The ‘obesity paradox’: Weight gain during hospitalization for stroke may improve survival

Key takeaways:

• Those who survived hospitalization for intracerebral hemorrhage logged a mean 2.6 kg change in weight.
• There were no differences between outcome groups when the researchers accounted for hospitalization length.

ORLANDO, Fla. — For individuals hospitalized with intracerebral hemorrhage, increased caloric intake that led to an increase in weight was associated with higher odds of survival after 3 months, according to a poster.

“Although overweight patients are likely to have [intracerebral hemorrhage], they are also more likely to survive in comparison to patients who are underweight or normal weight,” Natasha Gupta, BA, a doctoral student at the University of Cincinnati College of Medicine, said at the American Neurological Association annual meeting.

Although data associating weight and survival rates for intracerebral hemorrhage (ICH) are limited, Gupta and colleagues hypothesized that, since ICH is a high-caloric event, patients with obesity or overweight may have a caloric reserve that allows them to survive stroke occurrence better. As such, increased caloric intake may improve survival rates regardless of weight, according to Gupta and colleagues.

The researchers examined data on spontaneous ICH cases from the Genetic and Environmental Risk Factors for Hemorrhaging Stroke study as well as the Ethnic/Racial Variations of Intracranial Hemorrhage study, conducted between 2008 and 2021.

The analysis included 86 individuals who were fed exclusively by tube and then underwent a 3-month follow-up examination. Patient weight was logged at initial hospital admission, during admission and at discharge, while malnutrition levels were estimated by serum albumin levels taken at admission. In addition, data on IV fluids as well as caloric intake were collected throughout the hospital stay.

The primary outcome metric was patient survival, which the researchers defined as either “good” (patient survived hospitalization) or “bad” (patient discharge to either hospice care or death).

According to the results, at the 3-month follow-up exam, 68 patients survived (mean age, 65.5 years; 23.5% Black) and 18 died (mean age, 73.3 years, 94.4% white).

A multivariate analysis revealed a significant correlation between weight gain during hospitalization and survival outcomes. Those who survived their ICH-related hospital stay recorded a mean difference of 2.6 kg, while those who were discharged to hospice or died recorded a difference of –0.3 kg.

Those who survived also consumed a higher median caloric intake over the course of the hospitalization compared with those in hospice or who were deceased (1,831.4 vs. 1611.6)

However, when the researchers accounted for length of hospital stay, no significant differences were found between outcome groups with respect to association between caloric intake and survival. Additionally, data did not reveal any association between serum albumin levels and survival rates.

Gupta hypothesized that since individuals with obesity or who are overweight produce a higher level of estrogen, which is known to have neuroprotective effects, survival rates in ICH are better than those of lower weight.

“It is possible that greater calories were needed to be able to see that difference in survival,” Gupta noted. “It is also possible that there are other explanations in the obesity paradox.”