Body mass index, initial neurological severity and long-term mortality in ischemic stroke

Wi Sun Ryu, Seung Hoon Lee, Chi Kyung Kim, Beom Joon Kim, Byung Woo Yoon

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Background: Obesity is believed to increase the risks of ischemic stroke or coronary heart disease; however, regarding outcome after established vascular diseases, recent unexpected evidence has suggested that an increased body mass index (BMI) might have beneficial effects (obesity paradox). The aim of this study was to evaluate the independent association between BMI and long-term mortality after ischemic stroke. Methods: A total of 1,592 consecutive patients with ischemic stroke were prospectively included through our stroke cohort. In this study, the levels of BMI were classified based on guidelines for the Asian-Pacific population. Initial neurological severity was estimated by the National Institutes of Health Stroke Scale (NIHSS) score. Information on mortality was collected until the end of 2009, and the median follow-up period was 4 years. To examine the association between BMI and long-term mortality, we used Cox's proportional regression analysis. Results: During follow-up, 23% of patients died. Linear regression analysis showed that the level of BMI was inversely related to initial neurological severity (p = 0.002). In the model of adjustment of age and gender using Cox's proportional regression analysis, this inverse trend was also significant (reference, normal weight; hazard ratio of underweight, 2.45; overweight, 0.77; obesity, 0.60). However, after adjustment of all covariates, including initial neurological severity, only the harmful effect of underweight remained significant (2.79; 95% CI, 1.92-4.05); however, beneficial effects of overweight and obesity did not. Conclusion: Our study showed that an independent association between BMI and long-term mortality after ischemic stroke was found only in underweight patients. The obesity paradox phenomenon seems to be limited, and might not be interpreted as a direct causal relationship due to a strong association with initial neurological severity.

Original languageEnglish
Pages (from-to)170-176
Number of pages7
JournalCerebrovascular Diseases
Volume32
Issue number2
DOIs
Publication statusPublished - 2011 Aug 1
Externally publishedYes

Fingerprint

Body Mass Index
Stroke
Obesity
Mortality
Thinness
Regression Analysis
National Institutes of Health (U.S.)
Vascular Diseases
Myocardial Ischemia
Coronary Disease
Linear Models
Guidelines
Weights and Measures
Population

Keywords

  • Body mass index
  • Ischemic stroke
  • Mortality
  • Obesity
  • Outcome

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

Body mass index, initial neurological severity and long-term mortality in ischemic stroke. / Ryu, Wi Sun; Lee, Seung Hoon; Kim, Chi Kyung; Kim, Beom Joon; Yoon, Byung Woo.

In: Cerebrovascular Diseases, Vol. 32, No. 2, 01.08.2011, p. 170-176.

Research output: Contribution to journalArticle

Ryu, Wi Sun ; Lee, Seung Hoon ; Kim, Chi Kyung ; Kim, Beom Joon ; Yoon, Byung Woo. / Body mass index, initial neurological severity and long-term mortality in ischemic stroke. In: Cerebrovascular Diseases. 2011 ; Vol. 32, No. 2. pp. 170-176.
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