Effect of obesity on functional outcomes at 6 months post-stroke among elderly Koreans: a prospective multicentre study

Abstract

ObjectivesWe examined whether obesity based on body mass index (BMI) was a predictor of functional independence measure (FIM) at 6 months after ischaemic stroke onset while adjusting for stroke risk factors and covariates and stratifying by age group.DesignThis is an interim report of the Korean Stroke Cohort for Functioning and Rehabilitation that was designed as a nested case study within a nationwide hospital-based cohort.SettingWe identified all patients who were admitted to nine representative hospitals in Korea from 2012 until 2014 under a diagnosis of acute first-ever ischaemic stroke. The hospitals were selected from the metropolitan district, mid-sized cities and a small-sized city.ParticipantsThe sample included 2057 patients with acute ischaemic stroke who were at least 18 years old.Primary and secondary outcome measuresWe divided participants into two age levels (<65 and ≥65 years). Participants were classified into five groups according to their baseline BMI at admission: underweight (BMI<18.5), normal (18.5≤BMI<23), overweight (23≤BMI<25), obese (25≤BMI<30) and extremely obese (30≤BMI).ResultsThe proportion of patients who were aged ≥65 years was 55.0%. The proportions of underweight, normal, overweight, obese and extremely obese patients were 2.6%, 24.3%, 29.6%, 37.2% and 6.3%, respectively, in the <65 years group and 5.5%, 34.5%, 27.9%, 28.8% and 3.3%, respectively, in the ≥65 years group. In a multiple linear regression, the 6-month FIM after stroke in the elderly group was significantly associated with being extremely obese (7.95, p<0.05) after adjusting for confounding variables. In the <65 years group, the 6-month FIM was not associated with any weight category.ConclusionsThis nationwide hospital-based cohort study showed that extreme obesity is a predictor of a good 6-month FIM, especially in patients with ischaemic stroke who are at least 65 years of age.

Determining the joint effect of obesity and diabetes on functional disability at 3-months and on all-cause mortality at 1-year following an ischemic stroke

“…Some of the results from this study are consistent with several other studies that included only ischemic stroke subjects whereas the majority of the studies that support the obesity paradox included different patient populations (i.e. , only hemorrhagic [ 20 ], only ischemic [ 8 , 9 , 11 – 14 , 16 , 50 , 51 ], stroke or TIA [ 7 , 17 ], or both ischemic and hemorrhagic strokes [ 10 , 15 , 18 , 19 ]). It is important to point out these differences in the study population because the pathogenesis of ischemic stroke is markedly different from that of hemorrhagic stroke, thus the effect of obesity on post-stroke outcomes may not be the same [ 52 ].…”

“…Although obesity is a modifiable risk factor for ischemic stroke [ 27 , 28 ], the reported effects of obesity on post-stroke outcomes of functional disability and of all-cause mortality have been conflicting. Whereas studies of the general population have found that increasing body mass concurrently increases the risk of functional disability [ 29 ] and of all-cause mortality [ 30 , 31 ], a number of observational studies in a stroke population have reported that obesity is associated with a decreased risk of functional disability [ 7 – 9 ] and all-cause mortality [ 7 , 13 – 18 , 20 ]; this apparent discrepancy is referred to as the obesity paradox. As a result of these findings, the American Heart Association and American Stroke Association recommend all individuals who are diagnosed with an ischemic stroke be screened for obesity [ 5 ].…”

Changes in Language Function and Recovery-Related Prognostic Factors in First-Ever Left Hemispheric Ischemic Stroke

“…Our results showed that obesity was a positive factor for language deficit improvement in univariate analysis. The obesity paradox in functional recovery of ischemic stroke patients has been mentioned in many studies, and most observational data indicate a survival benefit and better functional outcome in obese patients after stroke [22][23][24][25]. However, obesity was not a statistically significant factor in multivariate analysis for aphasia recovery in the current study.…”

Role of Intensive Inpatient Rehabilitation for Prevention of Disability after Stroke: The Korean Stroke Cohort for Functioning and Rehabilitation (KOSCO) Study

“…Comorbidity was assessed using the combined condition-and age-related score in the Charlson comorbidity index [13]. Educational level was asked and patients chose an answer from following options; elementary school graduate or less, middle school graduate, high school graduate, and Bachelor's degree or higher [14]. Pre-stroke functional level was assessed using modified Rankin scale [15].…”