Impact of low body mass index on stroke outcomes: A propensity-matched analysis

Barbara Buccilli1

  • 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States.

Insights

Underweight patients (BMI < 19.9) face worse outcomes after ischemic stroke, including poor functional recovery and increased pneumonia risk. Nutritional status is crucial for stroke care planning and risk stratification.

Area of Science:

  • Neurology
  • Clinical Nutrition
  • Public Health

Background:

  • Body mass index (BMI) significantly impacts stroke outcomes.
  • The specific effects of being underweight (BMI < 19.9) on post-stroke prognosis are not well-understood.
  • This study investigates the association between underweight status and adverse outcomes following ischemic stroke.

Purpose of the Study:

  • To evaluate functional and clinical outcomes in ischemic stroke patients with underweight BMI compared to those with ideal BMI (20-24.9).
  • To determine if low BMI is a risk factor for poorer recovery and increased complications post-stroke.

Main Methods:

  • Utilized TriNetX data from the Mount Sinai Health System for adult ischemic stroke patients.
  • Cohorts were categorized by BMI: ideal weight (20-24.9) and underweight (<19.9).
  • Propensity score matching balanced 1,600 patients per group for a 2-year outcome assessment including modified Rankin Scale (mRS), pneumonia, and survival.

Main Results:

  • Underweight patients exhibited a higher incidence of poor functional outcome (mRS > 2: 18.1% vs 14.4%) and lower 2-year survival probability (79.3% vs 83.7%).
  • Pneumonia occurred more frequently in the underweight group (8.8% vs 6.9%).
  • No significant differences were found in repeat stroke, motor deficits, hemorrhagic transformation, or need for advanced interventions like thrombolytics or thrombectomy.

Conclusions:

  • Underweight status is significantly associated with poorer functional outcomes, increased risk of pneumonia, and reduced survival after ischemic stroke.
  • Nutritional status should be considered in the planning of post-stroke care.
  • Identifying underweight patients can aid in stroke risk stratification and management.
Abstract

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