Adiposity and Outcome After Ischemic Stroke

Abstract

Background and Purpose: A survival advantage among individuals with higher body mass index (BMI) has been observed for diverse acute illnesses, including stroke, and termed the obesity paradox. However, prior ischemic stroke studies have generally tested only for linear rather than nonlinear relations between body mass and outcome, and few studies have investigated poststroke functional outcomes in addition to mortality. Methods: We analyzed consecutive patients with acute ischemic stroke enrolled in a 60-center acute treatment trial, the NIH FAST-MAG acute stroke trial. Outcomes at 3 months analyzed were (1) death; (2) disability or death (modified Rankin Scale score, 2–6); and (3) low stroke-related quality of life (Stroke Impact Scale<median). Relations with BMI were analyzed univariately and in multivariate models adjusting for 14 additional prognostic variables. Results: Among 1033 patients with acute ischemic stroke, average age was 71 years (±13), 45.1% female, National Institutes of Health Stroke Scale 10.6 (±8.3), and BMI 27.5 (±5.6). In both unadjusted and adjusted analysis, increasing BMI was linearly associated with improved 3-month survival ( P =0.01) odds ratios in adjusted analysis for mortality declined across the BMI categories of underweight (odds ratio, 1.7 [CI, 0.6–4.9]), normal (odds ratio, 1), overweight (0.9 [CI, 0.5–1.4]), obese (0.5, [CI, 0.3–1.0]), and severely obese (0.4 [CI, 0.2–0.9]). In unadjusted analysis, increasing BMI showed a U-shaped relation to poststroke disability or death (modified Rankin Scale score, 2–6), with odds ratios of modified Rankin Scale score, 2 to 6 for underweight, overweight, and obese declined initially when compared with normal weight patients, but then increased again in severely obese patients, suggesting a U-shaped or J-shaped relation. After adjustment, including for baseline National Institutes of Health Stroke Scale, modified Rankin Scale score 2 to 6 was no longer related to adiposity. Conclusions: Mortality and functional outcomes after acute ischemic stroke have disparate relations with patients’ adiposity. Higher BMI is linearly associated with increased survival; and BMI has a U-shaped or J-shaped relation to disability and stroke-related quality of life. Potential mechanisms including nutritional reserve aiding survival during recovery and greater frequency of atherosclerotic than thromboembolic infarcts in individuals with higher BMI.

Association Between Body Mass Index and Intracranial Aneurysm Rupture: A Multicenter Retrospective Study

“…In the subgroup analysis, we found that there was a significant sex difference in the inverse association between BMI and intracranial aneurysm rupture. Our sex-strata result is similar to several previous cardiovascular and cerebrovascular studies where they also observed that the inverse association between BMI and adverse events is more prominent in males than in females (Hong et al, 2018;Liu et al, 2021). This result may be partly explained by the fact that there is a sex difference in the prevalence of obesity.…”

“…Traditionally, obesity has been regarded as a well-established risk factor for cardiovascular diseases and stroke. Nevertheless, a growing body of evidence has suggested that an "obesity paradox"-namely that there is an inverse association between obesity and clinical outcomes-exists for patients with hypertension (Kleinloog et al, 2018) coronary artery diseases (Uretsky et al, 2007;Wang et al, 2015), atrial fibrillation (Sandhu et al, 2016), intracerebral hemorrhage (Persaud et al, 2019), and ischemic stroke (Rodríguez-Castro et al, 2019;Liu et al, 2021). Likewise, this paradoxical phenomenon was also observed in patients with SAH (Rinaldo et al, 2019;Rautalin et al, 2020), suggesting a potential protective effect of increased BMI on the risk of adverse events after presenting intracranial aneurysms.…”

Obesity and Poststroke Fatigue: A 2-Year Longitudinal Study

“…However, consistent with our results, Mutai et al also reported that in patients with acute stroke, BMI is negatively associated with reduced motivation immediately after acute stroke, which was one of the five dimensions of the multidimensional fatigue inventory (MFI) [19]. A possible explanation is that acute stroke produces nutritional challenge, with increased metabolic catabolism due to physiological stress, and reduced caloric intake associated with dysphagia and disability [11]. Stroke patients with high BMI have greater metabolic reserve, which may be better able to withstand the nutritional damage [45,46] to maintain the stability of physiological and psychological state.…”

“…Obesity has become a global public health concern, and it directly or indirectly accounts for a large portion of health-related costs [10]. Overweight and obesity were not only important risk factors for stroke, but also related to disability and stroke-related quality of life [11]. In several studies, obesity has been associated with motor fatigue [12], cancer-related fatigue [13][14][15], chronic fatigue syndrome [16], and fatigue in patients with systemic lupus erythematosus (SLE) [17] and inflammatory bowel diseases [18].…”

Stroke Severity among Men and Women Acute Ischemic Stroke Patients in the Telestroke Network

“…Our finding that Caucasians and direct admission for treatment were associated with improving neurologic functions is consistent with other studies that show that Caucasian stroke patients [ 10 ] and direct admission [ 38 ] were associated with improved functional outcomes. In addition, our finding of an association between obesity and improving neurologic functions is similar to other studies on ischemic stroke [ 39 , 40 ], coronary artery disease, and congestive heart failure [ 41 , 42 ]. However, this finding needs to be cautiously interpreted, as we used a data analytical approach that does not allow the randomization of our data collection.…”