Weight reduction for primary prevention of stroke in adults with overweight or obesity

Curioni, Cíntia Chaves; André, Charles; Veras, Renato Peixoto

doi:10.1002/14651858.cd006062.pub2

Cited by 41 publications

(27 citation statements)

References 47 publications

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“…In fact, a systematic review of reported or ongoing trials revealed that no prospective data are available on the effect of weight loss or weight reduction on stroke in adults. 6 Moreover, a growing body of clinical data suggests a survival benefit for overweight patients after stroke (Table).…”

Section: Body Weight and Stroke: Before And After The Eventmentioning

confidence: 99%

Body Weight After Stroke

Scherbakov

Dirnagl

Doehner

2011

Stroke

126

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Background and Purpose-Outcome after acute stroke is determined to a large extent by poststroke complications. Nutritional status and metabolic balance may substantially contribute to outcome after stroke. Key mechanisms of stroke pathophysiology can induce systemic catabolic imbalance with impaired metabolic efficiency and degradation of body tissues. Summary-Tissue wasting, sarcopenia, and cachexia may impair and delay poststroke rehabilitation and worsen the prognosis. Although current guidelines for secondary prevention after stroke recommend weight reduction, increasing evidence suggests that patients who are overweight and mildly obese may actually have a better outcome. An "obesity paradox" has been identified to describe the contrasting impact of being overweight in patients with chronic illness compared with healthy populations. We present an overview on the metabolic regulation in patients with stroke and evaluate current data on the impact of body weight and weight change after stroke. The emerging picture suggests that being overweight and obese may impact patients with stroke differently than it does healthy subjects. Conclusions-We propose that current knowledge on obesity and its management in primary prevention cannot be transferred to patients with established stroke. Systematic studies on changes in body composition after stroke and on treatment options are warranted to establish the pathophysiology and evidence-driven management of nutritional status in these patients. (Stroke. 2011;42:3646-3650.)

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Section: Body Weight and Stroke: Before And After The Eventmentioning

confidence: 99%

Body Weight After Stroke

Scherbakov

Dirnagl

Doehner

2011

Stroke

126

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“…28 However, a recent Cochrane review concluded that this hypothesis is not based on strong scientific evidence resulting from randomized, controlled clinical trials, at least not for primary prevention. 29 Our results indicate a need to follow up weight after stroke to detect unintentional weight loss Ͼ3 kg related to possible malnutrition. Otherwise, the large proportion of patients with eating difficulties related to weight loss Ͼ3 kg and other factors related to nutritional status might not be detected.…”

Section: Discussionmentioning

confidence: 72%

Weight Loss After Stroke

Jönsson

Lindgren

Norrving

et al. 2008

Stroke

133

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Background and Purpose-Data on the prevalence and indicators of weight loss in population-based groups of stroke survivors are scarce. We aimed to find the predictors and indicators of weight loss Ͼ3 kg as a possible marker of malnutrition after stroke. Methods-We registered weight at baseline, after 4 months, and 1 year later in 305 survivors from a population-based cohort of first-ever stroke patients. Characteristics of the patients were registered at baseline and follow-ups, including glycosylated hemoglobin at baseline and follow-up II, eating difficulties at both follow-ups, and screening for depression at follow-up II. We used univariate and multivariate analyses to find baseline predictors and follow-up indicators related to weight loss Ͼ3 kg from baseline. Results-Among the 305 patients, 60% were male, the mean age was 72.5 years, and mean body mass index was 25.8 kg/m 2 . The main stroke types were cerebral infarction (89%), intracerebral hemorrhage (7%), and subarachnoid hemorrhage (4%). Weight loss Ͼ3 kg was found in 74 (24%) patients (mean, Ϫ6.6 kg) after 4 months and in 79 patients (26%; mean, Ϫ8.3 kg) 1 year later. Severe stroke and elevated glycosylated hemoglobin levels were baseline predictors of weight loss Ͼ3 kg. Indicators associated with short-term weight loss (at follow-up I) were eating difficulties, low prealbumin value, and dependence (Barthel Index), whereas indicators associated with long-term weight loss (follow-up II) were eating difficulties, hemorrhagic stroke, and low prealbumin value. Conclusions-Weight loss Ͼ3 kg after stroke indicates the need for closer observation regarding nutritional status.Monitoring of body weight may be useful, particularly among patients with severe stroke, eating difficulties, low prealbumin values, and impaired glucose metabolism.

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“…By contrast, data to support the widely adopted recommendation to reduce body weight after stroke are lacking. 5 In view of this emerging evidence, it seems well justified to challenge recent weight reduction recommendations because an "obesity paradox" seems apparent in stroke similar to previous reports in other illnesses. The question why we are calling this finding a paradox reveals more about our expectation than about the available evidence.…”

Section: To the Editormentioning

confidence: 87%