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

Kraft R, Herndon DN, Williams FN, Al-Mousawi AM, Finnerty CC, Jeschke MG - Int J Obes (Lond) (2011)

Bottom Line: 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).Patients ≥85th percentile showed a significant higher loss of bone mineral density and lipolysis compared with normal individuals.Our results suggest that impaired metabolism and an altered inflammatory response already exists in patients starting at the 85th percentile BMI.

View Article: PubMed Central - PubMed

Affiliation: Shriners Hospitals for Children, Galveston, TX, USA.

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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Related in: MedlinePlus

Comparison of cytokine, IGF-1, and IGFBP-3 levels in obese and normal weight patientsCytokine responses, exemplified by TNF-a and IL-6, were comparable between both groups, while IGF-1 and IGFBP-3 expression was higher in the normal weight group.
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Figure 3: Comparison of cytokine, IGF-1, and IGFBP-3 levels in obese and normal weight patientsCytokine responses, exemplified by TNF-a and IL-6, were comparable between both groups, while IGF-1 and IGFBP-3 expression was higher in the normal weight group.

Mentions: Cytokine levels did not differ between groups during the observed period (TNF and IL-6 are representative of cytokine responses in obese and normal patients, Fig. 3 a,b). In contrast, levels of insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) varied between groups (Fig. 3 c,d, p < 0.05). Of the constitutive and acute-phase proteins measured, Apolipoprotein A1 (ApoA1), Apolipoprotein B (ApoB), alpha-protein Macroglobulin (A2 Macro), and C-reactive protein (CRP) are displayed (Fig. 4 a-f). ApoA1, ApoB, and A2 Macro were lower in the ≥ 85th percentile group than in the normal group (p < 0.05). Conversely, CRP levels were higher in the ≥ 85th percentile group than in the normal group (p < 0.05). The ≥ 85th percentile group also had higher levels of triglycerides (p < 0.05) and discrete higher alkaline phosphatase (ALP) levels, an indicator of hepatic function. Measurement of renal function, as defined by the DENVER2 score, did not reveal any significant differences between the groups.


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

Kraft R, Herndon DN, Williams FN, Al-Mousawi AM, Finnerty CC, Jeschke MG - Int J Obes (Lond) (2011)

Comparison of cytokine, IGF-1, and IGFBP-3 levels in obese and normal weight patientsCytokine responses, exemplified by TNF-a and IL-6, were comparable between both groups, while IGF-1 and IGFBP-3 expression was higher in the normal weight group.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3299841&req=5

Figure 3: Comparison of cytokine, IGF-1, and IGFBP-3 levels in obese and normal weight patientsCytokine responses, exemplified by TNF-a and IL-6, were comparable between both groups, while IGF-1 and IGFBP-3 expression was higher in the normal weight group.
Mentions: Cytokine levels did not differ between groups during the observed period (TNF and IL-6 are representative of cytokine responses in obese and normal patients, Fig. 3 a,b). In contrast, levels of insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) varied between groups (Fig. 3 c,d, p < 0.05). Of the constitutive and acute-phase proteins measured, Apolipoprotein A1 (ApoA1), Apolipoprotein B (ApoB), alpha-protein Macroglobulin (A2 Macro), and C-reactive protein (CRP) are displayed (Fig. 4 a-f). ApoA1, ApoB, and A2 Macro were lower in the ≥ 85th percentile group than in the normal group (p < 0.05). Conversely, CRP levels were higher in the ≥ 85th percentile group than in the normal group (p < 0.05). The ≥ 85th percentile group also had higher levels of triglycerides (p < 0.05) and discrete higher alkaline phosphatase (ALP) levels, an indicator of hepatic function. Measurement of renal function, as defined by the DENVER2 score, did not reveal any significant differences between the groups.

Bottom Line: 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).Patients ≥85th percentile showed a significant higher loss of bone mineral density and lipolysis compared with normal individuals.Our results suggest that impaired metabolism and an altered inflammatory response already exists in patients starting at the 85th percentile BMI.

View Article: PubMed Central - PubMed

Affiliation: Shriners Hospitals for Children, Galveston, TX, USA.

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.

Show MeSH
Related in: MedlinePlus