The Impact of Body Weight on Mortality After Stroke

Doehner, Wolfram; Audebert, Heinrich J.

doi:10.1001/jamaneurol.2014.3631

Cited by 3 publications

(2 citation statements)

References 9 publications

(5 reference statements)

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“…A full discussion of these arguments is beyond the scope of this review, and have been previously discussed elsewhere. 54–56 Overall, the clinical studies investigating stroke outcome in obese patients have focused on whether obesity has a positive or negative effect on long-term morbidity and mortality. However, the actual mechanisms through which obesity is proposed to have a beneficial or detrimental effect have undergone little to no investigation in clinical studies.…”

Section: Stroke Outcome In Obese Patients: the Obesity Paradoxmentioning

confidence: 99%

Obesity and stroke: Can we translate from rodents to patients?

Haley

Lawrence

2016

J Cereb Blood Flow Metab

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Obesity is a risk factor for stroke and is consequently one of the most common co-morbidities found in patients. There is therefore an identified need to model co-morbidities preclinically to allow better translation from bench to bedside. In preclinical studies, both diet-induced and genetically obese rodents have worse stroke outcome, characterised by increased ischaemic damage and an altered inflammatory response. However, clinical studies have reported an ‘obesity paradox’ in stroke, characterised by reduced mortality and morbidity in obese patients. We discuss the potential reasons why the preclinical and clinical studies may not agree, and review the mechanisms identified in preclinical studies through which obesity may affects stroke outcome. We suggest inflammation plays a central role in this relationship, as obesity features increases in inflammatory mediators such as C-reactive protein and interleukin-6, and chronic inflammation has been linked to worse stroke risk and outcome.

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Section: Stroke Outcome In Obese Patients: the Obesity Paradoxmentioning

confidence: 99%

Obesity and stroke: Can we translate from rodents to patients?

Haley

Lawrence

2016

J Cereb Blood Flow Metab

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“…On the other hand, 85% of people with T2D are obese/overweight, and epidemiological studies have described a phenomenon called the "obesity paradox," indicating that these people have improved clinical outcome after stroke (8). The validity of the obesity paradox is under debate (8)(9)(10) and especially questionable in people with T2D in whom worsened stroke outcome has been demonstrated. Thus, more studies aimed at understanding the interplay between obesity and T2D on poststroke recovery are needed.…”

mentioning

confidence: 99%

Regulation of Glycemia in the Recovery Phase After Stroke Counteracts the Detrimental Effect of Obesity-Induced Type 2 Diabetes on Neurological Recovery

et al. 2020

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The interplay between obesity and type 2 diabetes (T2D) in poststroke recovery is unclear. Moreover, the impact of glucose control during the chronic phase after stroke is undetermined. We investigated whether obesity-induced T2D impairs neurological recovery after stroke by using a clinically relevant experimental design. We also investigated the potential efficacy of two clinically used T2D drugs: the dipeptidyl peptidase 4 inhibitor linagliptin and the sulfonylurea glimepiride. We induced transient middle cerebral artery occlusion (tMCAO) in T2D/obese mice (after 7 months of high-fat diet [HFD]) and age-matched controls. After stroke, we replaced HFD with standard diet for 8 weeks to mimic the poststroke clinical situation. Linagliptin or glimepiride were administered daily from 3 days after tMCAO for 8 weeks. We assessed neurological recovery weekly by upper-limb grip strength. Brain damage, neuroinflammation, stroke-induced neurogenesis, and atrophy of parvalbumin-positive (PV+) interneurons were quantified by immunohistochemistry. T2D/obesity impaired poststroke neurological recovery in association with hyperglycemia, neuroinflammation, and atrophy of PV+ interneurons. Both drugs counteracted these effects. In nondiabetic mice, only linagliptin accelerated recovery. These findings shed light on the interplay between obesity and T2D in stroke recovery. Moreover, they promote the use of rehabilitative strategies that are based on efficacious glycemia regulation, even if initiated days after stroke.

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The impact of body composition on functional recovery, mortality, and survival: a systematic review of research conducted in a cohort of stroke survivors

Ewah,

Badaru,

Abba

et al. 2024

Egypt J Neurol Psychiatry Neurosurg

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Background The phrase obesity paradox after stroke appears to be a recent phenomenon and was first coined in the early 2000s; thereafter, there has been a growing controversy about the phenomenon, with many studies in favor and a few others against it. Notably, obesity a major risk factor for stroke is now regarded as global pandemic. The purpose of this study was to carry out a systematic review on the impact of body weight on functional recovery, mortality, and survival among stroke survivors. Methods We searched PubMed and Google scholar from January 2011 to 2022. Studies were recruited if they reported the impact of body weight on functional recovery, mortality, and survival among stroke survivors. Results A total of 284,699 subjects (30-studies) were included, and 2 were RCTs and a nested case–control study. Seventeen (n = 197,833, two on intravenous thrombolysis-IVT), and two studies (n = 2565) on body weight and outcome among stroke patients receiving insulin were in support of the obesity paradox. Nine studies (n = 79,451, four on IVT) were against the obesity paradox. For body weight and outcome of ischemic stroke patients treated with IVT, a total of six studies (n = 2940) four against and two in support of the obesity paradox. In addition, two studies (n = 4124) reported on WHR, WC, and BMI on mortality and outcome. Conclusions Overall, the odds were in favor of the obesity paradox among stroke patients with their first-time stroke with no report on second-time stroke. The underweight patients showed the worst unfavorable outcome and mortality. Insulin resistance is a major factor underpinning the presence of a paradox among stroke patients with diabetes receiving treatment with insulin therapy. We recommend that the nutritional status of stroke patients be taken into consideration during management. More studies especially on RCT should be conducted to determine the impact of body weight other that BMI on mortality and functional recovery among stroke survivor of African descent.

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The Impact of Body Weight on Mortality After Stroke

Cited by 3 publications

References 9 publications

Obesity and stroke: Can we translate from rodents to patients?

Obesity and stroke: Can we translate from rodents to patients?

Regulation of Glycemia in the Recovery Phase After Stroke Counteracts the Detrimental Effect of Obesity-Induced Type 2 Diabetes on Neurological Recovery

The impact of body composition on functional recovery, mortality, and survival: a systematic review of research conducted in a cohort of stroke survivors

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