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Hips don’t lie: Waist-to-hip ratio in trauma patients

Joseph, Bellal MD; Zangbar, Bardiya MD; Haider, Ansab Abbas MD; Kulvatunyou, Naroung MD; Khalil, Mazhar MD; Tang, Andrew MD; O’Keeffe, Terence MB ChB; Friese, Randall S. MD; Orouji Jokar, Tahereh MD; Vercruysse, Gary MD; Latifi, Rifat MD; Rhee, Peter MD, MPH

Journal of Trauma and Acute Care Surgery: December 2015 - Volume 79 - Issue 6 - p 1055–1061
doi: 10.1097/TA.0000000000000876
WTA Plenary Papers

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 (R2 = 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).

CONCLUSION 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.

LEVEL OF EVIDENCE Prognostic study, level II.

Supplemental digital content is available in the text.

From the Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Department of Surgery, University of Arizona Medical Center, Tucson, Arizona.

Submitted: February 17, 2015, Revised: August 6, 2015, Accepted: September 2, 2015.

This study was presented at the 45th annual meeting of the Western Trauma Association, March 1–6, 2015, in Telluride, Colorado.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (

Address for reprints: Bellal Joseph, MD, Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Department of Surgery, University of Arizona, 1501 N Campbell Ave, Room 5411, PO Box 245063, Tucson, AZ 85724; email:

© 2015 Lippincott Williams & Wilkins, Inc.