title: Obesity and the risk of intracerebral hemorrhage: the multicenter study on cerebral hemorrhage in Italy.
abstract: OBJECTIVE
  The effect of obesity on the risk of intracerebral hemorrhage (ICH) may depend on the pathophysiology of vessel damage. To further address this issue, we investigated and quantified the correlations between obesity and obesity-related conditions in the causal pathways leading to ICH.
  
  
  METHODS
  A total of 777 ICH cases ≥ 55 years of age (287 lobar ICH and 490 deep ICH) were consecutively enrolled as part of the Multicenter Study on Cerebral Hemorrhage in Italy and compared with 2083 control subjects by a multivariate path analysis model. Separate analyses were conducted for deep and lobar ICH.
  
  
  RESULTS
  Obesity was not independently associated with an increased risk of lobar ICH (odds ratio [OR], 0.76; 95% confidence interval [CI], 0.58-1.01) or deep ICH (OR, 1.18; 95% CI, 0.95-1.45) when compared with control subjects. The path analysis confirmed the nonsignificant total effect of obesity on the risk of lobar ICH (OR, 0.77; 95% CI, 0.58-1.02) but demonstrated a significant indirect effect on the risk of deep ICH (OR, 1.28; 95% CI, 1.03-1.57), mostly determined by hypertension (OR, 1.07; 95% CI, 1.04-1.11) and diabetes mellitus (OR, 1.04; 95% CI, 1.01-1.07). Obesity was also associated with an increased risk of deep ICH when compared with lobar ICH (OR, 1.62; 95% CI, 1.14-2.31).
  
  
  CONCLUSIONS
  Obesity increases the risk of deep ICH, mostly through an indirect effect on hypertension and other intermediate obesity-related comorbidities, but has no major influence on the risk of lobar ICH. This supports the hypothesis of different, vessel-specific, biological mechanisms underlying the relationship between obesity and cerebral hemorrhage.
authors.affiliation: Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, P.le Spedali Civili 1, 25123 Brescia, Italia. alessandro.pezzini@med.unibs.it
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pezzini
authors.forename: Mario
authors.initials: M
authors.lastname: Grassi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Paciaroni
authors.forename: Andrea
authors.initials: A
authors.lastname: Zini
authors.forename: Giorgio
authors.initials: G
authors.lastname: Silvestrelli
authors.forename: Licia
authors.initials: L
authors.lastname: Iacoviello
authors.forename: Augusto
authors.initials: A
authors.lastname: Di Castelnuovo
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Del Zotto
authors.forename: Valeria
authors.initials: V
authors.lastname: Caso
authors.forename: Paolo Frigio
authors.initials: PF
authors.lastname: Nichelli
authors.forename: Alessia
authors.initials: A
authors.lastname: Giossi
authors.forename: Irene
authors.initials: I
authors.lastname: Volonghi
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Simone
authors.forename: Alessia
authors.initials: A
authors.lastname: Lanari
authors.forename: Paolo
authors.initials: P
authors.lastname: Costa
authors.forename: Loris
authors.initials: L
authors.lastname: Poli
authors.forename: Roberta
authors.initials: R
authors.lastname: Pentore
authors.forename: Francesca
authors.initials: F
authors.lastname: Falzone
authors.forename: Massimo
authors.initials: M
authors.lastname: Gamba
authors.forename: Andrea
authors.initials: A
authors.lastname: Morotti
authors.forename: Alfonso
authors.initials: A
authors.lastname: Ciccone
authors.forename: Marco
authors.initials: M
authors.lastname: Ritelli
authors.forename: Davide
authors.initials: D
authors.lastname: Guido
authors.forename: Marina
authors.initials: M
authors.lastname: Colombi
authors.forename: Giovanni
authors.initials: G
authors.lastname: De Gaetano
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Agnelli
authors.forename: Alessandro
authors.initials: A
authors.lastname: Padovani
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002543:Cerebral Hemorrhage / Q000145:classification* / Q000453:epidemiology*; D015897:Comorbidity; D048909:Diabetes Complications / Q000150:complications / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology; D007558:Italy / Q000453:epidemiology; D008297:Male; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications* / Q000453:epidemiology*; D012307:Risk Factors
keywords: hemorrhage; obesity; stroke