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

Abstract

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.

The relationship between nutritional status at the time of stroke on adverse outcomes: a systematic review and meta-analysis of prospective cohort studies

“…Of the 14 prospective cohort studies examining the relationship between BMI and outcomes, 149 107 participants (46% females) diagnosed with stroke were included. [14][15][16][17][18][19][20][21][22][23][24][25][26][27] Mean age across the studies ranged from 54.2 to 78.0 years. All-cause mortality was determined at three months for three studies 17,21,27 at six months for one study 18 and at 12 months or longer in the remaining ten studies.…”

“…All-cause mortality was determined at three months for three studies 17,21,27 at six months for one study 18 and at 12 months or longer in the remaining ten studies. [14][15][16]19,20,[22][23][24][25][26] Poor functional status was ascertained by the modified Rankin Scale (mRS), Barthel Index (BI) and Functional Independence Measure. This was measured at three months in two studies 16,20 and at six months in one study.…”

“…19 Common strengths were: Clear and focused question (n ¼ 26; 100%), selecting of participants (n ¼ 26; 100%) clearly defining the number of participants in each group (n ¼ 24; 92%), [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][33][34][35][36][37][38][39] distinctly stating outcomes (n ¼ 26; 100%) and reliable exposure assessment (n ¼ 25; 96%). 39 The majority of studies had acceptable drop-out rates (n ¼ 22; 85%), [14][15][16][17][18]20,[22][23][24][25][26][27][29][30][31][32][33][34][35][36][37]39 provided confidence intervals (n ¼ 23; 88%) …”

“…39 The majority of studies had acceptable drop-out rates (n ¼ 22; 85%), [14][15][16][17][18]20,[22][23][24][25][26][27][29][30][31][32][33][34][35][36][37]39 provided confidence intervals (n ¼ 23; 88%) [14][15][16][17][18][20][21][22][23][25][26][27][28][29][30][31][32][33][34][35][37][38][39] or found a clear association between exposure and outcome (n ¼ 23; 88%). [14][15][16][18][19]…”

Association between abnormal body weight and stroke outcome: A meta‐analysis and systematic review

“…Of the remaining 196 articles assessed for eligibility, 163 articles were excluded for having the same study population ( n = 5); for having a sample size < 100 ( n = 3); for lack of data on obesity, overweight, or underweight ( n = 108); or for not investigating the concerned outcome of stroke ( n = 47). Finally, 33 articles including 84,660 patients were included in the full analysis [9–41]. The detailed process of study selection is shown in Figure 1.…”