Prognostic importance of weight change on short-term functional outcome in acute ischemic stroke

Background Controversy exists regarding the question of whether weight change decreases or increases the risk of mortality. Aim The aim of this study was to evaluate the prognostic importance of weight change on short-term outcomes in acute ischemic stroke patients. Methods A total of 654 patients with acute ischemic stroke were enrolled in this study from March 2010 to May 2013. We assessed the weight change of each participant between admission and discharge from the Department of Neurology. Weight change was defined as change ≥0.05 kg/baseline body mass index unit. We evaluated the short-term outcomes using a modified Rankin Scale at three-months after the onset of a stroke. Results Among the 654 patients, 35.2% were included in the weight-change group. Weight loss occurred in 24.6% of the participants during the hospital stay following the stroke, which lasted an average of nine-days. Compared with the weight-stable group, the pronounced weight-loss group had a higher risk of unfavorable outcomes (odds ratio 2.43; 95% confidence interval 1.12-5.25). Conclusions Short-term weight loss after stroke appears to be more common than we expected, and our results suggest that it is associated with unfavorable functional outcomes. Therefore, clinical nutrition should be considered as a component of medical treatment and weight loss should be monitored as an indicator of malnutrition.

[1]  V. Somers,et al.  The prognostic importance of weight loss in coronary artery disease: a systematic review and meta-analysis. , 2014, Mayo Clinic proceedings.

[2]  Connie M. Rhee,et al.  To legitimize the contentious obesity paradox. , 2014, Mayo Clinic proceedings.

[3]  A. Day,et al.  Close to recommended caloric and protein intake by enteral nutrition is associated with better clinical outcome of critically ill septic patients: secondary analysis of a large international nutrition database , 2014, Critical Care.

[4]  C. Lavie,et al.  Body composition and mortality in a large cohort with preserved ejection fraction: untangling the obesity paradox. , 2013, Mayo Clinic proceedings.

[5]  Dong Joon Kim,et al.  Repeated Thrombolytic Therapy in Patients with Recurrent Acute Ischemic Stroke , 2013, Journal of stroke.

[6]  R. Arena,et al.  Impact of obesity and the obesity paradox on prevalence and prognosis in heart failure. , 2013, JACC. Heart failure.

[7]  J. Roh,et al.  Dynamics of obesity paradox after stroke, related to time from onset, age, and causes of death , 2012, Neurology.

[8]  U. Dirnagl,et al.  Body Weight After Stroke: Lessons From the Obesity Paradox , 2011, Stroke.

[9]  Nikhil A. Jain,et al.  The obesity paradox and weight loss. , 2011, The American journal of medicine.

[10]  W. Ryu,et al.  Body Mass Index, Initial Neurological Severity and Long-Term Mortality in Ischemic Stroke , 2011, Cerebrovascular Diseases.

[11]  C. Marone,et al.  Fluid balance in critically ill patients. Should we really rely on it? , 2011, Minerva anestesiologica.

[12]  Efstathios Manios,et al.  Association Between Obesity and Mortality After Acute First-Ever Stroke: The Obesity–Stroke Paradox , 2011, Stroke.

[13]  D. D. Ingram,et al.  Weight loss from maximum body weight and mortality: the Third National Health and Nutrition Examination Survey Linked Mortality File , 2010, International Journal of Obesity.

[14]  P. Schnohr,et al.  Combined effects of weight loss and physical activity on all-cause mortality of overweight men and women , 2010, International Journal of Obesity.

[15]  Jiang He,et al.  Body mass index and risk of stroke among Chinese men and women , 2010, Annals of neurology.

[16]  V. Chang,et al.  Weight Change, Initial BMI, and Mortality Among Middle- and Older-aged Adults , 2009, Epidemiology.

[17]  B. Ovbiagele,et al.  The Impact of Body Mass Index on Mortality After Stroke , 2009, Stroke.

[18]  F. Booth,et al.  Anti-TNF treatment reduces rat skeletal muscle wasting in monocrotaline-induced cardiac cachexia. , 2008, Journal of applied physiology.

[19]  B. Norrving,et al.  Weight Loss After Stroke: A Population-Based Study From the Lund Stroke Register , 2008, Stroke.

[20]  Werner Hacke,et al.  Thrombolysis with alteplase for acute ischaemic stroke in the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST): an observational study , 2007, The Lancet.

[21]  K. Dickstein,et al.  Weight-change as a prognostic marker in 12 550 patients following acute myocardial infarction or with stable coronary artery disease. , 2006, European heart journal.

[22]  T. Harris,et al.  Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. , 2006, The New England journal of medicine.

[23]  Paul Poirier,et al.  Obesity and Cardiovascular Disease: Pathophysiology, Evaluation, and Effect of Weight Loss: An Update of the 1997 American Heart Association Scientific Statement on Obesity and Heart Disease From the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism , 2006, Circulation.

[24]  C. Pichard,et al.  Hospital length of stay and nutritional status , 2005, Current opinion in clinical nutrition and metabolic care.

[25]  S. Gariballa.  Editorial comment: Protein-energy undernutrition and acute stroke outcome. , 2003, Stroke.

[26]  S. Wannamethee,et al.  Weight change, weight fluctuation, and mortality. , 2002, Archives of internal medicine.

[27]  L. Fried,et al.  Weight Change in Old Age and its Association with Mortality , 2001, Journal of the American Geriatrics Society.

[28]  K. Yarasheski,et al.  Resistance exercise decreases skeletal muscle tumor necrosis factor α in frail elderly humans , 2001 .

[29]  Lark,et al.  Body-mass index and mortality in a prospective cohort of U.S. adults. , 1999, The New England journal of medicine.

[30]  J. Manson,et al.  A prospective study of body mass index, weight change, and risk of stroke in women. , 1997, JAMA.

[31]  N. Chaturvedi,et al.  Mortality Risk by Body Weight and Weight Change in People with NIDDM: The WHO Multinational Study of Vascular Disease in Diabetes , 1995, Diabetes Care.

[32]  Denis Muller,et al.  Long-Term Effects of Change in Body Weight on All-Cause Mortality: A Review , 1993, Annals of Internal Medicine.

[33]  A. N. Roos,et al.  Weight changes in critically ill patients evaluated by fluid balances and impedance measurements , 1993, Critical care medicine.

[34]  J. Sowers,et al.  The effect of weight reduction on blood pressure, plasma renin activity, and plasma aldosterone levels in obese patients. , 1981, The New England journal of medicine.

[35]  P. Savage,et al.  Potential benefits of weight loss in coronary heart disease. , 2014, Progress in cardiovascular diseases.

[36]  V. Chair,et al.  Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. , 2014, Stroke.

[37]  G. Fonarow,et al.  Obesity and the obesity paradox in heart failure. , 2014, Progress in cardiovascular diseases.

[38]  K. Flegal,et al.  Obesity paradox in end-stage kidney disease patients. , 2014, Progress in cardiovascular diseases.

[39]  C. Lavie,et al.  The impact of obesity on risk factors and prevalence and prognosis of coronary heart disease-the obesity paradox. , 2014, Progress in cardiovascular diseases.

[40]  A. Kulshrestha,et al.  Critical nutritional aspects in intensive care patients , 2012 .

[41]  C. Lavie,et al.  Body composition and survival in stable coronary heart disease: impact of lean mass index and body fat in the "obesity paradox". , 2012, Journal of the American College of Cardiology.

[42]  G. Eastwood.  Evaluating the reliability of recorded fluid balance to approximate body weight change in patients undergoing cardiac surgery. , 2006, Heart & lung : the journal of critical care.

[43]  D. Slone,et al.  Nutritional support of the critically ill and injured patient. , 2004, Critical care clinics.

[44]  K. Yarasheski,et al.  Resistance exercise decreases skeletal muscle tumor necrosis factor alpha in frail elderly humans. , 2001, FASEB journal : official publication of the Federation of American Societies for Experimental Biology.

[45]  A. U. Rickel,et al.  Guidelines for Prevention, I , 1998 .