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BMC Neurology
Published in: BMC Neurology 1/2023

Open Access 01-12-2023 | Obesity | Research

Association of body mass index and waist-to-height ratio with outcomes in ischemic stroke: results from the Third China National Stroke Registry

Authors: Xiaolin Li, Qin Xu, Anxin Wang, Pei Zheng, Huimin Zhu, Ai Guo, Xia Meng, Yong Jiang

Published in: BMC Neurology | Issue 1/2023

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Abstract

Background and purpose

Conflicting reports of obesity paradox have led to confusion about weight management strategies for post-stroke patients. The main purpose of this study is to determine whether the obesity paradox measured by body mass index (BMI) or by waist-to-height ratio (WHtR) is real.

Methods

We evaluated the association of general obesity measured by BMI, and abdominal obesity measured by WHtR with 1-year all-cause mortality, recurrence of stroke and combined vascular events of acute ischemic stroke (AIS) patients in a cohort —— the Third China National Stroke Registry (CNSR-III). Cox proportional hazards models and restricted cubic splines were performed to investigate the association between obesity and clinical outcomes.

Results

A total of 14,146 patients with ischemic stroke were included. When BMI was used as a measure of obesity, compared to the normal weight patients, mortality decreased in overweight patients (hazard ratio [HR] 0.74 [95% confidence interval (CI) 0.61–0.91], P = 0.0035) and obese patients (HR 0.54 [0.40–0.73], P < 0.0001); and increased in underweight patients (HR 2.55 [1.75–3.73], P < 0.0001). After adjustment for confounding factors, the protective effect of obesity and overweight disappeared. BMI had no association with recurrence of stroke or combined vascular events. When WHtR was used as a measure of obesity, obese patients had lower 1-year all-cause mortality (HR 0.64 [0.43–0.97], P = 0.0357). After adjustment for confounding factors, this difference disappeared; overweight patients still had lower all-cause mortality (adjusted hazard ratio [aHR] 0.42 [0.26–0.67], P = 0.0003), recurrence of stroke (aHR 0.77 [0.60–0.99], P = 0.0440) and combined vascular events (aHR 0.75 [0.58–0.95], P = 0.0198).

Conclusions

Among Chinese patients with AIS, our study does not support the BMI paradox; overweight patients measured by WHtR had a more favorable prognosis. TOAST subtypes did not modify the association.
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Metadata
Title
Association of body mass index and waist-to-height ratio with outcomes in ischemic stroke: results from the Third China National Stroke Registry
Authors
Xiaolin Li
Qin Xu
Anxin Wang
Pei Zheng
Huimin Zhu
Ai Guo
Xia Meng
Yong Jiang
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Neurology / Issue 1/2023
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/s12883-023-03165-y

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