Kim Pum-Jun, Kim Chulho, Lee Sang-Hwa, Shon Jong-Hee, Kwon Youngsuk, Kim Jong-Ho, Kim Dong-Kyu, Yu Hyunjae, Ahn Hyo-Jeong, Jeon Jin-Pyeong, Kim Youngmi, Lee Jae-Jun
Institute of New Frontier Research Team, Hallym University College of Medicine, Chuncheon 24252, Korea.
Department of Neurology, Chuncheon Sacred Heart Hospital, Chuncheon 24253, Korea.
J Pers Med. 2021 Dec 29;12(1):16. doi: 10.3390/jpm12010016.
Though obesity is generally associated with the development of cardiovascular disease (CVD) risk factors, previous reports have also reported that obesity has a beneficial effect on CVD outcomes. We aimed to verify the existing obesity paradox through binary logistic regression (BLR) and clarify the paradox via association rule mining (ARM). Patients with acute ischemic stroke (AIS) were assessed for their 3-month functional outcome using the modified Rankin Scale (mRS) score. Predictors for poor outcome (mRS 3-6) were analyzed through BLR, and ARM was performed to find out which combination of risk factors was concurrently associated with good outcomes using maximal support, confidence, and lift values. Among 2580 patients with AIS, being obese (OR [odds ratio], 0.78; 95% CI, 0.62-0.99) had beneficial effects on the outcome at 3 months in BLR analysis. In addition, the ARM algorithm showed obese patients with good outcomes were also associated with an age less than 55 years and mild stroke severity. While BLR analysis showed a beneficial effect of obesity on stroke outcome, in ARM analysis, obese patients had a relatively good combination of risk factor profiles compared to normal BMI patients. These results may partially explain the obesity paradox phenomenon in AIS patients.
尽管肥胖通常与心血管疾病（CVD）危险因素的发展相关，但先前的报告也指出肥胖对CVD结局有有益影响。我们旨在通过二元逻辑回归（BLR）验证现有的肥胖悖论，并通过关联规则挖掘（ARM）阐明该悖论。使用改良Rankin量表（mRS）评分评估急性缺血性卒中（AIS）患者的3个月功能结局。通过BLR分析不良结局（mRS 3 - 6）的预测因素，并进行ARM以找出哪些危险因素组合同时与良好结局相关，使用最大支持度、置信度和提升值。在2580例AIS患者中，在BLR分析中，肥胖（比值比[OR]，0.78；95%置信区间，0.62 - 0.99）对3个月时的结局有有益影响。此外，ARM算法显示结局良好的肥胖患者还与年龄小于55岁和卒中严重程度较轻相关。虽然BLR分析显示肥胖对卒中结局有有益影响，但在ARM分析中，与正常体重指数患者相比，肥胖患者的危险因素概况组合相对较好。这些结果可能部分解释了AIS患者中的肥胖悖论现象。
