Neurology Unit, IRCCS "Sacro Cuore-Don Calabria" Hospital, Via don A. Sempreboni, 5, 37024, Negrar, Verona, Italy.
Stroke Unit, Department of Neuroscience, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
Eat Weight Disord. 2021 Mar;26(2):417-423. doi: 10.1007/s40519-020-00876-w. Epub 2020 Mar 2.
Despite obesity is an established risk factor for stroke, several studies reported a better outcome after stroke in obese and overweight patients. This counterintuitive finding, which was described in the whole spectrum of cardiovascular diseases, is known as obesity paradox.
This is a narrative overview on the obesity paradox and stroke.
We used as sources MEDLINE/PubMed, CINAHL, EMBASE, and Cochrane Library from inception to 2019, and selected papers that discussed the association of obesity with outcome and mortality after stroke.
The majority of studies reported lower mortality rates and better functional outcome after stroke in obese and overweight patients compared with normal weight and underweight patients, suggesting the existence of an obesity paradox in stroke. However, available studies are limited by several major methodological concerns including absence of randomized trials, retrospective nature of most studies, assessment of obesity with body mass index (BMI), non-linear relationship between BMI and outcome, short follow-up period, and differences in co-morbid conditions and stroke characteristics.
The existence of an obesity paradox in stroke is still controversial and further higher quality evidence is needed to clarify the relationship between obesity and stroke outcome.
Level V, narrative review.
尽管肥胖是中风的既定危险因素，但有几项研究报告称，肥胖和超重患者中风后的预后更好。这种与直觉相悖的现象在整个心血管疾病谱中都有描述，被称为肥胖悖论。
本文对肥胖悖论与中风进行了综述。
我们检索了 MEDLINE/PubMed、CINAHL、EMBASE 和 Cochrane Library 从建库到 2019 年的资料，选择了讨论肥胖与中风后结局和死亡率之间关系的论文。
大多数研究报告称，与正常体重和体重不足的患者相比，肥胖和超重患者的死亡率较低，功能预后较好，提示中风存在肥胖悖论。然而，现有研究受到几个主要方法学问题的限制，包括缺乏随机试验、大多数研究的回顾性、使用体重指数（BMI）评估肥胖、BMI 与结局之间的非线性关系、随访时间短，以及合并症和中风特征的差异。
中风中肥胖悖论的存在仍然存在争议，需要进一步高质量的证据来阐明肥胖与中风结局之间的关系。
五级，叙述性综述。
