Non-linear association between body weight and functional outcome after acute ischemic stroke

A Nonlinear Relation between Body Mass Index and Long-Term Poststroke Functional Outcome-The Importance of Insulin Resistance, Inflammation, and Insulin-like Growth Factor-Binding Protein-1

Both high serum insulin-like growth factor-binding protein-1 (s-IGFBP-1) and insulin resistance (IR) are associated with poor functional outcome poststroke, whereas overweight body mass index (BMI; 25-30) is related to fewer deaths and favorable functional outcome in a phenomenon labeled "the obesity paradox". Furthermore, IGFBP-1 is inversely related to BMI, in contrast to the linear relation between IR and BMI. Here, we investigated s-IGFBP-1 and IR concerning BMI and 7-year poststroke functional outcome. We included 451 stroke patients from the Sahlgrenska Study on Ischemic Stroke (SAHLSIS) with baseline measurements of s-IGFBP1, homeostasis model assessment of IR (HOMA-IR), BMI (categories: normal-weight (8.5-25), overweight (25-30), and obesity (>30)), and high-sensitivity C-reactive protein (hs-CRP) as a measure of general inflammation. Associations with poor functional outcome (modified Rankin scale [mRS] score: 3-6) after 7 years were evaluated using multivariable binary logistic regression, with overweight as reference due to the nonlinear relationship. Both normal-weight (odds-ratio [OR] 2.32, 95% confidence interval [CI] 1.30-4.14) and obese (OR 2.25, 95% CI 1.08-4.71) patients had an increased risk of poor functional outcome, driven by deaths only in the normal-weight. In normal-weight, s-IGFBP-1 modestly attenuated (8.3%) this association. In the obese, the association was instead attenuated by HOMA-IR (22.4%) and hs-CRP (10.4%). Thus, a nonlinear relation between BMI and poor 7-year functional outcome was differently attenuated in the normal-weight and the obese.

Association between abdominal adiposity and clinical outcomes in patients with acute ischemic stroke

BACKGROUND

It is unclear whether abdominal adiposity has an additional effect on post-stroke outcomes. This study aimed to determine whether waist circumference (WC) is independently associated with clinical outcomes after acute ischemic stroke.

METHODS

We enrolled patients with acute ischemic stroke from a multicenter hospital-based stroke registry in Fukuoka, Japan. We measured WC on admission and categorized patients into four groups (Q1-Q4) according to the quartiles in females and males. The clinical outcomes were poor functional outcome (modified Rankin scale score 2-6) and death from any cause. Logistic regression analysis was performed to estimate the odds ratio and 95% confidence interval of the outcomes of interest after adjusting for potential confounding factors, including body mass index (BMI).

RESULTS

A total of 11,989 patients (70.3±12.2 years, females: 36.1%) were included in the analysis. The risk of poor functional outcome significantly decreased for Q2-Q4 (vs. Q1) at discharge and Q2-Q3 (vs. Q1) at 3 months, even after adjusting for potential confounders, including BMI. In contrast, adjustment of BMI eliminated the significant association between WC and all-cause death at discharge and 3 months. The association between high WC and favorable functional outcome was not affected by fasting insulin levels or homeostatic model assessment for insulin resistance and was only found in patients without diabetes (P = 0.02 for heterogeneity).

CONCLUSIONS

These findings suggest that abdominal adiposity has an additional impact on post-stroke functional outcome, independent of body weight and insulin action.

[Risk factors for disability in patients with stroke in northeastern Mexico: A retrospective cross-sectional study]

OBJECTIVE

To determine the risk factors associated with disability in patients who had a stroke in northeastern Mexico.

DESIGN

This was an observational, retrospective, cross-sectional study. SITE: Conducted at the Family Medicine Unit No. 33 of the Mexican Institute of Social Security in Reynosa, Tamaulipas, Mexico.

PARTICIPANTS

One hundred and ninety-eight males and 146 females, above 18 years old, beneficiaries of the Mexican Institute of Social Security with a diagnosis of stroke between 2018 and 2021.

INTERVENTIONS

The Barthel index that assesses the degree of dependence to perform basic activities of daily living was applied to the participants and sociodemographic, biological and anthropometric variables were collected from the digital medical record.

MAIN MEASURES

A univariate, correlational and ordinal logistic regression statistical analysis was performed between independent and dependent variables to obtain measures of frequency, percentages, and associated risks.

RESULTS

The risk factors associated with disability were age (OR 1.03, CI 1.01-1.05), overweight (OR 1.81, CI 1.03-3.1), obesity grade I (OR 2.74, CI 1.46-5.1), obesity grade II (OR 4.38, CI 1.44-13), obesity grade III (OR 9.99, CI 2.12-47); type of stroke: ischemic (OR 4.60, CI 2.6-8) or thrombotic (OR 4.95, CI 1.57-15). The number of comorbidities was associated with disability when having one comorbidity (OR 2.80, CI 1.22-6.4), two comorbidities (OR 3.43, CI 1.37-8.5), three comorbidities (OR 2.71, CI 1.01-7.3), and with five comorbidities (OR 3.17, CI 1.01-9.9).

CONCLUSIONS

The risk factors found for disability were age, overweight, obesity, and type of ischemic and thrombotic stroke. Being cared for by a relative and/or spouse reduces the probability of disability.

A U-shaped relationship between body mass index and functional recovery in older Japanese stroke survivors undergoing hospital rehabilitation

OBJECTIVE

A relationship between body mass index and functional recovery in older survivors of stroke is unclear. Therefore, this study aimed to investigate the association of body mass index with post-stroke functional recovery in older Japanese stroke survivors undergoing hospital rehabilitation.

METHODS

This was a multicenter retrospective observational study of 757 older survivors of stroke, from six convalescent rehabilitation hospitals in Japan. The participants were classified into seven categories according to body mass index at admission. The measurements included outcomes of the absolute gain in the motor subscale of the Functional Independence Measure. Poor functional recovery was defined as gain < 17 points. Multivariate logistic regression analysis was performed to examine the impact of these body mass index categories on poor functional recovery.

RESULTS

The mean motor gains were highest in the 23.5-25.4 kg/m2 group (28.1 points), and lowest in the < 17.5 kg/m2 group (220.0 points). The results of the multivariate regression analyses (reference; 23.5-25.4 kg/m2 group) showed that the < 17.5 kg/m2 group (odds ratios 4.30; 95 % confidence intervals 2.09-8.87), the 17.5-19.4 kg/m2 group (1.99; 1.03-3.87), the 19.5-21.4 kg/m2 group (1.93; 1.05-3.54), and the ≥ 27.5 kg/m2 group (3.34; 1.33-8.42) were significantly associated with poor functional recovery, but not in the other groups.

CONCLUSIONS

Older survivors of stroke with high-normal weight had the most favorable functional recovery among the seven groups. Meanwhile, both low and extremely high body mass indexes were associated with poor functional recovery.