The Obesity Paradox in Spontaneous Intracerebral Hemorrhage: Results from a Retrospective Analysis of the Nationwide Inpatient Sample

Hoffman, Haydn; Jalal, Muhammad S.; Furst, Taylor; Chin, Lawrence S.

doi:10.1007/s12028-019-00796-3

Cited by 16 publications

(18 citation statements)

References 39 publications

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“…Some studies 30 31 showed obesity is a significant risk factor for the development of venous thromboembolism. Indeed, inconsistent with the previous study, 23 obese patients in our study had higher odds of DVT. The pathophysiological mechanism has not been fully explained.…”

Section: Discussioncontrasting

confidence: 99%

“…Kim et al 12 and Sun et al 24 showed that obesity was associated with a lower risk of long-term death. Hoffman et al 23 and Persaud et al 25 also found that obesity is associated with decreased in-hospital mortality. But other studies [12][13][14] found no evidence of obesity paradox in 30-day mortality after ICH.…”

Section: Discussionmentioning

confidence: 95%

“…Compared with Western patients with ICH, the mortality rate during hospitalisation in our cohort was much lower. 23 This indicated an ethnic difference in the prognosis after ICH.…”

Section: Discussionmentioning

confidence: 99%

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Body mass index and clinical outcomes in patients with intracerebral haemorrhage: results from the China Stroke Center Alliance

Cao

Liu

et al. 2021

Stroke Vasc Neurol

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Background and aimObesity paradox has aroused increasing concern in recent years. However, impact of obesity on outcomes in intracerebral haemorrhage (ICH) remains unclear. This study aimed to evaluate association of body mass index (BMI) with in-hospital mortality, complications and discharge disposition in ICH.MethodsData were from 85 705 ICH enrolled in the China Stroke Center Alliance study. Patients were divided into four groups: underweight, normal weight, overweight and obese according to Asian-Pacific criteria. The primary outcome was in-hospital mortality. The secondary outcomes included non-routine discharge disposition and in-hospital complications. Discharge to graded II or III hospital, community hospital or rehabilitation facilities was considered non-routine disposition. Multivariable logistic regression analysed association of BMI with outcomes.Results82 789 patients with ICH were included in the final analysis. Underweight (OR=2.057, 95% CI 1.193 to 3.550) patients had higher odds of in-hospital mortality than those with normal weight after adjusting for covariates, but no significant difference was observed for patients who were overweight or obese. No significant association was found between BMI and non-disposition. Underweight was associated with increased odds of several complications, including pneumonia (OR 1.343, 95% CI 1.138 to 1.584), poor swallow function (OR 1.351, 95% CI 1.122 to 1.628) and urinary tract infection (OR 1.532, 95% CI 1.064 to 2.204). Moreover, obese patients had higher odds of haematoma expansion (OR 1.326, 95% CI 1.168 to 1.504), deep vein thrombosis (OR 1.506, 95% CI 1.165 to 1.947) and gastrointestinal bleeding (OR 1.257, 95% CI 1.027 to 1.539).ConclusionsIn patients with ICH, being underweight was associated with increased in-hospital mortality. Being underweight and obese can both increased risk of in-hospital complications compared with having normal weight.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 95%

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Body mass index and clinical outcomes in patients with intracerebral haemorrhage: results from the China Stroke Center Alliance

Cao

Liu

et al. 2021

Stroke Vasc Neurol

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“…9,58 Table 1 presents additional studies regarding the beneficial or favorable relationship of the obesity paradox with stroke. [59][60][61][62][63][64][65] However, some studies indicate that for obesity class III (40 to 49.9 kg/m 2 ) the paradox is no longer applicable due to the U or J shaped effect. 30 Further, there is a clear association between BMI-related mortality and this effect.…”

Section: Current Evidence For the Obesity Paradox And Stroke Relationmentioning

confidence: 99%

Obesity and Stroke: Does the Paradox Apply for Stroke?

et al. 2021

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Historically, obesity has been identified as one of the most important risk factors for developing cardiovascular diseases including stroke; however, a theory called “The Obesity Paradox” has been recently considered. The paradoxical theory is that obese or overweight patients (according to body mass index score) can have better outcomes compared to leaner or malnourished patients. The paradox was initially discovered in patients with heart failure. The purpose of this manuscript was to investigate whether this paradox also applies to stroke patients, according to information available in the current literature.

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“…The obesity paradox has been described not only in the general population [1] but also in multiple cohorts of people with highly prevalent medical conditions including diabetes [22], heart disease [10,[25][26][27], kidney disease [28,29], cancer [30,31], stoke [32,33], and rheumatoid arthritis [34], among others. The potential explanations are described sometimes in relation to the nature of the clinical condition, and sometimes attributed to methodological biases.…”

Section: Introductionmentioning

confidence: 99%

Association of BMI, comorbidities and all-cause mortality by using a baseline mortality risk model

Simon

Castro

et al. 2021

PLoS ONE

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Objective The association of body mass index (BMI) and all-cause mortality is controversial, frequently referred to as a paradox. Whether the cause is metabolic factors or statistical biases is still controversial. We assessed the association of BMI and all-cause mortality considering a wide range of comorbidities and baseline mortality risk. Methods Retrospective cohort study of Olmsted County residents with at least one BMI measurement between 2000–2005, clinical data in the electronic health record and minimum 8 year follow-up or death within this time. The cohort was categorized based on baseline mortality risk: Low, Medium, Medium-high, High and Very-high. All-cause mortality was assessed for BMI intervals of 5 and 0.5 Kg/m2. Results Of 39,739 subjects (average age 52.6, range 18–89; 38.1% male) 11.86% died during 8-year follow-up. The 8-year all-cause mortality risk had a “U” shape with a flat nadir in all the risk groups. Extreme BMI showed higher risk (BMI <15 = 36.4%, 15 to <20 = 15.4% and ≥45 = 13.7%), while intermediate BMI categories showed a plateau between 10.6 and 12.5%. The increased risk attributed to baseline risk and comorbidities was more obvious than the risk based on BMI increase within the same risk groups. Conclusions There is a complex association between BMI and all-cause mortality when evaluated including comorbidities and baseline mortality risk. In general, comorbidities are better predictors of mortality risk except at extreme BMIs. In patients with no or few comorbidities, BMI seems to better define mortality risk. Aggressive management of comorbidities may provide better survival outcome for patients with body mass between normal and moderate obesity.

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The Obesity Paradox in Spontaneous Intracerebral Hemorrhage: Results from a Retrospective Analysis of the Nationwide Inpatient Sample

Cited by 16 publications

References 39 publications

Body mass index and clinical outcomes in patients with intracerebral haemorrhage: results from the China Stroke Center Alliance

Body mass index and clinical outcomes in patients with intracerebral haemorrhage: results from the China Stroke Center Alliance

Obesity and Stroke: Does the Paradox Apply for Stroke?

Association of BMI, comorbidities and all-cause mortality by using a baseline mortality risk model

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