Association Between Body Mass Index and Functional Outcomes in Patients With Intracerebral Hemorrhage

Authors

Andrea Becerril-Gaitan
Dale Ding
Natasha Ironside
Andrew M Southerland
Bradford B Worrall
Fernando D Testai
Matthew L Flaherty
Mitchell S Elkind
Sebastian Koch
Gene Sung
Steven J Kittner
Douglas J Mayson
Nicole Gonzales
Jacob L McCauley
Marc Malkoff
Christiana E Hall
Michael R Frankel
Michael L James
Christopher D Anderson
Jaroslaw Aronowski
Sean I Savitz
Daniel Woo
Ching-Jen Chen

Publication Date

1-23-2024

Journal

Neurology

DOI

10.1212/WNL.0000000000208014

PMID

38165334

PMCID

PMC10870743

PubMedCentral® Posted Date

12-21-2023

PubMedCentral® Full Text Version

Post-print

Abstract

BACKGROUND AND OBJECTIVES: Evidence of the so-called "obesity paradox," which refers to the protective effect and survival benefit of obesity in patients with spontaneous intracerebral hemorrhage (ICH), remains controversial. This study aims to determine the association between body mass index (BMI) and functional outcomes in patients with ICH and whether it is modified by race/ethnicity.

METHODS: Included individuals were derived from the Ethnic/Racial Variations of Intracerebral Hemorrhage study, which prospectively recruited 1,000 non-Hispanic White, 1,000 non-Hispanic Black, and 1,000 Hispanic patients with spontaneous ICH. Only patients with available BMI were included. The primary outcome was 90-day mortality. Secondary outcomes were mortality at discharge, modified Rankin Scale (mRS), Barthel Index, and self-reported health status measures at 90 days. Associations between BMI and ICH outcomes were assessed using univariable and multivariable logistic, ordinal, and linear regression models, as appropriate. Sensitivity analyses after excluding frail patients and by patient race/ethnicity were performed.

RESULTS: A total of 2,841 patients with ICH were included. The median age was 60 years (interquartile range 51-73). Most patients were overweight (n = 943; 33.2%) or obese (n = 1,032; 36.3%). After adjusting for covariates, 90-day mortality was significantly lower among overweight and obese patients than their normal weight counterparts (adjusted odds ratio [aOR] = 0.71 [0.52-0.98] and aOR = 0.70 [0.50-0.97], respectively). Compared with patients with BMI < 25 kg/m

CONCLUSION: We demonstrated that a higher BMI is associated with decreased mortality, improved functional outcomes, and better self-reported health status at 90 days, thus supporting the paradoxical role of obesity in patients with ICH. The beneficial effect of high BMI does not seem to be modified by race/ethnicity or sex, whereas age may play a significant role in patient functional outcomes.

Keywords

Humans, Middle Aged, Body Mass Index, Overweight, Ethnicity, Obesity, Cerebral Hemorrhage

Published Open-Access

yes

Recommended Citation

Becerril-Gaitan, Andrea; Ding, Dale; Ironside, Natasha; et al., "Association Between Body Mass Index and Functional Outcomes in Patients With Intracerebral Hemorrhage" (2024). Faculty, Staff and Student Publications. 4914.
https://digitalcommons.library.tmc.edu/uthgsbs_docs/4914