{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T09:38:22Z","timestamp":1778924302661,"version":"3.51.4"},"reference-count":44,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2021,11,16]],"date-time":"2021-11-16T00:00:00Z","timestamp":1637020800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004543","name":"China Scholarship Council","doi-asserted-by":"publisher","award":["201806260275"],"award-info":[{"award-number":["201806260275"]}],"id":[{"id":"10.13039\/501100004543","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Objectives In recent years; increasing evidence pointed out the clinical importance of adipose tissue (AT) distribution in various patient populations. In particular, visceral adipose tissue (VAT), when compared to subcutaneous adipose tissue (SAT), was found to play a pivotal role in the development of inflammatory reaction. The aim of the present study was to examine whether body fat distribution has an impact on the development of systemic inflammatory response syndrome (SIRS) in patients with polytrauma. Methods In our retrospective study; we filtered our institution records of the German Trauma Registry (Trauma Register DGU) from November 2018 to April 2021 and included 132 adult polytrauma patients with injury severity score (ISS) &gt;16. Subsequently; we measured the visceral and subcutaneous adipose tissue area based on whole-body CT scan and calculated the ratio of VAT to SAT (VSr). Thereafter, the patient population was evenly divided into three groups; respectively VSr value less than 0.4 for the first group (low ratio), 0.4\u20130.84 for the second group (intermediate ratio), and greater than 0.84 for the third group (high ratio). Considering the other influencing factors; the groups were further divided into subgroups in the respective analysis according to gender (male\/female), BMI (&lt;25 or \u226525), and ISS (&lt;26 or \u226526). Result VSr was an independent factor from body mass index (BMI) (r2 = 0.003; p = 0.553). VSr in male patients was significantly higher (p &lt; 0.001). Patients with low VSr had higher ISS scores (p = 0.028). Polytrauma patients with higher VSr tended to have lower SIRS scores and significant differences of SIRS score were found on multiple days during the whole hospitalization period. In the low VAT\/SAT group, male patients, and patients with BMI greater than 25, both exhibited higher SIRS scores during hospital stay (day 16: p = 0.01; day 22: p = 0.048 and p = 0.011; respectively). During hospitalization, patients with higher ISS score (\u226526) in the low VSr group was found to have higher SIRS score (day 16; p = 0.007). Over the hospital stay; serum markers of CRP; CK; and leukocyte in patients with low VSr were higher than those in patients in the intermediate and high VSr groups; with significant difference discovered on multiple days (day 16: 0.014; day 22: p = 0.048). Conclusion Lower VSr is associated with increased inflammatory response and worse clinical outcome in patients with polytrauma. Furthermore; VSr is an independent factor providing additional information to BMI.<\/jats:p>","DOI":"10.3390\/life11111243","type":"journal-article","created":{"date-parts":[[2021,11,17]],"date-time":"2021-11-17T02:42:28Z","timestamp":1637116948000},"page":"1243","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["The Effect of Fat Distribution on the Inflammatory Response of Multiple Trauma Patients\u2014A Retrospective Study"],"prefix":"10.3390","volume":"11","author":[{"given":"Zhaoxiong","family":"Chen","sequence":"first","affiliation":[{"name":"Center for Musculoskeletal Surgery, Charit\u00e9 - Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Berlin Institute of Health, 13353 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silvan","family":"Wittenberg","sequence":"additional","affiliation":[{"name":"Center for Musculoskeletal Surgery, Charit\u00e9 - Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Berlin Institute of Health, 13353 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5763-689X","authenticated-orcid":false,"given":"Timo Alexander","family":"Auer","sequence":"additional","affiliation":[{"name":"Clinic for Radiology, Charit\u00e9 - Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Berlin Institute of Health, 13353 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maxim","family":"Bashkuev","sequence":"additional","affiliation":[{"name":"Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charit\u00e9 - Universit\u00e4tsmedizin Berlin, 10115 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5946-7137","authenticated-orcid":false,"given":"Pimrapat","family":"Gebert","sequence":"additional","affiliation":[{"name":"Institute of Biometry and Clinical Epidemiology, Charit\u00e9 - Universit\u00e4tsmedizin Berlin, 10115 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3622-3268","authenticated-orcid":false,"given":"Uli","family":"Fehrenbach","sequence":"additional","affiliation":[{"name":"Clinic for Radiology, Charit\u00e9 - Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, 13353 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7348-0971","authenticated-orcid":false,"given":"Dominik","family":"Geisel","sequence":"additional","affiliation":[{"name":"Clinic for Radiology, Charit\u00e9 - Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, 13353 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0435-9059","authenticated-orcid":false,"given":"Frank","family":"Graef","sequence":"additional","affiliation":[{"name":"Center for Musculoskeletal Surgery, Charit\u00e9 - Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Berlin Institute of Health, 13353 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sven","family":"Maerdian","sequence":"additional","affiliation":[{"name":"Center for Musculoskeletal Surgery, Charit\u00e9 - Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Berlin Institute of Health, 13353 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6529-6864","authenticated-orcid":false,"given":"Serafeim","family":"Tsitsilonis","sequence":"additional","affiliation":[{"name":"Center for Musculoskeletal Surgery, Charit\u00e9 - Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Berlin Institute of Health, 13353 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,11,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1752","DOI":"10.1161\/CIRCRESAHA.115.306883","article-title":"Obesity and Cardiovascular Disease","volume":"118","author":"Ortega","year":"2016","journal-title":"Circ. Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1169","DOI":"10.1016\/j.jaci.2018.02.004","article-title":"Obesity and asthma","volume":"141","author":"Peters","year":"2018","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1016\/S1474-4422(15)70016-5","article-title":"Neuroinflammation in Alzheimer\u2019s disease","volume":"14","author":"Heneka","year":"2015","journal-title":"Lancet Neurol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1001\/archsurg.139.9.983","article-title":"Obesity is an independent risk factor of mortality in severely injured blunt trauma patients","volume":"139","author":"Neville","year":"2004","journal-title":"Arch. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1016\/j.jss.2014.07.027","article-title":"Obesity delays functional recovery in trauma patients","volume":"193","author":"Dhungel","year":"2015","journal-title":"J. Surg. Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1602","DOI":"10.1016\/j.jse.2015.04.019","article-title":"Obesity is associated with increased postoperative complications after operative management of distal humerus fractures","volume":"24","author":"Werner","year":"2015","journal-title":"J. Shoulder Elb. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1793","DOI":"10.1007\/s00134-011-2321-2","article-title":"The obesity paradox in surgical intensive care unit patients","volume":"37","author":"Hutagalung","year":"2011","journal-title":"Intensive Care Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1038\/oby.2007.102","article-title":"Obesity and mortality in critically ill adults: A systematic review and meta-analysis","volume":"16","author":"Oliveros","year":"2008","journal-title":"Obes. (Silver Spring)"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1202","DOI":"10.1378\/chest.123.4.1202","article-title":"Impact of body mass index on outcomes following critical care","volume":"123","author":"Tremblay","year":"2003","journal-title":"Chest"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/j.injury.2012.11.015","article-title":"The impact of body mass index on the development of systemic inflammatory response syndrome and sepsis in patients with polytrauma","volume":"45","author":"Mica","year":"2014","journal-title":"Injury"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1111\/obr.12440","article-title":"From the BMI paradox to the obesity paradox: The obesity-mortality association in coronary heart disease","volume":"17","author":"Antonopoulos","year":"2016","journal-title":"Obes. Rev."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1097\/NT.0000000000000092","article-title":"Body Mass Index: Obesity, BMI, and Health: A Critical Review","volume":"50","author":"Nuttall","year":"2015","journal-title":"Nutr. Today"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1111\/j.1467-789X.2009.00623.x","article-title":"Subcutaneous and visceral adipose tissue: Structural and functional differences","volume":"11","author":"Ibrahim","year":"2010","journal-title":"Obes. Rev."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1016\/j.cmet.2018.02.007","article-title":"Visceral Adipose Tissue Immune Homeostasis Is Regulated by the Crosstalk between Adipocytes and Dendritic Cell Subsets","volume":"27","author":"Macdougall","year":"2018","journal-title":"Cell Metab."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1455","DOI":"10.1016\/S0140-6736(14)60687-5","article-title":"The systemic immune response to trauma: An overview of pathophysiology and treatment","volume":"384","author":"Lord","year":"2014","journal-title":"Lancet"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.1007\/s00068-019-01264-5","article-title":"Impact of pathologic body composition assessed by CT-based anthropometric measurements in adult patients with multiple trauma: A retrospective analysis","volume":"47","author":"Poros","year":"2019","journal-title":"Eur. J. Trauma Emerg. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1002\/jcsm.12731","article-title":"Artificial intelligence-based analysis of body composition in Marfan: Skeletal muscle density and psoas muscle index predict aortic enlargement","volume":"12","author":"Beetz","year":"2021","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1644","DOI":"10.1378\/chest.101.6.1644","article-title":"Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP\/SCCM Consensus Conference Committee. American College of Chest Physicians\/Society of Critical Care Medicine","volume":"101","author":"Bone","year":"1992","journal-title":"Chest"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1046\/j.1467-789x.2001.00025.x","article-title":"Obesity and immune function relationships","volume":"2","author":"Marcos","year":"2001","journal-title":"Obes. Rev."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.amjcard.2010.02.017","article-title":"Relation of C-reactive protein to abdominal adiposity","volume":"106","author":"Brooks","year":"2010","journal-title":"Am. J. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"E26","DOI":"10.1210\/jc.2010-0305","article-title":"Plasma procalcitonin is associated with obesity, insulin resistance, and the metabolic syndrome","volume":"95","author":"Abbasi","year":"2010","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1111\/eci.12802","article-title":"Lean body mass and creatine kinase are associated with reduced inflammation in obesity","volume":"47","author":"Bekkelund","year":"2017","journal-title":"Eur. J. Clin. Investig."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/S0140-6736(74)91639-0","article-title":"Assessment of coma and impaired consciousness. A practical scale","volume":"2","author":"Teasdale","year":"1974","journal-title":"Lancet"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1016\/j.injury.2006.07.009","article-title":"AIS 2005: A contemporary injury scale","volume":"37","author":"Gennarelli","year":"2006","journal-title":"Injury"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1097\/00005373-197403000-00001","article-title":"The injury severity score: A method for describing patients with multiple injuries and evaluating emergency care","volume":"14","author":"Baker","year":"1974","journal-title":"J. Trauma"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1016\/j.jamcollsurg.2006.07.001","article-title":"Impact of obesity in the critically ill trauma patient: A prospective study","volume":"203","author":"Bochicchio","year":"2006","journal-title":"J. Am. Coll. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.1097\/00005373-199109000-00009","article-title":"Obesity and increased mortality in blunt trauma","volume":"31","author":"Choban","year":"1991","journal-title":"J. Trauma"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1097\/SLA.0000000000000330","article-title":"Impact of Obesity on Mortality and Complications in Trauma Patients","volume":"259","author":"Glance","year":"2014","journal-title":"Ann. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"345702","DOI":"10.1155\/2013\/345702","article-title":"Impact of the Body Mass on Complications and Outcome in Multiple Trauma Patients: What Does the Weight Weigh?","volume":"2013","author":"Andruszkow","year":"2013","journal-title":"Mediat. Inflamm."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/j.mayocp.2016.11.001","article-title":"Obesity and Heart Failure: Focus on the Obesity Paradox","volume":"92","author":"Carbone","year":"2017","journal-title":"Mayo Clin. Proc."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1093\/cvr\/cvx106","article-title":"The molecular mechanisms of obesity paradox","volume":"113","author":"Antonopoulos","year":"2017","journal-title":"Cardiovasc. Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1966","DOI":"10.1097\/CCM.0000000000001870","article-title":"Increased Ratio of Visceral to Subcutaneous Adipose Tissue in Septic Patients Is Associated With Adverse Outcome","volume":"44","author":"Pisitsak","year":"2016","journal-title":"Crit. Care Med."},{"key":"ref_33","first-page":"57","article-title":"Visceral adiposity is not associated with inflammatory markers in trauma patients","volume":"68","author":"Collier","year":"2010","journal-title":"J. Trauma"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/dote\/dox008","article-title":"Impact of visceral obesity and metabolic syndrome on the postoperative immune, inflammatory, and endocrine response following surgery for esophageal adenocarcinoma","volume":"30","author":"Doyle","year":"2017","journal-title":"Dis. Esophagus"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"6270514","DOI":"10.1155\/2018\/6270514","article-title":"High Visceral to Subcutaneous Fat Ratio Is Associated with Increased Postoperative Inflammatory Response after Colorectal Resection in Inflammatory Bowel Disease","volume":"2018","author":"Wei","year":"2018","journal-title":"Gastroenterol. Res. Pract."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1007\/s10388-008-0150-3","article-title":"Excess visceral fat accumulation is a risk factor for postoperative systemic inflammatory response syndrome in patients with esophageal cancer","volume":"5","author":"Tanaka","year":"2008","journal-title":"Esophagus"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.coph.2017.08.006","article-title":"Adipose tissue inflammation in obesity: A metabolic or immune response?","volume":"37","author":"Stolarczyk","year":"2017","journal-title":"Curr. Opin. Pharmacol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"156","DOI":"10.3389\/fendo.2020.00156","article-title":"Inflammatory Signaling and Brown Fat Activity","volume":"11","author":"Omran","year":"2020","journal-title":"Front. Endocrinol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.cmet.2007.08.010","article-title":"The rapidly expanding family of adipokines","volume":"6","author":"MacDougald","year":"2007","journal-title":"Cell Metab."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1016\/j.ejphar.2019.02.044","article-title":"Role of brown adipose tissue in modulating adipose tissue inflammation and insulin resistance in high-fat diet fed mice","volume":"854","author":"Shankar","year":"2019","journal-title":"Eur. J. Pharmacol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"27","DOI":"10.3389\/fcvm.2017.00027","article-title":"Humans and Mice Display Opposing Patterns of \u201cBrowning\u201d Gene Expression in Visceral and Subcutaneous White Adipose Tissue Depots","volume":"4","author":"Zuriaga","year":"2017","journal-title":"Front. Cardiovasc. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1080\/21623945.2015.1111971","article-title":"Surgical injury induces local and distant adipose tissue browning","volume":"5","author":"Longchamp","year":"2016","journal-title":"Adipocyte"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1038\/ncb2740","article-title":"Bi-directional interconversion of brite and white adipocytes","volume":"15","author":"Rosenwald","year":"2013","journal-title":"Nat. Cell Biol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/j.cmet.2015.06.022","article-title":"Browning of Subcutaneous White Adipose Tissue in Humans after Severe Adrenergic Stress","volume":"22","author":"Sidossis","year":"2015","journal-title":"Cell Metab."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/11\/11\/1243\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:31:11Z","timestamp":1760167871000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/11\/11\/1243"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,16]]},"references-count":44,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2021,11]]}},"alternative-id":["life11111243"],"URL":"https:\/\/doi.org\/10.3390\/life11111243","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,16]]}}}