title: [Above and beyond BMI : Alternative methods of measuring body fat and muscle mass in critically ill patients and their clinical significance].
abstract: Obesity leads to better survival in critically ill patients. Although there are several studies confirming this thesis, the "obesity paradox" is still surprising from the clinician's perspective. One explanation for the "obesity paradox" is the fact that the body mass index (BMI), which is used in almost all clinical evaluations to determine weight categories, is not an appropriate measure of fat and skeletal muscle mass and its distribution in critically ill patients. In addition, height and weight are frequently estimated rather than measured. Central obesity has been identified in many disorders as an independent risk factor for an unfavourable outcome. The first clues are to be found in intensive care. Along with obesity, an individual's entire muscle mass is a variable that has an influence on outcome. Central obesity can be measured relatively easily with an abdominal calliper, but the calculation of muscle mass is more complex. A valid and detailed measurement of this can be obtained using computed tomography (CT) images, acquired during routine care. For future clinical observation or interventional studies, single cross-sectional CT is a more sophisticated tool for measuring patients' anthropometry than a measuring tape and callipers. Patients with sarcopenic obesity, for example, who may be at a particular risk, can only be identified using imaging procedures such as single cross-sectional CT. Thus, BMI should take a back seat as an anthropometric tool, both in the clinic and in research.
authors.affiliation: Klinik für Anaesthesiologie, Klinikum der Universität München (LMU), Marchioninistr. 15, 81377, München, Deutschland. tweig@med.lmu.de.
authors.forename: T
authors.initials: T
authors.lastname: Weig
authors.affiliation: Klinik für Anaesthesiologie, Klinikum der Universität München (LMU), Marchioninistr. 15, 81377, München, Deutschland.
authors.forename: T
authors.initials: T
authors.lastname: Irlbeck
authors.affiliation: Klinik für Anaesthesiologie, Klinikum der Universität München (LMU), Marchioninistr. 15, 81377, München, Deutschland.
authors.forename: L
authors.initials: L
authors.lastname: Frey
authors.affiliation: Institut für klinische Radiologie, Klinikum der Universität München (LMU), München, Deutschland.
authors.forename: P
authors.initials: P
authors.lastname: Paprottka
authors.affiliation: Klinik für Anaesthesiologie, Klinikum der Universität München (LMU), Marchioninistr. 15, 81377, München, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Irlbeck
mesh_terms: D050153:Abdominal Fat / Q000000981:diagnostic imaging; D000273:Adipose Tissue / Q000000981:diagnostic imaging*; D050154:Adiposity; D000886:Anthropometry; D015992:Body Mass Index; D016638:Critical Illness / Q000628:therapy*; D006801:Humans; D008279:Magnetic Resonance Imaging; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging*; D009765:Obesity / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed
keywords: Anthropometry; Body Mass Index; Central obesity; Intra-abdominal fat; MDCT; Sarcopenia