Abstract：
Overweight and moderate obesity confer a survival benefit in chronic diseases such as coronary artery disease and chronic kidney disease, which has been termed the \"obesity paradox\". However, whether this phenomenon exists in trauma patients remains controversial. We performed a retrospective cohort study in abdominal trauma patients admitted to a Level I trauma center in Nanjing, China between 2010 and 2020. In addition to the traditional body mass index (BMI) based measures, we further examined the association between body composition-based indices with clinical severity in trauma populations. Body composition indices including skeletal muscle index (SMI), fat tissue index (FTI), and total fat-to-muscle ratio (FTI/SMI) were measured using computed tomography. Our study found that overweight was associated with a four-fold risk of mortality (OR, 4.47 [95% CI, 1.40-14.97], p = 0.012) and obesity was associated with a seven-fold risk of mortality (OR, 6.56 [95% CI, 1.07-36.57], p = 0.032) compared to normal weight. Patients with high FTI/SMI had a three-fold risk of mortality (OR, 3.06 [95% CI, 1.08-10.16], p = 0.046) and double the risk of an intensive care unit length of stay ≥ 5 d (OR, 1.75 [95% CI, 1.06-2.91], p = 0.031) compared to patients with low FTI/SMI. The obesity paradox was not observed in abdominal trauma patients, and high FTI/SMI ratio was independently associated with increased clinical severity.
摘要：
超重和中度肥胖赋予慢性疾病如冠状动脉疾病和慢性肾脏疾病的生存益处，这被称为“肥胖悖论”。然而,创伤患者是否存在这种现象仍存在争议。我们对南京一级创伤中心收治的腹部创伤患者进行了一项回顾性队列研究，2010年至2020年的中国。除了传统的基于体重指数(BMI)的测量之外，我们进一步研究了创伤人群中基于身体成分的指数与临床严重程度之间的相关性.身体成分指数，包括骨骼肌指数（SMI），脂肪组织指数（FTI），和总脂肪肌肉比（FTI/SMI）使用计算机断层扫描测量。我们的研究发现，超重与死亡风险的四倍(OR，4.47[95%CI，1.40-14.97]，p=0.012)，肥胖与7倍的死亡风险相关(OR，6.56[95%CI，1.07-36.57]，p=0.032）与正常体重相比。高FTI/SMI患者有3倍的死亡风险(OR，3.06[95%CI，1.08-10.16]，p=0.046)，重症监护病房住院时间≥5d的风险增加一倍(OR，1.75[95%CI，1.06-2.91]，p=0.031）与低FTI/SMI患者相比。在腹部创伤患者中未观察到肥胖悖论，高FTI/SMI比值与临床严重程度增加独立相关。
