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Clinical Research

Obesity paradox and stroke outcomes according to stroke subtype: a propensity score-matched analysis

International Journal of Obesity volume 47, pages 669–676 (2023)Cite this article

Subjects

Abstract

Objective

Obesity has traditionally been considered a risk factor for ischemic stroke. However, some clinical observations have reported a complex relationship between patients who are overweight or obese with paradoxically better stroke outcomes. Stroke subtypes have differing distributions of risk factors, so this study aimed to explain the relationship between body mass index (BMI) and functional prognosis according to stroke subtype.

Methods

A prospective institutional database on stroke was accessed between March 2014 and December 2021, and consecutive patients with ischemic stroke were retrospectively selected. BMI was categorized into five groups (underweight, normal weight, overweight, obese, and morbid obesity). The outcome of interest in this study was the modified Rankin Scale (mRS) at 90 d, which was divided into favorable (mRS = 0–2) and unfavorable (mRS ≥ 3) groups. The relationship between functional outcome and BMI was analyzed according to stroke subtype.

Results

Among 2779 patients with stroke, 913 (32.9%) had unfavorable outcomes. After a propensity score-matched analysis, obesity was inversely associated with unfavorable outcomes (adjusted odds ratio [aOR] = 0.61, 95% confidence interval [95% CI]: 0.46–0.80) in all patients with stroke. Among the stroke subtypes, overweight (aOR = 0.38, 95% CI: 0.20–0.74) and obese (aOR = 0.40, 95% CI: 0.21–0.76) groups were inversely associated with unfavorable outcomes in the cardioembolism subtype. Obesity (aOR = 0.55, 95% CI: 0.32–0.95) was inversely associated with unfavorable outcomes in the small vessel disease subtype. There was no significant relationship between stroke outcome and BMI classification in the large artery disease subtype.

Conclusions

These findings suggest that the obesity paradox in ischemic stroke outcomes might differ according to the stroke subtype.

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Fig. 1: Flowchart of patient inclusion and exclusion criteria.
Fig. 2: The association of BMI with unfavorable outcomes (3-month mRS) for all stroke subtypes.
Fig. 3: Logistic regression models for odds of unfavorable outcomes (3-month mRS) in patients with various stroke subtypes according to BMI.

Data availability

All data generated or analyzed during this study are included in this article and its supplementary material files. Further inquiries can be directed to the corresponding author.

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Funding

This study was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (R2015433).

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Authors and Affiliations

  1. Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea

    Sang-Hun Lee, Jin-Man Jung & Moon-Ho Park

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  1. Sang-Hun Lee
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Contributions

S-HL designed the study, collected the data, and wrote the manuscript. J-MJ revised the manuscript. M-HP designed the study, collected the data, and revised the manuscript.

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Correspondence to Moon-Ho Park.

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Lee, SH., Jung, JM. & Park, MH. Obesity paradox and stroke outcomes according to stroke subtype: a propensity score-matched analysis. Int J Obes 47, 669–676 (2023). https://doi.org/10.1038/s41366-023-01318-0

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