Wei Sheng Lun, Chiu Kuan Lin
The Department of Family Medicine, Taipei Medical University Hospital, # No. 252, Wuxing St., Xinyi Dist., Taipei City 110301, Taiwan, ROC.
The Department of Family Medicine, Taipei Medical University Hospital, # No. 252, Wuxing St., Xinyi Dist., Taipei City 110301, Taiwan, ROC.
Obes Res Clin Pract. 2025 May-Jun;19(3):202-213. doi: 10.1016/j.orcp.2025.05.003. Epub 2025 May 12.
This updated systematic review and meta-analysis aimed to re-evaluate the potential impact of body mass index (BMI) on the risk of recurrent stroke among stroke survivors.
We systematically searched PubMed, EMBASE, and Cochrane CENTRAL databases for studies published up to January 20, 2025. Eligible studies included randomized controlled trials, cohort studies, or case-control studies enrolling adult stroke or transient ischemic attack (TIA) survivors, with at least one year of follow-up, and reporting stroke recurrence by BMI categories. Studies were required to define stroke using clinical diagnosis or the International Classification of Disease (ICD) codes, and to categorize BMI using the World Health Organization (WHO) or Asia-Pacific classifications. The primary outcome was recurrent stroke risk between individuals with and without obesity, assessed using risk ratios (RRs). Secondary outcomes evaluated recurrent stroke risk across WHO BMI categories using adjusted hazard ratios (HRs). (PROSPERO: CRD42024580168) RESULTS: Fourteen studies (136,581 subjects) were included in the qualitative review (systematic review). Two using Asia-Pacific criteria were excluded, leaving 12 studies using WHO-classified BMI for quantitative synthesis (meta-analysis). Meta-analysis showed no significant difference in stroke recurrence between individuals with and without obesity (RR = 0.89, 95 % CI: 0.71-1.13). Meta-analysis of adjusted HRs showed no significant difference in stroke recurrence risk for individuals with underweight or overweight compared to those with normal weight. However, in the subgroup with ≥ 3 years follow-up, overweight was significantly associated with lower recurrent stroke risk (HR = 0.91). Also, individuals with obesity had a significantly lower stroke recurrence risk than normal weight individuals (HR = 0.85), particularly among those aged ≥ 65 years (HR = 0.82).
Overweight and obesity may be associated with a lower risk of stroke recurrence, particularly in older adults and during long-term follow-up (≥ 3 years). These findings suggest a potential obesity paradox in stroke survivors, warranting further investigations.
本更新的系统评价和荟萃分析旨在重新评估体重指数（BMI）对卒中幸存者复发性卒中风险的潜在影响。
我们系统检索了截至2025年1月20日发表的PubMed、EMBASE和Cochrane CENTRAL数据库中的研究。符合条件的研究包括随机对照试验、队列研究或病例对照研究，纳入成年卒中或短暂性脑缺血发作（TIA）幸存者，随访至少一年，并按BMI类别报告卒中复发情况。研究要求使用临床诊断或国际疾病分类（ICD）编码定义卒中，并使用世界卫生组织（WHO）或亚太地区分类对BMI进行分类。主要结局是肥胖和非肥胖个体之间的复发性卒中风险，使用风险比（RRs）进行评估。次要结局使用调整后的风险比（HRs）评估WHO BMI类别之间的复发性卒中风险。（国际前瞻性系统评价注册库：CRD42024580168）结果：定性评价（系统评价）纳入了14项研究（136,581名受试者）。两项使用亚太地区标准的研究被排除，剩下12项使用WHO分类BMI的研究进行定量综合分析（荟萃分析）。荟萃分析显示，肥胖和非肥胖个体之间的卒中复发无显著差异（RR = 0.89，95% CI：0.71 - 1.13）。调整后HRs的荟萃分析显示，体重过轻或超重个体与正常体重个体相比，卒中复发风险无显著差异。然而，在随访≥3年的亚组中，超重与较低的复发性卒中风险显著相关（HR = 0.91）。此外，肥胖个体的卒中复发风险显著低于正常体重个体（HR = 0.85），尤其是在年龄≥65岁的人群中（HR = 0.82）。
超重和肥胖可能与较低的卒中复发风险相关，尤其是在老年人和长期随访（≥3年）期间。这些发现提示卒中幸存者中可能存在肥胖悖论，值得进一步研究。
