Obesity Paradox and Stroke

Katsnelson, Michael; Rundek, Tatjana

doi:10.1161/strokeaha.111.632471

Cited by 23 publications

(7 citation statements)

References 14 publications

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“…However, it has been argued that this paradox may, in fact, reflect either the limitations of the methods used to define obesity, or the introduction of bias due to the selection of a cohort with a lesser degree of other risk factors [39]. In our study, we found no evidence of the obesity paradox, with waist circumference not associated with an increased risk of stroke recurrence.…”

Section: Discussioncontrasting

confidence: 70%

Metabolic Syndrome and Stroke Recurrence in Chinese Ischemic Stroke Patients – The ACROSS-China Study

Jia

Zheng

et al. 2012

PLoS ONE

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ObjectiveMetabolic syndrome has emerged as a novel risk factor in cardiovascular disease due to its potential for predicting stroke in population-based studies. We investigated the relationship of metabolic syndrome with stroke recurrence.MethodsThis was a retrospective analysis of Chinese patients enrolled in the prospective Abnormal gluCose Regulation in patients with acute strOke acroSS China (ACROSS-China) study after their first ischemic stroke. Metabolic syndrome was defined using the International Diabetes Federation (IDF) criteria. Vascular risk factors were assessed. Outcome was defined as recurrence of stroke within one year after the index ischemic stroke. Cox proportional hazards regression was performed to identify potential predictors of stroke recurrence.ResultsThe prevalence of metabolic syndrome among 2639 ischemic stroke patients was 51.35%. During the one-year follow-up, 195 strokes (7.4%) recurred. The multivariate hazard ratio (95% CI) of stroke recurrence was 1.94 (1.39–2.73) for metabolic syndrome. After adjustment for components, metabolic syndrome lost its association with stroke recurrence; in this model, high fasting plasma glucose (IDF definition) was a predictor for stroke recurrence.ConclusionMetabolic syndrome may not be predictive for stroke recurrence beyond its component individual factors for Chinese ischemic stroke patients.

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Section: Discussioncontrasting

confidence: 70%

Metabolic Syndrome and Stroke Recurrence in Chinese Ischemic Stroke Patients – The ACROSS-China Study

Jia

Zheng

et al. 2012

PLoS ONE

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“…Second, height and weight were measured once at admission to our study. Third, we did not account for the proportions and distributions of muscle, bone and adipose tissue 26 in obese patients in this study. Thus, further cardiovascular cohort studies that consider these variables are needed to verify the risk factors for cerebrovascular accident.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2015

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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.

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“…A full discussion of these arguments is beyond the scope of this review, and have been previously discussed elsewhere. 54–56 Overall, the clinical studies investigating stroke outcome in obese patients have focused on whether obesity has a positive or negative effect on long-term morbidity and mortality. However, the actual mechanisms through which obesity is proposed to have a beneficial or detrimental effect have undergone little to no investigation in clinical studies.…”

Section: Stroke Outcome In Obese Patients: the Obesity Paradoxmentioning

confidence: 99%

Obesity and stroke: Can we translate from rodents to patients?

Haley

Lawrence

2016

J Cereb Blood Flow Metab

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Obesity is a risk factor for stroke and is consequently one of the most common co-morbidities found in patients. There is therefore an identified need to model co-morbidities preclinically to allow better translation from bench to bedside. In preclinical studies, both diet-induced and genetically obese rodents have worse stroke outcome, characterised by increased ischaemic damage and an altered inflammatory response. However, clinical studies have reported an ‘obesity paradox’ in stroke, characterised by reduced mortality and morbidity in obese patients. We discuss the potential reasons why the preclinical and clinical studies may not agree, and review the mechanisms identified in preclinical studies through which obesity may affects stroke outcome. We suggest inflammation plays a central role in this relationship, as obesity features increases in inflammatory mediators such as C-reactive protein and interleukin-6, and chronic inflammation has been linked to worse stroke risk and outcome.

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Obesity Paradox and Stroke

Cited by 23 publications

References 14 publications

Metabolic Syndrome and Stroke Recurrence in Chinese Ischemic Stroke Patients – The ACROSS-China Study

Metabolic Syndrome and Stroke Recurrence in Chinese Ischemic Stroke Patients – The ACROSS-China Study

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

Obesity and stroke: Can we translate from rodents to patients?

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