Does the obesity paradox predict functional outcome in intracerebral hemorrhage?

Abstract

OBJECTIVE Being overweight or mildly obese has been associated with a decreased risk of death or hospitalization in patients with cardiovascular disease. Similarly, overweight patients admitted to an intensive care unit (ICU) have improved survival up to 1 year after admission. These counterintuitive observations are examples of the "obesity paradox." Does the obesity paradox exist in patients with intracerebral hemorrhage (ICH)? In this study the authors examined whether there was an association between obesity and functional outcome in patients with ICH. METHODS The authors analyzed 202 patients admitted to the neurological ICU (NICU) who were prospectively enrolled in the Columbia University ICH Outcomes Project between September 2009 and December 2012. Patients were categorized into 2 groups: overweight (body mass index [BMI] ≥ 25 kg/m) and not overweight (BMI < 25 kg/m). The primary outcome was defined as survival with favorable outcome (modified Rankin Scale [mRS] score 0-3) versus death or severe disability (mRS score 4-6) at 3 months. RESULTS The mean age of the patients in the study was 61 years. The mean BMI was 28 ± 6 kg/m. The mean Glasgow Coma Scale score was 10 ± 4 and the mean ICH score was 1.9 ± 1.3. The overall 90-day mortality rate was 41%. Among patients with a BMI < 25 kg/m, 24% (17/70) had a good outcome, compared with 39% (52/132) among those with a BMI ≥ 25 kg/m (p = 0.03). After adjusting for ICH score, sex, do-not-resuscitate code status, and history of hypertension, being overweight or obese (BMI ≥ 25 kg/m) was associated with twice the odds of having a good outcome compared with patients with BMI < 25 kg/m (adjusted odds ratio 2.05, 95% confidence interval 1.03-4.06, p = 0.04). CONCLUSIONS In patients with ICH admitted to the NICU, being overweight or obese (BMI ≥ 25 kg/m) was associated with favorable outcome after adjustment for established predictors. The reason for this finding requires further study.

Obesity and Stroke: Does the Paradox Apply for Stroke?

“…8,28,33 Altogether, they have contributed to the weight gain in the population that lead to the fact that obesity is currently considered a pandemic. 8,28,34 Obesity is diagnosed as a BMI >30 kg/m 2 (calculated by the patient's weight in kilograms divided by the squared height in meters). 20,22,29,30,35,36 However, it is important to consider the world regions and countries, as the measurement can change somewhat.…”

“…As we previously mentioned, obesity predisposes an increased risk of suffering cardiovascular and systemic diseases, such as stroke and other diseases. 29,33,34,[47][48][49] It is associated with premature mortality; and, in multiple studies, a higher risk of cardiovascular disease incidence has been demonstrated in underweight adults or just overweight (but not obese) patients. As a result, there is no clear evidence of a higher prevalence or incidence of stroke in those with an obesity diagnosis.…”

Obesity paradox in subarachnoid hemorrhage: a systematic review

“…According to this theory, overweight and obese people may have a survival benefit in various acute illnesses and medical conditions. In stroke subtypes other than SAH, such as intracerebral hemorrhage (ICH) [7,21] and ischemic stroke [20,22,35,45,47], being overweight or obese is associated with a favorable outcome. However, the true impact of BMI on the survival of any ICU patient group has remained unclear, and several studies have reported controversial results about the effects of obesity on the outcome of critically ill patients [1,16,31].…”

Factors Associated with Inpatient Mortality after Intracerebral Hemorrhage: Updated Information from the United States Nationwide Inpatient Sample

“…[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] Observation of obesity paradox in intracerebral hemorrhage is reported in fewer studies. Of interest for our study, Dangayach et al 37 reported an overweight or obese status (BMI 25 kg/m2) was associated with twice the odds of having a good outcome compared with patients with BMI less than 25 kg/m2. In the study by Kim et al 38 obesity was associated with a lower risk of longterm death but not with 30-day mortality after ICH.…”