Photo Credit: Mr. Suphachai Praserdumrongchai
The following is a summary of “Association Between Body Mass Index and Functional Outcomes in Patients With Intracerebral Hemorrhage,” published in the December 2023 issue of Neurology by Becerril-Gaitan et al.
Despite hints of a protective “obesity paradox” in intracerebral hemorrhage (ICH), the evidence remains controversial.
Researchers started a retrospective study to determine the link between BMI and functional outcomes in patients with ICH and whether it is modified by race/ethnicity.
They utilized data from the Ethnic/Racial Variations of Intracerebral Hemorrhage study, enrolling 1,000 non-Hispanic White, non-Hispanic Black, and Hispanic patients with spontaneous ICH. Only individuals with recorded BMI were included. The main focus was 90-day mortality, and secondary outcomes included discharge mortality, modified Rankin Scale (mRS), Barthel Index, and self-reported health status at 90 days.BMI, ICH outcomes, and race/ethnicity were analyzed using logistic, ordinal, and linear regression models. Sensitivity analyses were conducted, excluding frail patients and considering the patient’s race/ethnicity.
The results showed 2,841 ICH patients with a median age of 60 (IQR 51–73). Most were overweight (n = 943; 33.2%) or obese (n = 1,032; 36.3%). Adjusted for covariates, overweight and obese patients had lower 90-day mortality than normal-weight individuals (aOR = 0.71 [0.52–0.98] and aOR = 0.70 [0.50–0.97], respectively). Compared to BMI <25 kg/m22, BMI ≥25 kg/m2 correlated with improved 90-day mRS (aOR = 0.80 [CI 0.67–0.95]), EuroQoL Group 5-Dimension (EQ-5D) (aβ = 0.05 [0.01–0.08]), and EQ-5D VAS (aβ = 3.80 [0.80–6.98]) scores. After excluding withdrawal of care, these trends show an inverse relationship between BMI and 90-day mortality (aOR = 0.97 [0.96–0.99]). While non-Hispanic White patients had higher 90-day mortality than non-Hispanic Black and Hispanic patients (26.6% vs. 19.5% vs. 18.0%, P<0.001), no significant BMI-race/ethnicity interactions were found. No significant BMI interactions with age or sex for 90-day mortality, but a significant age interaction was noted for 90-day mRS. (P interaction = 0.004).
They concluded that high BMI in ICH patients: less death, better function, happier at 90 days. The paradox holds that race/sex-neutral age might matter.
Source: neurology.org/doi/10.1212/WNL.0000000000208014
