Data Management And Sharing System of China National Clinical Research Center for Neurological Diseases

Journal：stroke

Publication type: Original Contributions

IF(IF): 7.914

PMID: 31043152 Link To Pubmed Full text Download

Obesity is generally associated with increased risk of stroke; however, many studies, but not all, suggest a better prognosis in overweight and obese patients after stroke, which was termed as stroke-obesity paradox.Although the related factors and metabolic pathways have been documented in previous studies, the underpinning mechanisms are still not fully understood. As we know, insulin resistance is an independent risk factor for mortality and major disability after stroke. Meanwhile, insulin resistance is also closely associated with obesity. More than 70% of obese population are insulin resistant. However, more than 50% of lean individuals are also accompanied with insulin-resistant status, which may be even higher in lean stroke patients. If stroke-obesity paradox did exist, a possible explanation is that insulin resistance may have a worse impact on lean patients than obese patients. Hence, we hypothesized that, if patients with stroke had insulin resistance status, obese patients with stroke may have better prognosis than lean patients; however, if stroke patients were insulin sensitive, stroke-obesity paradox does not exist. To date, the joint effect of insulin resistance and obesity on the stroke outcomes has not been reported. The current study aims to examine whether the association between body mass index (BMI) and stroke outcomes was modified by insulin resistance status, by using data derived from the Abnormal Glucose Regulation in Patients With Acute Stroke Across-China registry.

Patients with ischemic stroke without history of diabetes mellitus in the Abnormal Glucose Regulation in Patients With Acute Stroke Across-China registry were included. Overweight or obese was de ned as body mass index ≥23, and the median of homeostasis model assessment–insulin resistance index was chosen as cutoff to de ne insulin resistance. Cox or logistic regression model was used to assess the interaction between body mass index and homeostasis model assessment–insulin resistance on 1-year prognosis (all-cause mortality and poor functional outcome de ned as modifed Rankin Scale score 3–6).