Professor Gary Frost
Head of the Nutrition and Dietetic Research Group
Is fat important?
Insulin resistance
Obesity Lipodystrophy
Fat Content
Fat Distribution
Visceral fat Liver fat
Is there a problem with the obese in hospital?
• Increase length of stay – a BMI >35 = 5 days extra stay in some elective surgery
• Anaesthetic risk• More nursing time• More post op complication• Mid term survival from elective surgery is decreases
• Pregnancy requiring intervention increase length of stay and cost of management
Wounds
• Wound complication are higher in the obese (5x)– Impaired pulmonary function
– Hyperglycaemia
– Immobility
Is there a problem?
Obesity as a principle diagnosis as increased by 45% between 1997 – 2004Length of stay within the obese population is greater As obesity is more common the cost of treatment by 200%
What can be done?
• Weight loss prior to elective surgery– Most the data concerns bariatric surgery
– Weight loss is associated with • Improved anaesthetic risk
• Decrease length of surgery
• Improved outcome long term outcome
Death in ITU
Insulin resistance despite tight glucose control is associated with mortality in
critically ill surgical patients.
• Objective is to determine if critically ill surgical patients vary in their extent of IR and is IR associated with mortality
• Glucose the same in survivors and non survivors
• Insulin resistance increase increased in non survivors
J Intensive Care Med. 2009 Jul‐Aug;24(4):242‐51
Why?
Protein Metabolism
Obesity, gut and trauma
? Due to change in the gut microbiotia
Body composition
BMI: 30.2 BMI: 29.1
visible cardiac fat minimal cardiac fat
Elevated IAAT intra‐abdominal fat
5% liver fat <1% liver fat
BMI = 23.50 kg/m2; TAT = 13.19 l BMI = 23.52 kg/m2; TAT = 21.79 l BMI = 23.53 kg/m2; TAT = 17.33 l
BMI = 23.57 kg/m2; TAT = 21.43 l BMI = 23.88 kg/m2; TAT = 16.84 l BMI = 24.27 kg/m2; TAT = 24.11 l
BMI = 24.29 kg/m2; TAT = 14.33 l BMI = 24.07 kg/m2; TAT = 12.40 l BMI = 23.62 kg/m2; TAT = 26.17 l
BMI = 23.50 kg/m2; TAT = 13.19 l BMI = 23.52 kg/m2; TAT = 21.79 l BMI = 23.53 kg/m2; TAT = 17.33 l
BMI = 23.57 kg/m2; TAT = 21.43 l BMI = 23.88 kg/m2; TAT = 16.84 l BMI = 24.27 kg/m2; TAT = 24.11 l
BMI = 24.29 kg/m2; TAT = 14.33 l BMI = 24.07 kg/m2; TAT = 12.40 l BMI = 23.62 kg/m2; TAT = 26.17 l
BMI = 23.50 kg/m2; TAT = 13.19 l BMI = 23.52 kg/m2; TAT = 21.79 l BMI = 23.53 kg/m2; TAT = 17.33 l
BMI = 23.57 kg/m2; TAT = 21.43 l BMI = 23.88 kg/m2; TAT = 16.84 l BMI = 24.27 kg/m2; TAT = 24.11 l
BMI = 24.29 kg/m2; TAT = 14.33 l BMI = 24.07 kg/m2; TAT = 12.40 l BMI = 23.62 kg/m2; TAT = 26.17 l
BMI = 23.50 kg/m2; TAT = 13.19 l BMI = 23.52 kg/m2; TAT = 21.79 l BMI = 23.53 kg/m2; TAT = 17.33 l
BMI = 23.57 kg/m2; TAT = 21.43 l BMI = 23.88 kg/m2; TAT = 16.84 l BMI = 24.27 kg/m2; TAT = 24.11 l
BMI = 24.29 kg/m2; TAT = 14.33 l BMI = 24.07 kg/m2; TAT = 12.40 l BMI = 23.62 kg/m2; TAT = 26.17 l
Size 12 Size 12 Size 12 Size 12 Size 12 Size 12 Size 12 Size 12
Size 12
1
2
3
4
5
6
7
8
9
10
11
12
Lean Overweight Obese Morbidly obese
Intr
a-ab
dom
inal
AT
(litr
es)
Measurements of Body Fat
1
2
3
4
5
6
7
8
9
10
11
12
Lean Overweight Obese Morbidly obese
Intr
a-ab
dom
inal
AT
(litr
es) Phenotype: “thin on the outside, fat on the inside”= TOFI”
TOFI
• Male TOFI = 15.9 % of lean males
• Female TOFI = 11.5% of lean females
TOFIBMI 25.8 kg/m2
IAAT = 3.3 litresTAT = 22.3 litres
Healthy volunteerBMI 26.5 kg/m2
IAAT = 2.2 litresTAT = 20.8 litres
TOFI
1
2
3
4
5
6
7
8
9
10
11
12
Lean Overweight Obese Morbidly obese
Intr
a-ab
dom
inal
AT
(litr
es)
Phenotype: “Fat on the outside, thin on the inside”= FOTI”
FOTI
Does this matter????
The strongest relationship is between VAT and IHCL
Why is this important?
Copyright ©2008 The American Society for Nutrition
Koska, J. et al. Am J Clin Nutr 2008;87:295-302
FIGURE 3. Pearson correlation of insulin-mediated glucose disposal (M) with visceral adipose tissue, intrahepatic fat content, and fasting plasma adiponectin concentration in men (*) and
women ({circ})
Inflammatory response
Summary
• Obesity play a major role in patient outcome
• Body composition may underlie some of the response to trauma independent of body weight
Thanks to
• Professor Jimmy Bell and his team for there input.