The obesity paradox in intracerebral hemorrhage: a systematic review and meta-analysis

Zexu Wang; Jie Wang; Jiayan Wang; Yinghua Liao; Xin Hu; Manni Wang

doi:10.3389/fendo.2023.1255538

The obesity paradox in intracerebral hemorrhage: a systematic review and meta-analysis

Front Endocrinol (Lausanne). 2023 Nov 29:14:1255538. doi: 10.3389/fendo.2023.1255538. eCollection 2023.

Authors

Zexu Wang^#¹, Jie Wang^#², Jiayan Wang¹, Yinghua Liao¹, Xin Hu¹, Manni Wang³

Affiliations

¹ Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
² Department of Hematology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
³ Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.

^# Contributed equally.

Abstract

Background: Intracerebral hemorrhage (ICH) has a mortality rate which can reach 30-40%. Compared with other diseases, obesity is often associated with lower mortality; this is referred to as the 'obesity paradox'. Herein, we aimed to summarize the studies of the relations between obesity and mortality after ICH.

Method: For this systematic review and meta-analysis (PROSPERO registry CRD42023426835), we conducted searches for relevant articles in both PubMed and Embase. Non-English language literature, irrelevant literature, and non-human trials were excluded. All included publications were then qualitatively described and summarized. Articles for which quantitative analyses were possible were evaluated using Cochrane's Review Manager.

Results: Ten studies were included. Qualitative analysis revealed that each of the 10 studies showed varying degrees of a protective effect of obesity, which was statistically significant in 8 of them. Six studies were included in the quantitative meta-analysis, which showed that obesity was significantly associated with lower short-term (0.69 [0.67, 0.73], p<0.00001) and long-term (0.62 [0.53, 0.73], p<0.00001) mortality. (Data identified as (OR [95%CI], p)).

Conclusion: Obesity is likely associated with lower post-ICH mortality, reflecting the obesity paradox in this disease. These findings support the need for large-scale trials using standardized obesity classification methods.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023426835, identifier CRD42023426835.

Keywords: intracerebral hemorrhage; mortality; obesity; obesity paradox; stroke.

Publication types

Meta-Analysis
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Cerebral Hemorrhage* / complications
Cerebral Hemorrhage* / epidemiology
Humans
Obesity / complications
Obesity Paradox*
Registries

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by the 1.3.5 Projects for Disciplines of Excellence of West China Hospital of Sichuan University (grant numbers: ZY2016102 and 2021HXFH045).