FYI.
The Obesity Paradox: Effect of Body Mass Index and Waist Circumference on Post-Stroke Cognitive Impairment
Received 20 June 2023
Accepted for publication 2 August 2023
Published 16 August 2023 Volume 2023:16 Pages 2457—2467
DOI https://doi.org/10.2147/DMSO.S420824
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Dr Konstantinos Tziomalos
Qi Liu,1 Xiaoling Liao,1,2 Yuesong Pan,2 Xianglong Xiang,2 Yumei Zhang2,3
1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China; 2China National Clinical Research Center for Neurological Diseases, Beijing, People’s Republic of China; 3Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
Correspondence:
Yumei Zhang, Department of Rehabilitation Medicine, Beijing Tiantan
Hospital, Capital Medical University, No. 119 South 4th Ring West Road,
Fengtai District, Beijing, 100070, People’s Republic of China, Tel
+86-10-59975531, Email zhangyumei95@aliyun.com
Background:
Obesity is a risk factor for dementia within the old population however
not within the middle-aged population, that is referred to the “obesity
paradox”. This study explored the association of body mass index (BMI)
and waist circumference (WC) with post-stroke cognitive impairment
(PSCI) in middle-aged (40– 65 years) versus old population (≥ 65 years).
Methods:
The current study enrolled 1735 individuals over the age of 40 who had
their first ischemic stroke from the Impairment of Cognition and Sleep
(ICONS) subgroup of the China National Stroke Registry-3 (CNSR-3). BMI
and WC were used for the diagnosis of obesity and central obesity,
respectively. PSCI was diagnosed according to the Montreal Cognitive
Assessment (MoCA). The main clinical outcome was the incidence of PSCI
assessed at three months after stroke. Multivariable regression analysis
was performed to evaluate the association between obesity and
three-month PSCI. Stratified analysis was also performed to explore the
effect of age on the relationship between obesity and PSCI.
Results:
In the general population, multivariable logistic regression found that
the adjusted odds ratio (OR) with 95% confidence interval (CI) of
general obesity was 1.45 (1.06– 1.98) and that of central obesity was
1.54 (1.24– 1.91) for the three-month incidence of PSCI. Stratified
analysis by age showed that the adjusted OR with a 95% CI of general
obesity was 1.84 (1.24– 2.72) in middle-aged patients and 0.89 (0.52–
1.54) in elderly patients (p-value for interaction = 0.05). Central
obesity was associated with PSCI in all age groups: 1.57 (1.18– 2.09) in
middle-aged patients and 1.52 (1.08– 2.15) in elderly patients (p-value
for interaction= 0.93).
Conclusion: General obesity
was related to an increased risk of PSCI in middle-aged but not elderly
patients, whereas central obesity was associated with an increased risk
of PSCI in all age groups, suggesting that the obesity paradox arises
only obesity is outlined by BMI.
Keywords: post-stroke cognitive impairment, obesity paradox, ischemic stroke, middle-aged and elderly population, follow-up study
Introduction
Post-stroke cognitive impairment (PSCI) is a serious disability experienced by stroke survivors, and approximately one-third of stroke survivors develop cognitive impairment.1,2 Identifying and controlling risk factors for PSCI would play a pivotal role in prevention and intervention. The prevalence of obesity has risen rapidly in the past four decades and has been demonstrated to increase the risk of cognitive decline.3–5 However, some studies indicated that the impact of obesity on cognition varies by age6 In the middle-aged population, but not in the elderly population, overweight or obesity has been found to have a significant correlation with the heightened risk of experiencing cognitive decline.7,8 Contrary to common knowledge, some studies even found a positive effect of a higher body mass index (BMI) on cognition among elderly individuals.9–12 The unexpected phenomenon of improved cognitive function in individuals with obesity has been referred to as the “obesity paradox”, creating uncertainty regarding the impact of obesity on cognitive abilities.
Recently, several studies have explored whether stroke patients with obesity have impaired cognitive performance than normal weight patients.13,14 However, there is a lack of research on whether this relationship varies depending on age and whether the obesity paradox persists in patients with stroke. Additionally, previous studies have not explored the effects of central obesity on cognitive function. To investigate the impact of aging on fat distribution, previous studies have suggested that waist circumference (WC) is a more effective marker of adiposity than BMI in the elderly population.15 Thus, this study evaluated general obesity and central obesity using BMI and WC as adiposity markers, respectively. We hypothesized that the effect of obesity on PSCI may differ based on age. This study aimed to investigate the association between high BMI and large WC with PSCI in middle-aged (40–65) versus elderly patients (≥ 65 years) with minor stroke or transient ischemic attack (TIA). The meaning of this study lies in its provision of evidence for obesity management in stroke patients of different ages to prevent the occurrence of PSCI.
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