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Body weight after stroke: lessons from the obesity paradox.

Abstract

BACKGROUND AND PURPOSE

Outcome after acute stroke is determined to a large extent by poststroke complications. Nutritional status and metabolic balance may substantially contribute to outcome after stroke. Key mechanisms of stroke pathophysiology can induce systemic catabolic imbalance with impaired metabolic efficiency and degradation of body tissues.

SUMMARY

Tissue wasting, sarcopenia, and cachexia may impair and delay poststroke rehabilitation and worsen the prognosis. Although current guidelines for secondary prevention after stroke recommend weight reduction, increasing evidence suggests that patients who are overweight and mildly obese may actually have a better outcome. An "obesity paradox" has been identified to describe the contrasting impact of being overweight in patients with chronic illness compared with healthy populations. We present an overview on the metabolic regulation in patients with stroke and evaluate current data on the impact of body weight and weight change after stroke. The emerging picture suggests that being overweight and obese may impact patients with stroke differently than it does healthy subjects.

CONCLUSIONS

We propose that current knowledge on obesity and its management in primary prevention cannot be transferred to patients with established stroke. Systematic studies on changes in body composition after stroke and on treatment options are warranted to establish the pathophysiology and evidence-driven management of nutritional status in these patients.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Center for Stroke Research Berlin, Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.

    ,

    Source

    Stroke 42:12 2011 Dec pg 3646-50

    MeSH

    Body Mass Index
    Body Weight
    Humans
    Obesity
    Stroke

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    21960580

    Citation

    Scherbakov, Nadja, et al. "Body Weight After Stroke: Lessons From the Obesity Paradox." Stroke, vol. 42, no. 12, 2011, pp. 3646-50.
    Scherbakov N, Dirnagl U, Doehner W. Body weight after stroke: lessons from the obesity paradox. Stroke. 2011;42(12):3646-50.
    Scherbakov, N., Dirnagl, U., & Doehner, W. (2011). Body weight after stroke: lessons from the obesity paradox. Stroke, 42(12), pp. 3646-50. doi:10.1161/STROKEAHA.111.619163.
    Scherbakov N, Dirnagl U, Doehner W. Body Weight After Stroke: Lessons From the Obesity Paradox. Stroke. 2011;42(12):3646-50. PubMed PMID: 21960580.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Body weight after stroke: lessons from the obesity paradox. AU - Scherbakov,Nadja, AU - Dirnagl,Ulrich, AU - Doehner,Wolfram, Y1 - 2011/09/29/ PY - 2011/10/1/entrez PY - 2011/10/1/pubmed PY - 2012/8/14/medline SP - 3646 EP - 50 JF - Stroke JO - Stroke VL - 42 IS - 12 N2 - BACKGROUND AND PURPOSE: Outcome after acute stroke is determined to a large extent by poststroke complications. Nutritional status and metabolic balance may substantially contribute to outcome after stroke. Key mechanisms of stroke pathophysiology can induce systemic catabolic imbalance with impaired metabolic efficiency and degradation of body tissues. SUMMARY: Tissue wasting, sarcopenia, and cachexia may impair and delay poststroke rehabilitation and worsen the prognosis. Although current guidelines for secondary prevention after stroke recommend weight reduction, increasing evidence suggests that patients who are overweight and mildly obese may actually have a better outcome. An "obesity paradox" has been identified to describe the contrasting impact of being overweight in patients with chronic illness compared with healthy populations. We present an overview on the metabolic regulation in patients with stroke and evaluate current data on the impact of body weight and weight change after stroke. The emerging picture suggests that being overweight and obese may impact patients with stroke differently than it does healthy subjects. CONCLUSIONS: We propose that current knowledge on obesity and its management in primary prevention cannot be transferred to patients with established stroke. Systematic studies on changes in body composition after stroke and on treatment options are warranted to establish the pathophysiology and evidence-driven management of nutritional status in these patients. SN - 1524-4628 UR - https://www.unboundmedicine.com/medline/citation/21960580/full_citation L2 - http://www.ahajournals.org/doi/full/10.1161/STROKEAHA.111.619163?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -