Prognosis of patients with coexisting obesity and malnutrition after ischemic stroke: A cohort study

Niu, Huicong; Chu, Min; Yang, Ning; Wang, Daosheng; Liu, Yang; Mao, Xueyu; Xia, Shiliang; Wang, Delong; Wu, Xuechun; Zhao, Jing

doi:10.1016/j.clnu.2024.04.005

Cited by 3 publications

(1 citation statement)

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“…More importantly, the nutrition hypothesis has become a research hotspot in recent years, which holds that the serum cholesterol and TG levels of patients with good nutritional reserve are higher than those of patients with modest nutritional status. 34 . In this work, our results clearly validated that the lipid paradox, utilizing RC as the measurement, was presented only in patients with malnutrition (Fig.…”

Section: Discussionmentioning

confidence: 99%

Elevated remnant cholesterol improves prognosis of patients with ischemic stroke and malnutrition: a cohort-based study

Niu,

Wang,

Yang

et al. 2024

Preprint

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BackgroundAggressive lipid-lowering therapy is recommended for patients with ischemic stroke; however, lipid paradox has been reported in several clinical studies. The mechanism of lipid paradox remains uncertain, and nutrition maybe one explanation. In this prospective cohort study, we explored the associations between baseline remnant cholesterol (RC) concentrations and clinical outcomes in patients with ischemic stroke, stratified by nutritional status.Materials and MethodsA total of 5257 patients with ischemic stroke were recruited for analysis. The Controlling Nutritional Status (CONUT) score was utilized to investigate the risk of malnutrition. Individuals were classified into 4 groups based on their CONUT score. Poor outcomes and all-cause mortality were compared among patients with varied nutritional status and RC levels.ResultsPatients with moderate-severe malnutrition had the highest incidences of in-hospital complications, including pulmonary infection, renal dysfunction, and hemorrhagic transformation, and the highest rates of poor outcomes (61.3%,P<0.001) and all-cause mortality (32.8%,P< 0.001) during the 3-month follow-up period. Baseline higher RC level was an independent protective factor of adverse clinical outcomes for patients with any degree of malnutrition, which was not observed in patients without malnutrition. In addition, compared with the moderate-severe malnourished with RC <0.471 mmol/L, the adjusted ORs for poor outcomes and all-cause mortality were 0.805 (0.450–1.438) and 0.898 (0.502-1.607) for participants with 0.471-0.632 mmol/L, 0.259 (0.095-0.704) and 0.222 (0.061-0.810) for 0.633-0.868 mmol/L, and 0.160 (0.037–0.689) and 0.202 (0.042-0.967) for ≥ 0.869 mmol/L, prospectively.ConclusionLipid paradox was only observed in the malnourished patients with ischemic stroke. Strict lipid reduction therapy is still recommended for patients with ischemic stroke and good nutritional status. However, when treating patients at any risk of malnutrition, the improvement of nutritional status may be more crucial than aggressive lipid control.

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Section: Discussionmentioning

confidence: 99%