Association between body mass index and outcome in <scp>J</scp>apanese ischemic stroke patients

Kawase, Shinya; Kowa, Hisanori; Suto, Yutaka; Fukuda, Hiroki; Kusumi, Masayoshi; Nakayasu, Hiroyuki; Nakashima, Kenichiro

doi:10.1111/ggi.12713

Cited by 29 publications

(35 citation statements)

References 29 publications

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“…Furthermore, our findings revealed that obesity confer decreased risk of mortality without statistical significance, which is consistent with other findings [23,24]. A Chinese follow-up study [25], have found obesity (27.5-32.4 kg/m 2 ) isn't associate with increased risk, which is similar to the South Korea result of Ryu et al [24].…”

Section: Discussionsupporting

confidence: 91%

“…There are some proposed explanations for the paradox. Firstly, obese patients may tend to present earlier/more aggressive treatment, varying the natural history of their disease, which may have benefited from lead-time bias [23]. Meanwhile, obese counterparts were encouraged to change unhealthy lifestyle [2] and thereby acquired a better prognosis, but this requires additional research.…”

Section: Discussionmentioning

confidence: 99%

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Association between dynamic obesity and mortality in patients with first-ever ischemic stroke: a hospital-based prospective study

Wang¹,

Li³

et al. 2019

Preprint

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Background and Purpose: Although obesity is an established risk factor for the occurrence of a primary stroke, the association between obesity with post-stroke mortality remains unclear. We evaluated the association of dynamic obesity status with mortality among first-ever stroke survivors in China. Methods: Data from 775 patients with first-ever ischaemic stroke from a longitudinal study, 754 patients were categorized 4 categories of BMI (underweight, normal weight, overweight and obese) and 2 categories of WC (normal WC and abdominal obesity) according to Chinese-specific criteria. Mortality information and obesity status were obtained through every 3 months via telephone follow-up, beginning in 2010 and continuing through 2016. Chi-square tests were used to compare different obesity status at admission and personal characteristics. Time-dependent Cox proportional hazards models were used to estimate the unadjusted and adjusted hazard ratios (HRs) for relationship between all-cause mortality and dynamic obesity status. Results: Of 754 analyzed patients, 60.87% were males, with a mean age of 61.45 years. After adjusting for possible confounders, there were significant inverse associations between BMI and WC with all-cause mortality: compared with normal BMI or WC counterparts, overweight and abdominal obesity patients significantly decrease risk of all-cause mortality (HR and 95% confidence interval (CI):0.521(0.303,0.897),0.545(0.352,0.845),respectively), whereas under-weight patients have the highest risk and obese have decreased risk of mortality, though significance was not obtained (1.241(0.691,2.226),0.486(0.192,1.231), respectively). Conclusions: Overweight and abdominal obesity was paradoxically associated with reduced risk of mortality among first-ever ischaemic stroke survivors in China. Body weight management recommendations ought to not be based on mere projection from primary prevention of stroke.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Association between dynamic obesity and mortality in patients with first-ever ischemic stroke: a hospital-based prospective study

Wang¹,

Li³

et al. 2019

Preprint

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“…Another study described that low BMI was associated with poor short and long-term outcome after stroke. 6 and further studies are warranted to examine whether underweight is really a modifiable risk factor after stroke. 30 Our study area includes eight municipalities in the Skåne Region in southern Sweden with both urban and rural populations and can therefore be regarded as representative for Sweden.…”

Section: Discussionmentioning

confidence: 99%

“…6 It has been reported that treatment goals according to national and international guidelines have often not been reached in secondary prevention after stroke. 6 It has been reported that treatment goals according to national and international guidelines have often not been reached in secondary prevention after stroke.…”

Section: Introductionmentioning

confidence: 99%

“…cohort, epidemiology, lifestyle, longitudinal study, outcome, risk factors, secondary prevention, stroke underweight may be of importance in short-term as well as longterm perspectives. 6 It has been reported that treatment goals according to national and international guidelines have often not been reached in secondary prevention after stroke. 7 Optimizing secondary prevention after stroke in accordance with the WSO Global Stroke Guidelines is therefore important for recovery and to prevent vascular morbidity and recurrent stroke.…”

Section: Introductionmentioning

confidence: 99%

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Secondary prevention and lifestyle indices after stroke in a long-term perspective

et al. 2018

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The obesity paradox may not lead to functional gains in stroke patients undergoing acute inpatient rehabilitation

Freeman

Blough

Rotich

et al. 2021

PM&R

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Introduction Obesity is a risk factor for many adverse health outcomes. However for some cardiac conditions and cancers, evidence of an “obesity paradox” seems to exist where an elevated body mass index (BMI) is linked to protective effects in mortality and functional outcomes. Within the stroke rehabilitation literature, there are conflicting findings on this phenomenon possibly due to unaccounted for variables, such as comorbid medical conditions. Objective To investigate the association between BMI and functional gains made in acute inpatient stroke rehabilitation, and the effects of multiple confounding variables. Design Retrospective cohort study. Setting Tertiary academic hospital. Patients Three hundred ninety‐two adults following a recent ischemic (82%) or hemorrhagic (18%) stroke with a mean age 62.9 years. Interventions Acute inpatient rehabilitation. Main Outcome Measures Functional Independence Measure (FIM) score and BMI. Results A significant association was found between motor FIM score gains and elevated BMI when BMI was treated as a continuous variable (p < .05). However, this association disappeared when patient factors and comorbid conditions were taken into account and when BMI was conceptualized categorically (underweight [BMI <18.5], normal [BMI 18.5–24.9], overweight [BMI 25.0–29.9], obese [BMI 30.0–39.9], and severely obese [BMI ≥40.0]). Advanced age, higher motor function on admission, and a diagnosis of diabetes were all significantly associated with decreased motor FIM gains. Conclusions The results from this study provide insufficient evidence to support the “obesity paradox” once patient factors and comorbid conditions are taken into account. Diabetes was the single comorbidity tracked that showed a significant association with change in motor function (p = .01). Further studies might explore how the unique interventions of rehabilitation physicians and ancillary health professionals might mitigate the functional debility associated with diabetes and obesity in stroke patients.

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Association between body mass index and outcome in Japanese ischemic stroke patients

Abstract: Lower BMI might be a predictor of poorer short-term and long-term stroke outcomes. Geriatr Gerontol Int 2017; 17: 369-374.

Cited by 29 publications

References 29 publications

Association between dynamic obesity and mortality in patients with first-ever ischemic stroke: a hospital-based prospective study

Association between dynamic obesity and mortality in patients with first-ever ischemic stroke: a hospital-based prospective study

Secondary prevention and lifestyle indices after stroke in a long-term perspective

The obesity paradox may not lead to functional gains in stroke patients undergoing acute inpatient rehabilitation

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