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Non-linear association between body weight and functional outcome after acute ischemic stroke
Kayo Wakisaka1, Ryu Matsuo2,3, Koutarou Matsumoto4,5
1Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Scientific Reports
|May 29, 2023
Summary
Body weight impacts stroke recovery. Underweight individuals face higher risks of poor outcomes after ischemic stroke, while overweight patients show reduced risks. Obesity showed no significant association with stroke outcomes.
Area of Science:
- Neurology
- Public Health
- Epidemiology
Background:
- Functional outcome after acute ischemic stroke is a critical determinant of patient recovery and quality of life.
- Body Mass Index (BMI) is a widely used metric for categorizing body weight, encompassing underweight, normal weight, overweight, and obesity.
- Previous research has yielded conflicting results regarding the association between body weight and stroke outcomes.
Purpose of the Study:
- To investigate the association between Body Mass Index (BMI) and functional outcomes at three months post-acute ischemic stroke.
- To explore the non-linear relationship between different BMI categories and the risk of poor functional outcomes.
Main Methods:
- A cohort of 11,749 patients with acute ischemic stroke was analyzed.
- Body Mass Index (BMI) was categorized into underweight (<18.5 kg/m²), normal weight (18.5-22.9 kg/m²), overweight (23.0-24.9 kg/m²), and obesity (≥25.0 kg/m²).
- Logistic regression and machine learning models (eXtreme Gradient Boosting with SHapley Additive exPlanation) were used to assess the association between BMI and poor functional outcome (modified Rankin Scale [mRS] score: 3-6).
Main Results:
- Underweight patients had a significantly higher risk of poor functional outcome compared to normal weight individuals.
- Overweight patients demonstrated a lower risk of poor functional outcome.
- Obesity did not show a significant association with poor functional outcomes. Non-linear relationships were confirmed by advanced statistical modeling.
- These associations remained consistent even when excluding mortality or including mild disability as outcomes, and were particularly strong in older, non-diabetic, and mildly affected patients.
Conclusions:
- Body weight exhibits a non-linear relationship with functional outcomes following acute ischemic stroke.
- Both underweight and overweight statuses are associated with altered risks of poor functional outcomes, highlighting the complexity beyond simple weight categories.
- These findings underscore the importance of considering BMI in stroke patient management and prognosis, particularly in specific subgroups.
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