Association of BMI with total mortality and recurrent stroke among stroke patients: A meta-analysis of cohort studies.
Studies of the association between obesity and total mortality and recurrent stroke events have shown contradictory results. Therefore, we aimed to conduct a meta-analysis to examine the association of body mass index (BMI) with total mortality and recurrent stroke events among patients after stroke onset.



We performed an electronic search of PubMed, EMBASE and the Cochrane Library Database, as well as a bibliography review to identify relevant cohort studies published prior to 15th December 2015. Estimates of relative risks (RRs) and corresponding 95% confidence intervals (CIs) comparing underweight, overweight and obese groups with normal weight were pooled using random effects models.



In total, 15 studies with 122,472 stroke patients were eligible for inclusion in the meta-analysis. Compared with the normal weight group, obese stroke patients had a significant decreased risk for total mortality (RR = 0.83, 95% CI, 0.73-0.93, p = 0.002), while underweight patients had a significant increased risk for total mortality (RR = 1.54, 95% CI, 1.31-1.82, p = 3.66 × 10-7). A similar, but not significant, association of BMI categories with recurrent stroke events was also observed. Furthermore, the dose-response meta-analysis identified a nonlinear trend for total mortality and a linear trend for recurrent stroke events, associated with BMI.



Our results suggested that obesity may have a protective effect on total mortality and recurrent stroke events among patients with established stroke.
State Key Laboratory of Cardiovascular Disease, Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Keyong
K
Huang
State Key Laboratory of Cardiovascular Disease, Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Fangchao
F
Liu
State Key Laboratory of Cardiovascular Disease, Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Xikun
X
Han
State Key Laboratory of Cardiovascular Disease, Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Chen
C
Huang
State Key Laboratory of Cardiovascular Disease, Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Jianfeng
J
Huang
State Key Laboratory of Cardiovascular Disease, Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Dongfeng
D
Gu
State Key Laboratory of Cardiovascular Disease, Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Electronic address: yangxueli1985@126.com.
Xueli
X
Yang
D000328:Adult; D000368:Aged; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009765:Obesity / Q000097:blood* / Q000150:complications; D050177:Overweight / Q000097:blood / Q000150:complications; D012008:Recurrence; D055502:Secondary Prevention; D020521:Stroke / Q000097:blood* / Q000150:complications; D013851:Thinness; D016896:Treatment Outcome
Body mass index; Meta-analysis; Mortality; Recurrent stroke