Association Between Body Mass Index and Intracranial Aneurysm Rupture: A Multicenter Retrospective Study

Sifang Chen; Jianyao Mao; Xi Chen; Zhangyu Li; Zhi Zhu; Yukui Li; Zhengye Jiang; Wenpeng Zhao; Zhanxiang Wang; Ping Zhong; Qinghai Huang

doi:10.3389/fnagi.2021.716068

Association Between Body Mass Index and Intracranial Aneurysm Rupture: A Multicenter Retrospective Study

Front Aging Neurosci. 2021 Aug 16:13:716068. doi: 10.3389/fnagi.2021.716068. eCollection 2021.

Authors

Sifang Chen¹, Jianyao Mao¹, Xi Chen¹, Zhangyu Li¹, Zhi Zhu², Yukui Li¹, Zhengye Jiang¹, Wenpeng Zhao¹, Zhanxiang Wang^{3

4}, Ping Zhong⁵, Qinghai Huang⁶

Affiliations

¹ Department of Neurosurgery, The First Affiliated Hospital of Xiamen University, Xiamen, China.
² Department of Neurosurgery, Heze Municipal Hospital, Heze, China.
³ Department of Neurosurgery, Xiamen Key Laboratory of Brain Center, The First Affiliated Hospital of Xiamen University, Xiamen, China.
⁴ Department of Neuroscience, School of Medicine, Institute of Neurosurgery, Xiamen University, Xiamen, China.
⁵ BE and Phase I Clinical Trial Center, The First Affiliated Hospital of Xiamen University, Xiamen, China.
⁶ Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai, China.

Abstract

Background and Aims: It has recently emerged the concept of "obesity paradox," a term used to describe an inverse association between obesity and clinical outcomes in cardiovascular diseases and stroke. The purpose of this study was to investigate the association between body mass index (BMI) and the risk of intracranial aneurysm rupture. Methods: In this study, we conducted a retrospective analysis of a prospectively maintained database of patients with intracranial aneurysms from 21 medical centers in China. A total of 3,965 patients with 4,632 saccular intracranial aneurysms were enrolled. Patients were separated into unruptured (n = 1,977) and ruptured groups (n = 1,988). Univariable and multivariable logistic regression analyses were performed to determine the association between BMI and intracranial aneurysm rupture. Results: Compared to the patients with normal BMI (18.5 to < 24.0 kg/m²), the odds of intracranial aneurysm rupture were significantly lower in patients with BMI 24.0 to < 28.0 kg/m² (OR = 0.745, 95% CI = 0.638-0.868, P = 0.000) and patients with BMI ≥ 28.0 kg/m² (OR = 0.628, 95% CI = 0.443-0.890, P = 0.009). Low BMI (<18.0 kg/m²) was not associated with intracranial aneurysm rupture (OR = 0.894, 95% CI = 0.483-1.657, P = 0.505). For males, both the BMI 24.0 to < 28.0 kg/m² (OR = 0.606, 95% CI = 0.469-0.784, P = 0.000) and the BMI ≥ 28.0 kg/m² (OR = 0.384, 95% CI = 0.224-0.658, P = 0.001) were associated with a lower rupture risk, whereas the inverse association was not observed in females. Both the BMI 24.0 to < 28.0 kg/m² (OR = 0.722 for aged 50-60y, 95% CI = 0.554-0.938, P = 0.015; OR = 0.737 for aged >60y, 95% CI = 0.586-0.928, P = 0.009) and the BMI ≥ 28.0 kg/m² (OR = 0.517 for aged 50-60y, 95% CI = 0.281-0.950, P = 0.0034; OR = 0.535 for aged >60y, 95% CI = 0.318-0.899, P = 0.0018) was associated with a lower rupture risk in patients aged ≥50 years, whereas the association was not significant in patients aged <50 years. Conclusions: Increased BMI is significantly and inversely associated with saccular intracranial aneurysm rupture in males and patients aged ≥50 years.

Keywords: body mass index; cerebrovascular disease; intracranial aneurysms; stroke; subarachnoid hemorrhage.