Body mass index has a non-linear association with three-month outcomes in men with acute ischemic stroke: An analysis based on data from a prospective cohort study

Abstract

ObjectiveDespite reports of a connection between body mass index (BMI) and stroke outcome, the findings remain debatable. In this investigation, we sought to determine whether BMI was associated with the probability of 3-month unfavorable outcomes in patients with acute ischemic stroke (AIS).MethodsThis is a second analysis based on a cohort study. 1,897 people with AIS who were treated at a hospital in South Korea from January 2010 to December 2016 were included in the study. The linear relationship between BMI and unfavorable outcomes for AIS patients was evaluated using a binary logistic regression model. The generalized additive model (GAM) and smoothed curve fitting (penalized spline approach) were employed to see if there was a non-linear association between BMI and unfavorable outcomes in patients with AIS.ResultsThe binary logistic regression model did not detect any statistically significant correlation between BMI and unfavorable outcomes in AIS patients after controlling for variables. The association between them, however, was non-linear, with the BMI inflection point occurring at 23.07 kg/m2. Each 1 kg/m2 rise in BMI on the left side of the inflection point was linked to a 12% lower risk of unfavorable outcomes (OR= 0.88, 95% CI: 0.82 to 0.96, p = 0.003). We stratified the AIS patients by gender to further explore their relationship. The results showed a specific non-linear relationship and saturation effect of BMI (kg/m2) with 3-month unfavorable outcomes in male patients but not in female patients. The inflection point for BMI was 23.35 kg/m2. When BMI was below 23.35 kg/m2 in men with AIS, BMI was inversely associated with unfavorable outcomes (OR=0.89,95% CI:0.80-0.98).ConclusionA particular non-linear connection and saturation effect between BMI (kg/m2) and 3-month unfavorable outcomes were present in male patients with AIS but not in females. 23.35 kg/m2 was the BMI’s inflection point. The probability of unfavorable outcomes was substantially and inversely associated with BMI in men with AIS when it was less than 23.35 kg/m2. Men with AIS should have a BMI of no less than 23.35 kg/m2 to reduce the probability of unfavorable outcomes following AIS.

Relationship between glycated hemoglobin levels and three-month outcomes in acute ischemic stroke patients with or without diabetes: a prospective Korean cohort study

“…In the diabetic group, AIS patients with HbA1c < 6.0% had the highest levels of Scr, C-reactive protein, the lowest HGB, and the highest percentage of hypertension. These are risk factors for adverse outcomes in AIS patients [ 18 , 24 , 25 ]. Therefore, in order to reduce the risk of adverse clinical outcomes, HbA1c should ideally be controlled at around 6.1% in diabetic patients with AIS.…”

“…We calculated effect sizes with 95% confidence intervals (95%CI). Confounding variables were adjusted based on clinical knowledge, literature reports, and univariate analysis results [ 17 , 18 ]. Additionally, TC was excluded from the final multivariate logistic regression equation due to collinearity with other factors (Table S 1 ).…”

Association between Triglyceride-Glucose Index and carotid plaque in Japanese population: a cross-sectional study

“…Furthermore, interactions and stratified analyses were conducted, as previously described. In addition, we investigated potential unobserved confusion between the TyG Index and carotid plaque by calculating the E-value 28 29. Statistical software packages R (http://www.R-project.org.…”

Characteristic variables of acute ischemic stroke categorized according to body mass index classifications

“…Conversely, the BMI category of underweight in both sexes is also associated with a higher risk of ischemic stroke, and this category has a significantly higher rate of poor short and long-term outcomes than the BMI category of normal weight 9,10,11 . Other studies regarding the association between BMI and the prognosis after acute ischemic stroke have shown that BMI has a non-linear association with 3-month outcomes in men with acute ischemic stroke 8 , and that the BMI categories of underweight and obesity were generally associated with poorer outcomes 12,13,14 .…”

“…3. According to a previous meta-analysis 4, the risk of stroke is positively correlated with BMI, and this correlation is stronger in men and patients with ischemic stroke. The findings of yet another study supported this meta-analysis, revealing that the BMI categories of overweight and obesity were associated with an increased risk only in men 5. It has been shown that there is a positive correlation between the whole range of BMI categories and ischemic stroke 6 , with no evidence of a threshold or a J-shaped curve 7,8 . Conversely, the BMI category of underweight in both sexes is also associated with a higher risk of ischemic stroke, and this category has a significantly higher rate of poor short and long-term outcomes than the BMI category of normal weight 9,10,11 .…”