Association between dietary fat content and outcomes in pediatric burn patients

Abstract

Background: The aim of the study was to compare a low fat/high-carbohydrate diet and a high-fat diet on clinical outcomes by a retrospective cohort study.

Methods: Nine hundred forty-four children with burns ≥ 40% of their total body surface area (TBSA) were divided into two groups: patients receiving Vivonex T.E.N. (low-fat/high-carbohydrate diet; n = 518) and patients receiving milk (high-fat diet; n = 426). Patient demographics, caloric intake, length of hospital stay, and incidence of sepsis, mortality, hepatic steatosis, and organomegaly at autopsy were determined.

Results: Demographics and caloric intake were similar in both groups. Patients receiving Vivonex T.E.N. had shorter (intensive care unit) ICU stays (Vivonex T.E.N.: 31 ± 2 d; milk: 47 ± 2 d; P < 0.01), shorter ICU stay per % TBSA burn (Vivonex T.E.N.: 0.51 ± 0.02 d/%; milk: 0.77 ± 0.03 d/%; P < 0.01), lower incidence of sepsis (Vivonex T.E.N.: 11%; milk: 20%; P < 0.01), and lived significantly longer until death than those receiving milk (Vivonex T.E.N.: 20 ± 3 d; milk: 10 ± 2 d; P < 0.01). There was no difference in overall mortality between the two groups (Vivonex T.E.N.:15% versus milk: 13%; P < 0.9). Autopsies revealed decreased hepatic steatosis and decreased enlargement of kidney and spleen in patients receiving Vivonex T.E.N.

Conclusions: The period with a low-fat/high-carbohydrate diet was associated with lower LOS, decreased incidence of organomegaly, infection, and hepatic steatosis post-burn compared with the period when a high-fat diet was used. These associations indicate the benefit of high carbohydrate/low fat nutrition; however, the findings in these time periods can also be likely due to the multifactorial effects of advances in burn care. We believe that these results have some relevance because high fat is associated with poorer outcomes compared with low fat.

Figure 1

Vivonex^®T.E.N.-fed patients are associated with a shorter stay in the intensive care unit (A) and a decreased length of ICU Stay per % TBSA when compared to children receiving milk (B). Bars represent means; error bars correspond to SD. Asterisks denote statistical difference between groups, p<0.01.

Figure 2

Analysis of patients receiving Vivonex^®T.E.N. revealed significantly lower incidence of sepsis (A) and a significantly longer survival rate (B, C) when compared to children receiving milk (20%). Bars represent means; error bars correspond to SD. Asterisks denote statistical difference between groups, p<0.01.

Figure 3

Vivonex^®T.E.N.-fed burned children were associated with a significantly lower incidence of hepatic fatty metamorphosis (milk, n = 57, vs. Vivonex^®T.E.N., n = 78) (A) and significantly lower spleen (milk, n = 55, vs. Vivonex^®T.E.N., n = 75) (B) and kidney (milk, n = 52, vs. Vivonex^®T.E.N., n = 72) (C) weights when compared to children receiving milk. Spleen and kidney weights, measured at autopsy, are presented as a percentage of predicted. Predicted weights are based on age and height. Bars represent means; error bars correspond to SD. Asterisks denote statistical difference between groups, p< 0.05.

Figure 4

Annual rates of mortality (A), length of intensive care unit (ICU) stay (B) and incidence of sepsis (C) during the whole period studied. Bars represent means. Black errors indicate when the change in nutrition took place.