U-shaped Relationship Between Body Mass Index and Intracerebral Hemorrhage-Related Functional Decline

Abstract

ABSTRACTBACKGROUNDIntracerebral hemorrhage (ICH) has a high mortality rate, and even if patients survive, they are likely to have severe disability. Body mass index (BMI) is associated with ICH risk, and extremely low and high BMIs are associated with the site of ICH, which affects functional decline. However, few reports exist on ICH-related functional decline and BMI. This study aimed to clarify the relationship between BMI and stroke-related disability of patients with ICH.METHODSPatients with ICH registered in the Japanese Registry Of All Cardiac and Vascular Diseases Diagnosis Procedure Combination (JROAD-DPC) database from April 2016 to March 2020 were included. BMI was defined according to the World Health Organization Asia-Pacific classification. Functional disability was assessed using the modified Rankin Scale (mRS). ICH-related functional decline was defined as an increase in mRS score at discharge compared with that of the pre-stroke assessment.RESULTSThis study included 155,211 patients with ICH whose median age was 72.0 years and mean BMI was 22.3 kg/m2. The ratio of patients with ICH who experience functional decline was 74.9%. The spline curve between BMI and ICH-related functional decline was U-shaped, revealing that the Normal to Obese I BMI groups (BMI: 22.2–30.4 kg/m2) exhibited reduced odds ratios for ICH-related functional decline. Hospitalization cost and BMI showed similar U-shaped patterns, with a BMI of 25.0 kg/m2as the lowest point, regardless of age group.CONCLUSIONIn patients with ICH, those with both extremely low and high BMIs were more likely to experience functional decline after ICH onset, which resulted in increased hospitalization costs. To reduce ICH-related functional decline, patients should be managed at a normal to slightly obese BMI.