Favorable Functional Recovery in Overweight Ischemic Stroke Survivors: Findings from the China National Stroke Registry

Zhao, Lu; Du, Wanliang; Zhao, Xingquan; Liu, Liping; Wang, Chunxue; Wang, Yilong; Wang, Anxin; Liu, Gaifen; Xu, Yuming

doi:10.1016/j.jstrokecerebrovasdis.2013.10.002

Cited by 65 publications

(48 citation statements)

References 37 publications

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“…Out of these 19 studies, 9 focus on the relationship between BMI and mortality [18–25,27] and 3 on both mortality and non-fatal outcome. [26,30,35] In addition, 6 studies examined further outcomes such as hemorrhagic transformation after acute ischemic stroke, recurrent vascular events, stroke rehabilitation and hospital discharge outcomes. [28,29,31,32,34,36] One study used central obesity as measurement and investigated the prognostic performance of waist-to-height ratio on mortality after acute first-ever stroke.…”

Section: Resultsmentioning

confidence: 99%

“…[18–22,24–26,30,35] Olsen et al followed 21’884 patients up to 5 years after stroke (median 1.5 years) and demonstrated first in 2008 that poststroke mortality was inversely associated with BMI. [18] Compared to the cohort with normal body weight (BMI 18.5 to 24.9kg/m 2 ), mortality risk was lowest in overweight patients (HR 0.73, 95% CI 0.66–0.81) followed by the cohort of obese patients (HR 0.84, 95% CI 0.74–0.96), whereas the risk of death was increased in under-weight patients (HR 1.63, 95% CI 1.41–1.90).…”

Section: Resultsmentioning

confidence: 99%

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Obesity paradox in stroke – Myth or reality? A systematic review

et al. 2017

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Background and purposeBoth stroke and obesity show an increasing incidence worldwide. While obesity is an established risk factor for stroke, its influence on outcome in ischemic stroke is less clear. Many studies suggest a better prognosis in obese patients after stroke (“obesity paradox”). This review aims at assessing the clinical outcomes of obese patients after stroke by performing a systematic literature search.MethodsThe reviewers searched MEDLINE from inception to December 2015. Studies were eligible if they included outcome comparisons in stroke patients with allocation to body weight.ResultsTwenty-five studies (299’750 patients) were included and none was randomised. Ten of 12 studies (162’921 patients) reported significantly less mortality rates in stroke patients with higher BMI values. Seven of 9 studies (92’718 patients) ascertained a favorable effect of excess body weight on non-fatal outcomes (good clinical outcome, recurrence of vascular events). Six studies (85’042 patients) indicated contradictory results after intravenous thrombolysis (IVT), however. Several methodological limitations were observed in major part of studies (observational study design, inaccuracy of BMI in reflecting obesity, lacking body weight measurement, selection bias, survival bias).ConclusionMost observational data indicate a survival benefit of obese patients after stroke, but a number of methodological concerns exist. No obesity paradox was observed in patients after IVT. There is a need for well-designed randomized controlled trials assessing the effects of weight reduction on stroke risk in obese patients.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Obesity paradox in stroke – Myth or reality? A systematic review

et al. 2017

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“…17–19 Some studies have suggested that stroke patients who are overweight or obese may have better outcomes. 20–22 However, limited evidence exists on the effect of BMI on stroke outcomes in initially healthy populations. Information on diet and stroke outcomes in initially healthy populations is limited.…”

Section: Discussionmentioning

confidence: 99%

Healthy Lifestyle and Functional Outcomes from Stroke in Women

Rist

Buring

Kase

et al. 2016

The American Journal of Medicine

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Purpose While a healthy lifestyle has been associated with reduced risk of developing ischemic stroke, less is known about its effect on stroke severity. Methods We performed a prospective cohort study among 37,634 women without stroke or missing risk factor data at baseline. The healthy lifestyle index was composed of smoking, physical activity, body mass index, alcohol consumption, and diet (range 0–20, with 20 representing healthiest lifestyle). Possible functional outcomes were no stroke or stroke with modified Rankin Scale (mRS) score of 0–1 (mild), 2–3 (moderate), or 4–6 (severe). Multinomial logistic regression was used to analyze the association between healthy lifestyle and functional outcomes from stroke. Results Over 17.2 years of follow-up, 867 total strokes were confirmed. Compared to the lowest category (0–4), the highest category (17–20) was associated with reductions in risk of total stroke with mild (OR=0.43; 95% CI: 0.20–0.90), moderate (OR=0.53; 95% CI: 0.27–1.06) and severe (OR=0.48; 95% CI: 0.20–1.18) functional outcomes. Even a modest healthy lifestyle index (5–8 points) was associated with significant decreases in total stroke with severe and moderate functional outcomes. Similar results were seen for ischemic but not hemorrhagic strokes. Conclusions Highest versus lowest scores on the healthy lifestyle index were associated with reductions in risk of total and ischemic strokes with mild, moderate, and severe functional outcomes among women. The evidence that even modest healthy lifestyle index scores reduced risks of total and ischemic stroke with moderate and severe functional outcomes suggests modest lifestyle changes may reduce risk of disabling stroke events.

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“…In a group of 22,216 patients with acute cerebrovascular events, overweight was associated with favorable functional recovery; however severe obesity (BMI > 32.5 kg/m 2 ) was associated with higher 3-month mortality (OR 2.01; 95% CI 1.10-3.69) [40].…”

Section: Doubts About the Obesity Paradoxmentioning

confidence: 93%

Obesity Paradox in the Course of Cerebrovascular Diseases

Brzecka¹,

Ejma²

2015

Adv Clin Exp Med

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Obesity remains an important risk factor of cardiovascular and cerebrovascular diseases. However, it has been observed that increased body fat and body mass index predicted longer survival after the occurrence of a cardiovascular event. This observation has been named the obesity paradox. Initially, the term obesity paradox referred to the observation of the better outcome of cardiovascular diseases, such as heart failure and coronary heart disease, in obese patients as compared to underweight and normal-weight patients. Recently, similar, although fewer, observations confirm the occurrence of the obesity paradox in patients with acute cerebrovascular diseases. The underlying reasons for the protective effects of excessive body fat tissue against the consequences of acute cardiovascular and cerebrovascular diseases are poorly understood. The effect of preconditioning may be associated with the obesity paradox. The issue of the correlation between obesity and better survival of patients with cardiovascular and cerebrovascular diseases still remains largely unexplored. Debates for and against the obesity paradox continue (Adv Clin Exp Med 2015, 24, 3, 379-383).

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Favorable Functional Recovery in Overweight Ischemic Stroke Survivors: Findings from the China National Stroke Registry

Cited by 65 publications

References 37 publications

Obesity paradox in stroke – Myth or reality? A systematic review

Obesity paradox in stroke – Myth or reality? A systematic review

Healthy Lifestyle and Functional Outcomes from Stroke in Women

Obesity Paradox in the Course of Cerebrovascular Diseases

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