title: The obesity paradox and survivors of ischemic stroke.
abstract: BACKGROUND
  Although obesity is a risk factor for stroke and achieving normal weight is advocated to decrease stroke risk, the risk associated with obesity and weight loss after stroke has not been well established. The aim of this study was to assess the association of obesity at the time of stroke admission and weight loss after stroke with total mortality.
  
  
  METHODS
  We analyzed 736 consecutive patients (mean age, 66 ± 11 years; 58% men) hospitalized for their first ischemic stroke. Body weight at hospital admission and at the outpatient visit during follow-up was used in the analysis.
  
  
  RESULTS
  After multivariate adjustment, obesity at admission was associated with lower mortality risk as compared with normal weight (hazard ratio [HR], .50, P = .03). At the outpatient visit, with a median follow-up time of 16 months, 21% of patients had lost more than 3 kg of weight. Stroke severity, heart failure, transient ischemic attack, and depression after stroke were independently associated with significant weight loss. Weight loss of more than 3 kg was associated with increased mortality risk (HR, 5.87; P = .001) independently of other factors. Similar results were seen when weight loss was defined as losing more than 3% of baseline weight (HR, 4.97; P = .004). Weight gain of more than 5% of the baseline weight tended to be associated with better survival when compared with no weight change (log-rank test, P = .07).
  
  
  CONCLUSIONS
  Normal weight at hospital admission and weight loss after ischemic stroke are independently associated with increased mortality. Overweight and obesity at baseline do not decrease the risk associated with weight loss.
authors: Center for Cardiovascular Prevention of the First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic; International Clinical Research Center, St Ann's University Hospital, Brno, Czech Republic; Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic. Electronic address: wohlfp@gmail.com.
authors: Peter
authors: P
authors: Wohlfahrt
authors: Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic Rochester, Rochester, Minnesota.
authors: Francisco
authors: F
authors: Lopez-Jimenez
authors: Center for Cardiovascular Prevention of the First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic.
authors: Alena
authors: A
authors: Krajcoviechova
authors: Center for Cardiovascular Prevention of the First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic.
authors: Marie
authors: M
authors: Jozifova
authors: 2nd Department of Internal Medicine, Charles University, Center for Hypertension, Pilsen, Czech Republic.
authors: Otto
authors: O
authors: Mayer
authors: 2nd Department of Internal Medicine, Charles University, Center for Hypertension, Pilsen, Czech Republic.
authors: Jiri
authors: J
authors: Vanek
authors: 2nd Department of Internal Medicine, Charles University, Center for Hypertension, Pilsen, Czech Republic.
authors: Jan
authors: J
authors: Filipovsky
authors: University of Texas Southwestern Medical School, Dallas, Texas.
authors: Ernesto M
authors: EM
authors: Llano
authors: Center for Cardiovascular Prevention of the First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic; International Clinical Research Center, St Ann's University Hospital, Brno, Czech Republic; Department of Cardiology and Angiology, First Faculty of Medicine, Charles, University, Prague, Czech Republic.
authors: Renata
authors: R
authors: Cifkova
mesh_terms: D000368:Aged; D015992:Body Mass Index; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000503:physiopathology; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D015431:Weight Loss / Q000502:physiology*
keywords: Ischemic stroke; mortality; obesity; outcome; weight loss