Association between abnormal body weight and stroke outcome: A meta‐analysis and systematic review

• Published in: European journal of neurology Vol. 28; no. 8; pp. 2552 - 2564
• Main Authors: Zhang, Peng, Yan, Xiu‐Li, Qu, Yang, Guo, Zhen‐Ni, Yang, Yi
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01.08.2021
• Subjects: Body weight; clinical outcome; Confidence intervals; Ischemia; Literature reviews; Meta-analysis; Mortality; Obesity; obesity paradox; Overweight; prognosis; Stroke; Survival; Systematic review; Underweight; clinical outcome; obesity paradox; prognosis; stroke
• ISSN: 1351-5101; 1468-1331
• DOI: 10.1111/ene.14881

Background and purpose To test the hypothesis that “obesity paradox” exists in stroke patients, we conducted a meta‐analysis and systematic review on the association between abnormal body weight (obesity, overweight, or underweight) and the outcome of different types of stroke. Methods This meta‐analysis and systematic review was performed in conformity to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analysis) guidelines in Appendix S2. Studies investigating the association between abnormal body weight and the outcome of different types of stroke were searched for in the PubMed and Embase databases from their inception to 20 March 2021. Results Thirty‐three articles including 84,660 patients were included in this study. Obesity and overweight were associated with longer survival in mixed‐stroke patients (acute ischemic stroke [AIS] combined with one or more other stroke subtypes) than was normal weight, whereas underweight was related to shorter survival; the pooled hazard ratios (HRs) of mortality were 0.77 (95% confidence interval [CI] = 0.71–0.83) for obesity, 0.76 (95% CI = 0.72–0.80) for overweight, and 1.71 (95% CI = 1.56–1.87) for underweight. However, only obesity was associated with longer survival in AIS patients compared with normal weight, and underweight was related to shorter survival; the pooled HR of mortality was 0.75 (95% CI = 0.64–0.88) for obesity and 1.53 (95% CI = 1.27–1.85) for underweight. After merging mixed‐stroke and AIS patients, we obtained similar results as in mixed‐stroke patients. Conclusions Our results suggested that in patients with mixed stroke or AIS, obesity was associated with a longer survival time than normal weight, whereas underweight was associated with a shorter survival time. In patients with mixed‐stroke or AIS, obesity was associated with a longer survival time than normal weight, while underweight was associated with a shorter survival time.