Obesity Paradox in Intracerebral Hemorrhage

Abstract

Background and Purpose— Although obesity is an established risk factor for cardiovascular disease and stroke, studies have shown evidence of an obesity paradox—a protective effect of obesity in patients who already have these disease states. Data on the obesity paradox in intracerebral hemorrhage is limited. Methods— Clinical data for adult intracerebral hemorrhage patients were extracted from the National Inpatient Sample between 2007 and 2014. Multivariable logistic regression analyzed the association of body habitus with in-hospital mortality, discharge disposition, length of stay, tracheostomy or gastrostomy placement, and ventriculoperitoneal shunt placement. Results— There were 99 212 patients who were eligible. Patients with both obesity (OR=0.69; 95% CI=0.62–0.76; P <0.001) and morbid obesity (OR=0.85; 95% CI=0.74–0.97; P =0.02) were associated with decreased odds of in-hospital mortality. Morbid obesity was significantly associated with increased odds of a tracheostomy or gastrostomy placement (OR=1.42; 1.20–1.69; P <0.001) and decreased odds of a routine discharge disposition (OR=0.84; 0.74–0.97; P =0.014). Conclusions— Obesity and morbid obesity appear to protect against mortality in intracerebral hemorrhage.

Body mass index and clinical outcomes in patients with intracerebral haemorrhage: results from the China Stroke Center Alliance

“…Kim et al 12 and Sun et al 24 showed that obesity was associated with a lower risk of long-term death. Hoffman et al 23 and Persaud et al 25 also found that obesity is associated with decreased in-hospital mortality. But other studies [12][13][14] found no evidence of obesity paradox in 30-day mortality after ICH.…”

Obesity and Stroke: Does the Paradox Apply for Stroke?

“…9,58 Table 1 presents additional studies regarding the beneficial or favorable relationship of the obesity paradox with stroke. [59][60][61][62][63][64][65] However, some studies indicate that for obesity class III (40 to 49.9 kg/m 2 ) the paradox is no longer applicable due to the U or J shaped effect. 30 Further, there is a clear association between BMI-related mortality and this effect.…”

“…Very few studies regarding obese patients and the paradox relation with stroke reach an adequate level of evidence. For example, Persaud et al 65 in 2019 showed that obese patients with intracranial hemorrhage had a better survival rate during the in-hospital stay, and they credited this result to statins intake and its pleiotropic effect with respective anti-inflammatory and anti-thrombotic properties that might reduce the infarcted area and increase survival rates. Regarding the relation of BMI to outcomes after a surgical procedure, the results might be a little controversial, and this may be because of the difference in the treatment and its frequency.…”

Association Between Body Mass Index and Intracranial Aneurysm Rupture: A Multicenter Retrospective Study

“…Traditionally, obesity has been regarded as a well-established risk factor for cardiovascular diseases and stroke. Nevertheless, a growing body of evidence has suggested that an "obesity paradox"-namely that there is an inverse association between obesity and clinical outcomes-exists for patients with hypertension (Kleinloog et al, 2018) coronary artery diseases (Uretsky et al, 2007;Wang et al, 2015), atrial fibrillation (Sandhu et al, 2016), intracerebral hemorrhage (Persaud et al, 2019), and ischemic stroke (Rodríguez-Castro et al, 2019;Liu et al, 2021). Likewise, this paradoxical phenomenon was also observed in patients with SAH (Rinaldo et al, 2019;Rautalin et al, 2020), suggesting a potential protective effect of increased BMI on the risk of adverse events after presenting intracranial aneurysms.…”