SIGNIFICANCE OF OBESITY ON NUTRITIONAL, IMMUNOLOGICAL, HORMONAL, AND CLINICAL OUTCOME PARAMETERS IN BURNS

Objective The potential additive effect of obesity on selected nutriti onal, immunologic, hormonal, and clinical outcome parameters was evalu ated. Design Fifteen obese patients were randomly matched for age, per centage of burn, percentage of third-degree burn, and inhalation injur y to 15 nonobese patients. Setting Subjects were admitted to Shriners Burns Institute or University Hospital in Cincinnati, Ohio. Results Th e results of this study established a significant relationship between obesity and morbidity. Incidence of infection was greatest in the obe se group (P < .03). Bacteremia (P < .008) and clinical sepsis (P < .00 5) occurred concomitant with obesity. The obese group required signifi cantly (P < .05) more days on mechanical ventilatory support. Exogenou s insulin supplementation (obese = 14.5 +/- 5.3 days, nonobese = 6.2 /- 2.2 days) and antibiotic therapy (obese = 8.5 +/- 2.3 days, nonobes e = 3.4 +/- 1.5 days) were required more than twice as many days in th e obese group, although these trends did not reach statistical signifi cance. Resting energy expenditure measurements were significantly high er in the obese group during weeks 1 (P < .0006) and 2 (P < .02), and the trend continued into weeks 3 and 4. Transferrin values for the obe se group remained suppressed throughout the first 4 weeks after the bu rn, whereas the transferrin levels of the nonobese group were normal b y week 4. Compared with normal-weight burn patients, obese burn patien ts had markedly lower alpha 2-macroglobulin values and higher glucagon levels throughout the study period. Applications/conclusions The data demonstrate the many metabolic and biochemical aberrations associated with obesity, distinct from the burn injury itself, and suggest that the overweight burn patient is at increased risk of morbidity. Given t he prevalence of obesity in the United States, greater attention clear ly needs to be given to its prevention and management.