Body composition and trauma - BAPEN...• Increase length of stay –a BMI >35 = 5 days extra stay in some elective surgery • Anaesthetic risk • More nursing time • More post

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












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Size 12

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Lean Overweight Obese Morbidly obese

Intr

a-ab

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inal

AT

(litr

es)

Measurements of Body Fat

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Intr

a-ab

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(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

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Intr

a-ab

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(litr

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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.

Documents

Body composition and trauma - BAPEN...• Increase length of stay –a BMI >35 = 5 days extra stay in some elective surgery • Anaesthetic risk • More nursing time • More post