Association of body mass index with mortality and functional outcome after acute ischemic stroke

Sun, Weiping; Huang, Yining; Xian, Ying; Zhu, Shijun; Jia, Zhiyuan; Liu, Ran; Fan, Li; Wei, Jianhua; Wang, Ji‐Guang; Liu, Ming; Anderson, Craig S.

doi:10.1038/s41598-017-02551-0

Cited by 41 publications

(30 citation statements)

References 38 publications

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“…Some of the results from this study are consistent with several other studies that included only ischemic stroke subjects whereas the majority of the studies that support the obesity paradox included different patient populations (i.e. , only hemorrhagic [ 20 ], only ischemic [ 8 , 9 , 11 – 14 , 16 , 50 , 51 ], stroke or TIA [ 7 , 17 ], or both ischemic and hemorrhagic strokes [ 10 , 15 , 18 , 19 ]). It is important to point out these differences in the study population because the pathogenesis of ischemic stroke is markedly different from that of hemorrhagic stroke, thus the effect of obesity on post-stroke outcomes may not be the same [ 52 ].…”

Section: Discussionsupporting

confidence: 90%

“…In comparison to some of the studies that cite the obesity paradox on post-stroke outcomes, there are several potential reasons for the discrepant results in the present study. First, the population only consisted of acute ischemic stroke subjects [ 33 , 35 , 50 ]. Some of the results from this study are consistent with several other studies that included only ischemic stroke subjects whereas the majority of the studies that support the obesity paradox included different patient populations (i.e.…”

Section: Discussionmentioning

confidence: 99%

“…However, results of this study were similar to several other studies that only included recent ischemic stroke subjects [ 8 , 9 , 51 ]. Second, the outcomes of interest in studies that support the association between obesity and a decreased risk of all-cause mortality post-stroke were assessed at widely varying periods ranging from a week to 10 years [ 33 , 35 , 50 ]. However, the studies that had time points similar to the time points of acute stroke trials (IMS III, for example) determined that there was no functional or survival benefit for obese subjects [ 8 , 50 , 53 ].…”

Section: Discussionmentioning

confidence: 99%

“…Second, the outcomes of interest in studies that support the association between obesity and a decreased risk of all-cause mortality post-stroke were assessed at widely varying periods ranging from a week to 10 years [ 33 , 35 , 50 ]. However, the studies that had time points similar to the time points of acute stroke trials (IMS III, for example) determined that there was no functional or survival benefit for obese subjects [ 8 , 50 , 53 ]. Third, the inclusion of important prognostic factors, such as stroke severity and smoking use, as potential confounders differed across studies [ 33 , 35 , 50 ].…”

Section: Discussionmentioning

confidence: 99%

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Determining the joint effect of obesity and diabetes on functional disability at 3-months and on all-cause mortality at 1-year following an ischemic stroke

et al. 2018

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BackgroundObesity and diabetes mellitus, or diabetes, are independently associated with post-ischemic stroke outcomes (e.g., functional disability and all-cause mortality). Although obesity and diabetes are also associated with post-ischemic stroke outcomes, the joint effect of obesity and diabetes on these post-ischemic stroke outcomes has not been explored previously. The purpose of the current study was to explore whether the effect of obesity on post-ischemic stroke outcomes differed by diabetes status in a cohort of acute ischemic stroke subjects with at least a moderate stroke severity.MethodsData from the Interventional Management of Stroke (IMS) III clinical trial was analyzed for this post-hoc analysis. A total of 656 subjects were enrolled in IMS III and were followed for one year. The joint effects of obesity and diabetes on functional disability at 3-months and all-cause mortality at 1-year were examined.ResultsOf 645 subjects with complete obesity and diabetes information, few were obese (25.74%) or had diabetes (22.64%). Obese subjects with diabetes and non-obese subjects without diabetes had similar odds of functional disability at 3-months following an ischemic stroke (adjusted common odds ratio, 1.038, 95% CI: 0.631, 1.706). For all-cause mortality at 1-year following an ischemic stroke, obese subjects with diabetes had a similar hazard compared with non-obese subjects without diabetes (adjusted hazard ratio, 1.005, 95% CI: 0.559, 1.808). There was insufficient evidence to declare a joint effect between obesity and diabetes on either the multiplicative scale or the additive scale for both outcomes.ConclusionsIn this post-hoc analysis of data from the IMS III clinical trial of acute ischemic stroke patients with at least a moderate stroke severity, there was not sufficient evidence to determine that the effect of obesity differed by diabetes status on post-ischemic stroke outcomes. Additionally, there was not sufficient evidence to determine that either factor was independently associated with all-cause mortality. Future studies could differentiate between metabolically healthy and metabolically unhealthy patients within BMI categories to determine if the effect of obesity on post-stroke outcomes differs by diabetes status.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Determining the joint effect of obesity and diabetes on functional disability at 3-months and on all-cause mortality at 1-year following an ischemic stroke

et al. 2018

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“…Overweight, general obesity, and abdominal obesity were defined by the standard criteria for the Chinese population (underweight: BMI <18.5 kg/m 2 ; normal weight: BMI, 18.5 to <24 kg/m 2 ; overweight: BMI, 24–28 kg/m 2 ; general obesity: BMI >28 kg/m 2 [ 24 , 27 ] ; abdominal obesity: WC ≥85 cm for men and ≥80 cm for women [ 28 , 29 ] ).…”

Section: Methodsmentioning

confidence: 99%

Association between dynamic obesity and mortality in patients with first-ever ischemic stroke

Wang

et al. 2020

Medicine

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Although obesity is an established risk factor of primary stroke, the association between obesity and post-stroke mortality remains unclear. The aim of this study was to investigate the association between dynamic obesity status and mortality in survivors of their first stroke in China. Of 775 patients with first-ever ischemic stroke included in a longitudinal study, 754 patients were included in this study and categorized into 4 categories of body mass index (BMI) (underweight, normal weight, overweight, and obese) and 2 categories of waist circumference (WC) (normal WC and abdominal obesity) according to standard Chinese criteria. The mortality information and obesity status were obtained via telephone follow-up every 3 months, beginning in 2010 through 2016. Time-dependent Cox proportional hazards models were used to estimate the unadjusted and adjusted hazard ratios (HRs) for the relationship between all-cause mortality and dynamic obesity status. Of 754 patients, 60.87% were male, and the overall mean age was 61.45 years. After adjusting for possible confounders, significant inverse associations were identified between BMI and WC and all-cause mortality. Compared with those with normal BMI or WC, those with abdominal obesity or overweight had a significantly lower risk of all-cause mortality (HR and 95% confidence intervals [CI]: .521 [.303–.897] and 0.545 [.352–.845], respectively), whereas patients with underweight had the highest risk and those with obesity had lower risk of mortality, though it was not statistically significant (1.241 [.691–2.226] and .486 [.192–1.231], respectively). Overweight and abdominal obesity were paradoxically associated with reduced risk of mortality in patients who survived their first-ever ischemic stroke in China. Future prospective studies must look at evaluating the role of obesity in different stroke subtypes and devise appropriate weight-management strategies for optimal prognoses in secondary prevention in these survivors.

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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 of body mass index with mortality and functional outcome after acute ischemic stroke

Cited by 41 publications

References 38 publications

Determining the joint effect of obesity and diabetes on functional disability at 3-months and on all-cause mortality at 1-year following an ischemic stroke

Determining the joint effect of obesity and diabetes on functional disability at 3-months and on all-cause mortality at 1-year following an ischemic stroke

Association between dynamic obesity and mortality in patients with first-ever ischemic stroke

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

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