Body Composition Changes in Severely Burned Children During ICU Hospitalization*

Abstract

Objective Prolonged hospitalization due to burn injury results in physical inactivity and muscle weakness. However, how these changes are distributed among body parts is unknown. The aim of this study was to evaluate the degree of body composition changes in different anatomical regions during intensive care unit hospitalization (ICUh). Design Retrospective chart review. Setting Children’s burn hospital. Patients Twenty-four severely burned children admitted to our institution between 2000 and 2015. Interventions All patients underwent a dual-energy x-ray absorptiometry (DEXA) within 2 weeks after injury and 2 weeks before discharge to determine body composition changes. No subject underwent anabolic intervention. We analyzed changes of bone mineral content, bone mineral density, total fat mass, total mass, and total lean mass of the entire body and specifically analyzed the changes between the upper and lower limbs. Measurements and Main Results In the 24 patients, age was 10±5 years, total body surface area burned was 59±17%, time between DEXAs was 34±21 days, and length of stay was 39±24 days. We found a significant (p<0.001) average loss of 3% of lean mass in the whole body; this loss was significantly greater (p<0.001) in the upper extremities (17%) than in the lower extremities (7%). We also observed a remodeling of the fat compartments, with a significant whole-body increase in fat mass (p<0.001) that was greater in the truncal region (p<0.0001) and in the lower limbs (p<0.05). Conclusions ICUh is associated with greater lean mass loss in the upper limbs of burned children. Mobilization programs should include early mobilization of upper limbs to restore upper extremity function.

Children with severe burns display no sex differences in exercise capacity at hospital discharge or adaptation after exercise rehabilitation training

“…Burn injury is met with an aggressive nutritional intervention that attenuates the hypermetabolic response and reduces morbidity and mortality 27 and it may be possible that nutritional differences caused fat storage. An increase in fat mass, as we have reported previously, that occurs primarily in the truncal region and in the lower limbs during the intensive care unit 28 may have life-long consequences that may increase risk for developing type 2 diabetes mellitus and cardiovascular disease. Thus, further study on drug, exercise, and nutritional interventions at discharge and outpatient continued care are required to minimize the negative consequences of an accumulation of fat mass in burn patients.…”

“…Our data differ given that, at discharge and after RET, we determined total absolute values as well as values relative to those for nonburned age- and sex-matched children to further control for sex differences. Recently, we have found prolonged hospitalization from burn injury in children to have greater lean mass loss in the upper extremity and remodeling of the fat compartments from admittance to discharge 25 . Interestingly, we found that at discharge fat mass was increased and after exercise training fat mass was greater in boys than girls.…”

Energy Expenditure and Protein Requirements Following Burn Injury

“…It appears that loss of muscle mass is not distributed equally throughout the body but occurs more significantly in the upper extremities. Simultaneously, there is an increase in total body fat, which is largely in the trunk . Loss of lean body mass can be attributed both to the catabolic state induced by burn injury in addition to resultant immobility.…”

“…Simultaneously, there is an increase in total body fat, which is largely in the trunk. 57 Loss of lean body mass can be attributed both to the catabolic state induced by burn injury in addition to resultant immobility. Animal studies have demonstrated that both burned and unburned rats that were not ambulating experienced decreased lean muscle mass when compared with both burned and unburned ambulatory peers.…”

The Long-Term Impact of Severe Burn Trauma on Musculoskeletal Health

“…4 On average, pediatric patients lose from 3% to 10% of total lean mass during their ICU stay, whereas at the same time, fat accretion reportedly increases by 13%. 36,37 Lean mass continues to decline until at least 9 to 12 months post-burn. 27,38 Although a gradual restoration in lean mass can be seen in burn patients in the first year post-injury, particularly in those participating in rehabilitative exercise programs, there is evidence that even after 3 years lean mass remains lower in burned patients when compared with age-matched healthy individuals.…”