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The effect of obesity on adverse outcomes and metabolism in pediatric burn patients

International Journal of Obesity volume 36, pages 485–490 (2012)Cite this article

Abstract

HYPOTHESIS:

Obesity influences metabolism and increases the incidence of clinical complications and worsens outcomes in pediatric burn patients.

DESIGN:

Retrospective, single-center study.

SUBJECTS:

In all, 592 severely burned pediatric patients who had burns covering more than 30% of the total body surface area and who were treated between 2001 and 2008 were enrolled in this study. Patients were divided into ⩾85th percentile (n=277) and normal (n=315) weight groups based on body mass index (BMI) percentiles.

RESULTS:

Patients stratified below (normal) and ⩾85th percentile had similar age, gender distribution and total burn size. No significant differences were detected in the incidence of sepsis (11% for obese vs 10% for normal), the incidence of multiple organ failure (MOF) (21% for obese and 16% for normal) or mortality (11% for obese vs 8% for normal). Compared with the normal group, the ⩾85th percentile group had low levels of constitutive proteins (α2macroglobulin and Apolipoprotein A1) (P<0.05 for both) as well as high levels of triglycerides and the acute-phase protein, C-reactive protein (P<0.05 for both) up to 60 days after injury. Patients ⩾85th percentile showed a significant higher loss of bone mineral density and lipolysis compared with normal individuals. Stepwise logistic regression analysis revealed that BMI had a positive predictive value towards the maximum DENVER2 score, an index of organ failure (P<0.001).

CONCLUSIONS:

BMI⩾85th percentile altered the post-burn acute phase and catabolic response but did not increase the incidence of sepsis, MOF or mortality in pediatric burn patients. Our results suggest that impaired metabolism and an altered inflammatory response already exists in patients starting at the 85th percentile BMI.

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Acknowledgements

We thank all the individuals who participated in this clinical trial. We would also like to thank the following research staff for their help and assistance: Deb Benjamin, Wes Benjamin, Joanna Huddleston, Lucy Robles, Sylvia Ojeda, Rosa Chapa, Guadalupe Jecker, Mary Kelly, Karen Henderson, Maria Magno, Liz Montemayor, Victor Baras, Gabriela Kulp and Maricela Pantoja. This work was supported, in part, by the American Surgical Association Foundation, NIH grants R01 GM-08725 (MGJ), R01-GM56687 (DNH), P50-GM60338 (DNH), NIDRR H133A070026 (DNH) and T32-GM08256 (DNH) as well as Shriners Hospitals for Children grants 8740 (CCF), 8660 (MGJ), 9145 and 8760 (DNH). CCF is an ITS Career Development Scholar supported, in part, by NIH KL2RR029875 and NIH UL1RR029876.

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Authors and Affiliations

  1. Shriners Hospitals for Children, Galveston, TX, USA

    R Kraft, D N Herndon, F N Williams, A M Al-Mousawi & C C Finnerty

  2. Department of Surgery, University Texas Medical Branch, Galveston, TX, USA

    R Kraft, D N Herndon, F N Williams, A M Al-Mousawi & C C Finnerty

  3. Institute for Translational Sciences, University Texas Medical Branch, Galveston, TX, USA

    C C Finnerty

  4. Sealy Center for Molecular Medicine, University Texas Medical Branch, Galveston, TX, USA

    C C Finnerty

  5. Department of Surgery and Sunnybrook Research Institute, Ross Tilley Burn Centre, Sunnybrook Health Science Centre and University of Toronto, Toronto, Ontario, Canada

    M G Jeschke

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  1. R Kraft
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Correspondence to M G Jeschke.

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Kraft, R., Herndon, D., Williams, F. et al. The effect of obesity on adverse outcomes and metabolism in pediatric burn patients. Int J Obes 36, 485–490 (2012). https://doi.org/10.1038/ijo.2011.224

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