title: Hips don't lie: Waist-to-hip ratio in trauma patients.
abstract: BACKGROUND
  Obesity measured by body mass index (BMI) is known to be associated with worse outcomes in trauma patients. Recent studies have assessed the impact of distribution of body fat measured by waist-hip ratio (WHR) on outcomes in nontrauma patients. The aim of this study was to assess the impact of distribution of body fat (WHR) on outcomes in trauma patients.
  
  
  METHODS
  A 6-month (June to November 2013) prospective cohort analysis of all admitted trauma patients was performed at our Level 1 trauma center. WHR was measured in each patient on the first day of hospital admission. Patients were stratified into two groups: patients with WHR of 1 or greater and patients with WHR of less than 1. Outcome measures were complications and in-hospital mortality. Complications were defined as infectious, pulmonary, and renal complications. Regression and correlation analyses were performed.
  
  
  RESULTS
  A total of 240 patients were enrolled, of which 28.8% patients (n = 69) had WHR of 1 or greater. WHR had a weak correlation with BMI (R = 0.231, R = 0.481). Eighteen percent (n = 43) of the patients developed complications, and the mortality rate was 10% (n = 24). Patients with a WHR of 1 or greater were more likely to develop in-hospital complications (32% vs. 13%, p = 0.001) and had a higher mortality rate (24% vs. 4%, p = 0.001) compared with the patients with a WHR of less than 1. In multivariate analysis, a WHR of 1 or greater was an independent predictor for the development of complications (odds ratio, 3.1; 95% confidence interval 1.08-9.2; p = 0.03) and mortality (odds ratio, 13.1; 95% confidence interval, 1.1-70; p = 0.04).
  
  
  CONCLUSIONS
  Distribution of body fat as measured by WHR independently predicts mortality and complications in trauma patients. WHR is better than BMI in predicting adverse outcomes in trauma patients. Assessing the fat distribution pattern in trauma patients may help improve patient outcomes through focused targeted intervention.
  
  
  METHODS
  Prognostic study, level II.
authors.affiliation: From the Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Department of Surgery, University of Arizona Medical Center, Tucson, Arizona.
authors.forename: Bellal
authors.initials: B
authors.lastname: Joseph
authors.forename: Bardiya
authors.initials: B
authors.lastname: Zangbar
authors.forename: Ansab Abbas
authors.initials: AA
authors.lastname: Haider
authors.forename: Naroung
authors.initials: N
authors.lastname: Kulvatunyou
authors.forename: Mazhar
authors.initials: M
authors.lastname: Khalil
authors.forename: Andrew
authors.initials: A
authors.lastname: Tang
authors.forename: Terence
authors.initials: T
authors.lastname: O'Keeffe
authors.forename: Randall S
authors.initials: RS
authors.lastname: Friese
authors.forename: Tahereh
authors.initials: T
authors.lastname: Orouji Jokar
authors.forename: Gary
authors.initials: G
authors.lastname: Vercruysse
authors.forename: Rifat
authors.initials: R
authors.lastname: Latifi
authors.forename: Peter
authors.initials: P
authors.lastname: Rhee
mesh_terms: D015992:Body Mass Index; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D014193:Trauma Centers; D049629:Waist-Hip Ratio; D014947:Wounds and Injuries / Q000401:mortality*