Relationship between Body Mass Index and 3-Month Prognosis of Stroke Patients

doi:10.3969/j.issn.1673-5765.2023.07.008

Abstract

Abstract: Objective To explore the impact of BMI on the 3-month prognosis of inpatients of first stroke onset.
Methods This study enrolled the consecutive inpatients within 7 days of first stroke onset from the multicenter and prospective investigation of nutrition statusin stroke patients of China (INSIS) registry study. The baseline general information such as age, sex, education level, medical insurance, risk factors of stroke, and clinical data such as BMI, NIHSS score at admission and pneumonia during hospitalization were collected. mRS Scores were followed up 3 months after onset. Good prognosis was defined as a mRS of 0-2. The patients were divided into four groups according to BMI at admission: the underweight group (BMI<18.5 kg/m2) , the normal weight group (18.5 kg/m2≤BMI<24 kg/m2) , the overweight group (24 kg/m2) ≤BMI<28 kg/m2), and the obese group (BMI≥28 kg/m2). Logistic regression analysis was used to determine the impact of BMI on 3-month outcomes of stroke.
Results A total of 733 patients were included in this study, with an average age of 63.5±12.8 years and 259 females (35.3%). Cerebral hemorrhage occurred in 181 cases (24.7%). The average NIHSS score at admission was 7.85±6.45. The average BMI was 24.67±3.59 (kg/m2) .
There were 22 cases (3%) in the underweight group, 303 cases (41.3%) in the normal weight group, 291 cases (39.7%) in the overweight group, and 117 cases (16.0%) in the obese group. The mean age, sex distribution, education level, incidence of hyperlipidemia, NIHSS score at admission, and whether there was swallowing disorder among the four groups were statistically significant, while the overall differences in other indicators among the four groups were not statistically significant. After adjusting for confounding factors, low weight, overweight or obesity had no independent effect on 3-month prognosis compared with normal BMI.
Conclusions In this study population, low weight, overweight and obesity at admission had no significant impact on 3-month outcomes of stroke compared to normal BMI.

Key words: Stroke; Body mass index; Prognosis;Nursing

摘要： 目的探讨BMI对首次急性卒中住院患者3个月预后的影响。
方法基于多中心、连续性、前瞻性登记研究——中国卒中患者营养调查（investigation of nutrition status in stroke patients of China，INSIS），连续收集首次急性卒中（发病7 d内）住院患者的资料，包括年龄、性别、受教育程度、医疗保险等一般资料，脑血管病危险因素，以及入院时BMI、NIHSS评分、住院期间肺炎等临床资料。随访发病3个月后mRS评分，mRS评分0～2分为预后良好。根据入院时BMI将患者分为4组：低BMI组（BMI＜18.5 kg/m2）、正常BMI组（18.5 kg/m2≤BMI＜24.0 kg/m2）、超重组（24.0 kg/m2≤BMI＜28.0 kg/m2）及肥胖组（BMI≥28.0 kg/m2）。采用logistic回归分析BMI对卒中发病3个月结局的影响。
结果共733例患者纳入本研究，平均年龄（63.5±12.8）岁，女性259例（35.3%），脑出血者181例（24.7%），入院时平均NIHSS评分（7.85±6.45）分，平均BMI为（24.67±3.59）kg/m2。低BMI组22例（3.0%），正常BMI组303例（41.3%），超重组291例（39.7%），肥胖组117例（16.0%）。4组间平均年龄、性别分布、受教育程度、高脂血症发生率、入院时NIHSS评分、是否存在吞咽障碍等指标差异具有统计学意义，其他指标4组间整体差异未达统计学意义。校正混杂因素之后，与正常BMI相比，低BMI、超重或肥胖均对患者发病3个月预后没有独立影响。
结论在本研究人群中，与正常BMI相比，入院时低BMI、超重、肥胖对3个月卒中结局无显著影响。

关键词: 卒中; 体重指数; 预后; 护理

WANG Yao, QIN Haiqiang, WANG Anxin, ZHANG Xiaoli, ZUO Yingting, ZHANG Yaqing, YANG Bo, YU Dandan, WEI Na, ZHANG Jing. Relationship between Body Mass Index and 3-Month Prognosis of Stroke Patients [J]. Chinese Journal of Stroke, 2023, 18(07): 793-798.

王垚, 秦海强, 王安心, 张晓丽, 左颖婷, 张亚清, 杨波, 于丹丹, 魏娜, 张婧. 卒中患者入院体重指数与3个月预后的关系研究[J]. 中国卒中杂志, 2023, 18(07): 793-798.

References

[1] OLSEN T S，DEHLENDORFF C，PETERSEN H G，et al. Body mass index and post stroke mortality[J]. Neuroepidemiology，2008，30（2）：93-100.
[2] VEMMOS K，NTAIOS G，SPENGOS K，et al. Association between obesity and mortality after acute first-ever stroke：the obesity–stroke paradox[J]. Stroke，2011，42（1）：30-36.
[3] DOEHNER W，SCHENKEL J，ANKER S D，et al. Overweight and obesity are associated with improved survival，functional outcome，and stroke recurrence after acute stroke or transient ischaemic attack：observations from the tempis trial[J]. Eur Heart J，2013，34（4）：268-277.
[4] WOHLFAHRT P，LOPEZ-JIMENEZ F，KRAJCOVIECHOVA A，et al. The obesity paradox and survivors of ischemic stroke[J]. J Stroke Cerebrovasc Dis，2015，24（6）：1443-1450.
[5] ROZEN G，ELBAZ-GREENER G，MARGOLIS G，et al. The obesity paradox in real-world nation-wide cohort of patients admitted for a stroke in the U. S[J/OL]. J Clin Med，2022，11（6）：1678[2022-10-21]. https://doi.org/10.3390/jcm11061678.
[6] WANG J，LI J J，LI M E，et al. Association between dynamic obesity and mortality in patients with first-ever ischemic stroke：a hospital-based prospective study[J/OL]. Medicine（Baltimore），2020，99（38）：e22243[2022-10-21]. https://doi.org/10.1097/md.0000000000022243.
[7] ZHAO L，DU W L，ZHAO X Q，et al. Favorable functional recovery in overweight ischemic stroke survivors：findings from the China national stroke registry[J/OL]. J Stroke Cerebrovasc Dis，2014，23（3）：e201-e206[2022-10-01]. https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.10.002.
[8] CHEN W Q，Pan Y S，JING J，et al. Association of body mass index and risk of stroke after acute minor stroke or TIA：a post hoc analysis of a randomized controlled trial[J]. Neurotox Res，2019，36（4）：836-843.
[9] BELL C L，RANTANEN T，CHEN R，et al. Prestroke weight loss is associated with poststroke mortality among men in the Honolulu-Asia aging study[J]. Arch Phys Med Rehabil，2014，95（3）：472-479.
[10] SKOLARUS L E，SANCHEZ B N，LEVINE D A，et al. Association of body mass index and mortality after acute ischemic stroke[J]. Circ Cardiovasc Qual Outcomes，2014，7（1）：64-69.
[11] DEHLENDORFF C，ANDERSEN K K，OLSEN T S. Body mass index and death by stroke：no obesity paradox[J]. JAMA Neurol，2014，71（8）：978–984.
[12] GARCÍA-RUDOLPH A，KELLEHER J D，CEGARRA B，et al. The impact of body mass index on functional rehabilitation outcomes of working age inpatients with stroke[J]. Eur J Phys Rehabil Med，2021，57（2）：216-226.
[13] KALICHMAN L，ALPEROVITCH-NAJENSON D，TREGER I. The impact of patient's weight on post stroke rehabilitation[J]. Disabil Rehabil，2016，38（17）：1684-1690.
[14] SUN W P，HUANG Y N，XIAN Y，et al . Association of body mass index with mortality and functional outcome after acute ischemic stroke[J/OL]. Sci Rep，2017，7（1）：2507[2022-10-21]. https://doi.org/10.1038/s41598-017-02551-0.
[15] CHIQUETE E，RUIZ-SANDOVAL J L，MURILLO-BONILLA L，et al. Central adiposity and mortality after first-ever acute ischemic stroke[J]. Eur Neurol，2013，70（1/2）：117-123.
[16] ZHANG J，ZHAO X Q，WANG A X，et al. Emerging malnutrition during hospitalization independently predicts poor 3-month outcomes after acute stroke：data from a Chinese cohort[J]. Asia Pac J Clin Nutr，2015，24（3）：379-386.
[17] 中国超重肥胖医学营养治疗专家共识编写委员会. 中国超重/肥胖医学营养治疗专家共识（2016年版）[J]. 中华糖尿病杂志，2016，8（9）：525-540.
[18] KIM B J，LEE S H，JUNG K H，et al. Dynamics of obesity paradox after stroke，related to time from onset，age，and causes of death[J]. Neurology，2012，79（9）：856-863.
[19] MATSUSHITA T，NISHIOKA S，TAGUCHI S，et al. Sarcopenic obesity and activities of daily living in stroke rehabilitation patients：a cross-sectional study[J/OL]. Healthcare，2020，8（255）：255[2022-10-21]. https://doi.org/10.3390/healthcare8030255.
[20] KNOWLES R，CARTER J，JEBB S A，et al. Associations of skeletal muscle mass and fat mass with incident cardiovascular disease and all‐cause mortality：a prospective cohort study of UK biobank participants[J/OL]. J Am Heart Assoc，2021，10（9）：e019337[2022-10-21]. https://doi.org/10.1161/jaha.120.019337.
[21] DE SOUZA J T，MINICUCCI M F，ZORNOFF L A M，et al. Adductor pollicis muscle thickness and obesity are associated with poor outcome after stroke：a cohort study[J]. J Stroke Cerebrovasc Dis，2018，27（5）：1375-1380.