Skip to main content

Advertisement

SpringerLink
Log in

The relationship between body mass index and stroke: a systemic review and meta-analysis

  • Review
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

Background

Stroke is an acute cerebrovascular event closely related to brain tissue damage, and is one of the major causes of death and disability in worldwide. Various studies have reported the effects of body mass index (BMI) on the risk of stroke, but the results remain varied and these results have not been synthesized. Therefore, a meta-analysis was performed to evaluate the relationship between BMI and the risk of stroke.

Objectives

This systematic review was conducted to explore the relationship between BMI and the risk of stroke.

Methods

PubMed, EMBASE, Web of Science and Cochrane Library, China Knowledge Resource Integrated Database (CNKI), WanFang Database, Chinese Biomedical Database (CBM), and CQVIP were comprehensively searched for studies exploring the relationship between BMI and stroke from inception to December 1, 2021.

Results

This review included 24 studies involving 5,798,826 subjects. The results of meta-analysis showed that the pooled RR of stroke risk was 0.93 (95% confidence interval [CI] 0.82–1.06, I2 = 88.8%, P = 0.29) for the underweight group. Higher BMI (overweight or obese group) was associated with an increased overall risk of stroke, with pooled RR values of 1.25 (95% CI 1.16–1.34, I2 = 84.8%, P = 0.00) and 1.47 (95% CI: 1.02–2.11, I2 = 99.4%, P = 0.04).

Conclusion

The risk of stroke was positively correlated with BMI, and the association was stronger in male and ischemic stroke. Lowering BMI can be used as a way to prevent stroke, and for people who are overweight or obese, lowering body weight can reduce the risk of stroke.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Sacco RL, Kasner SE, Broderick JP et al (2013) An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association [J]. Stroke 44(7):2064–2089

    Article  PubMed  Google Scholar 

  2. Lackland DT, Roccella EJ, Deutsch AF et al (2014) Factors influencing the decline in stroke mortality: a statement from the American Heart Association/American Stroke Association [J]. Stroke 45(1):315–353

    Article  PubMed  Google Scholar 

  3. Feigin VL, Norrving B, Mensah GA (2017) Global Burden of Stroke [J]. Circ Res 120(3):439–448

    Article  CAS  PubMed  Google Scholar 

  4. Abbafati C, Abbas KM, Abbasi M et al (2020) Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 396(10258):1204–1222

    Google Scholar 

  5. Strong K, Mathers C, Bonita R (2007) Preventing stroke: saving lives around the world [J]. Lancet Neurol 6(2):182–187

    Article  PubMed  Google Scholar 

  6. O’Donnell MJ, Chin SL, Rangarajan S et al (2016) Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study [J]. Lancet 388(10046):761–775

    Article  PubMed  Google Scholar 

  7. Seravalle G, Grassi G (2017) Obesity and hypertension [J]. Pharmacol Res 122:1–7

    Article  CAS  PubMed  Google Scholar 

  8. La Sala L, Pontiroli AE (2020) Prevention of diabetes and cardiovascular disease in obesity [J]. Int J Mol Sci 21(21):8178

    Article  CAS  PubMed Central  Google Scholar 

  9. Virani SS, Alonso A, Benjamin EJ et al (2020) Heart disease and stroke statistics-2020 update: a report from the American Heart Association [J]. Circulation 141(9):e139–e596

    Article  PubMed  Google Scholar 

  10. Guo Y, Yue XJ, Li HH et al (2016) Overweight and obesity in young adulthood and the risk of stroke: a meta-analysis [J]. J Stroke Cerebrovasc Dis 25(12):2995–3004

    Article  PubMed  Google Scholar 

  11. Abete I, Arriola L, Etxezarreta N et al (2015) Association between different obesity measures and the risk of stroke in the EPIC Spanish cohort [J]. Eur J Nutr 54(3):365–375

    Article  PubMed  Google Scholar 

  12. Ohlsson C, Bygdell M, Sondén A et al (2017) BMI increase through puberty and adolescence is associated with risk of adult stroke [J]. Neurology 89(4):363–369

    Article  PubMed  PubMed Central  Google Scholar 

  13. Yao Y, Lin J, Xu K (2010) Effects of BMI on ischaemic stroke in hospital patients with essential hypertension [J]. Heart 96:A185–A186

    Article  Google Scholar 

  14. Hills NK, Johnston SC, Sidney S et al (2010) Is BMI related to stroke in children? [J]. Stroke 41(4):E323–E324

    Google Scholar 

  15. Bardugo A, Fishman B, Libruder C et al (2021) Body mass index in 1.9 million adolescents and stroke in young adulthood [J]. Stroke 52(6):2043–2052

    Article  PubMed  Google Scholar 

  16. Jood K, Jern C, Wilhelmsen L et al (2004) Body mass index in mid-life is associated with a first stroke in men: a prospective population study over 28 years [J]. Stroke 35(12):2764–2769

    Article  PubMed  Google Scholar 

  17. Song YM, Sung J, Smith GD et al (2004) Body mass index and ischemic and hemorrhagic stroke—a prospective study in Korean men [J]. Stroke 35(4):831–836

    Article  PubMed  Google Scholar 

  18. Hu G, Sarti C, Jousilahti P et al (2005) Leisure time, occupational, and commuting physical activity and the risk of stroke [J]. Stroke 36(9):1994–1999

    Article  PubMed  Google Scholar 

  19. Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration [J]. BMJ 339:b2700

    Article  PubMed  PubMed Central  Google Scholar 

  20. Stang A (2010) Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses [J]. Eur J Epidemiol 25(9):603–605

    Article  PubMed  Google Scholar 

  21. Andersen KK, Olsen TS (2015) The obesity paradox in stroke: lower mortality and lower risk of readmission for recurrent stroke in obese stroke patients [J]. Int J Stroke 10(1):99–104

    Article  PubMed  Google Scholar 

  22. Bazzano LA, Gu D, Whelton MR et al (2010) Body mass index and risk of stroke among Chinese men and women [J]. Ann Neurol 67(1):11–20

    Article  PubMed  PubMed Central  Google Scholar 

  23. Crump C, Sundquist J, Winkleby MA et al (2016) Interactive effects of physical fitness and body mass index on risk of stroke: a national cohort study [J]. Int J Stroke 11(6):683–694

    Article  PubMed  PubMed Central  Google Scholar 

  24. Dey DK, Rothenberg E, Sundh V et al (2002) Waist circumference, body mass index, and risk for stroke in older people: a 15 year longitudinal population study of 70-year-old [J]. J Am Geriatr Soc 50(9):1510–1518

    Article  PubMed  Google Scholar 

  25. Falkstedt D, Hemmingsson T, Rasmussen F et al (2007) Body mass index in late adolescence and its association with coronary heart disease and stroke in middle age among Swedish men [J]. Int J Obes 31(5):777–783

    Article  CAS  Google Scholar 

  26. Hu G, Tuomilehto J, Silventoinen K et al (2007) Body mass index, waist circumference, and waist-hip ratio on the risk of total and type-specific stroke [J]. Arch Intern Med 167(13):1420–1427

    Article  PubMed  Google Scholar 

  27. Kawate N, Kayaba K, Hara M et al (2017) Body mass index and stroke incidence in Japanese community residents: the Jichi Medical School (JMS) Cohort Study [J]. J Epidemiol 27(7):325–330

    Article  PubMed  PubMed Central  Google Scholar 

  28. Kurth T, Berger K, Kase CS et al (2002) Body mass index and the risk of stroke in men [J]. Arch Intern Med 162(22):2557–2562

    Article  PubMed  Google Scholar 

  29. Kurth T, Gaziano JM, Rexrode KM et al (2005) Prospective study of body mass index and risk of stroke in apparently healthy women [J]. Circulation 111(15):1992–1998

    Article  PubMed  Google Scholar 

  30. Park JW, Lee SY, Kim SY et al (2008) BMI and stroke risk in Korean women [J]. Obesity (Silver Spring, Md) 16(2):396–401

    Article  Google Scholar 

  31. Rexrode KM, Hennekens CH, Willett WC et al (1997) A prospective study of body mass index, weight change, and risk of stroke in women [J]. JAMA 277(19):1539–1545

    Article  CAS  PubMed  Google Scholar 

  32. Wang C, Liu Y, Yang Q et al (2013) Body mass index and risk of total and type-specific stroke in Chinese adults: results from a longitudinal study in China [J]. Int J Stroke 8(4):245–250

    Article  PubMed  Google Scholar 

  33. Yonemoto K, Doi Y, Hata J et al (2011) Body mass index and stroke incidence in a Japanese community: the Hisayama study [J]. Hypertens Res 34(2):274–279

    Article  PubMed  Google Scholar 

  34. 赵连成, 武阳丰, 周北凡, et al. (2002) 体质指数与冠心病、脑卒中发病的前瞻性研究 %J 中华心血管病杂志 [J]. (07): 49–52

  35. He J, Gu DF, Reynolds K et al (2006) Overweight and risk of stroke in China: a prospective study of 169,871 men and women [J]. Circulation 113(8):E314

    Google Scholar 

  36. Chen WQ, Pan YS, Jing J et al (2019) Association of Body Mass Index and risk of stroke after acute minor stroke or TIA: a post hoc analysis of a randomized controlled trial [J]. Neurotox Res 36(4):836–843

    Article  CAS  PubMed  Google Scholar 

  37. Wannamethee SG, Shaper AG, Whincup PH et al (2013) Adiposity, adipokines, and risk of incident stroke in older men [J]. Stroke 44(1):3–8

    Article  CAS  PubMed  Google Scholar 

  38. 赫鹏, 孙文慧, 马翠, et al. (2012) 中青年体质指数、腰围及腰臀比与脑卒中发生的相关性研究 %J 中国全科医学 [J]. 15(17): 1924–7+31

  39. 皇甫春梅, 于俊杏, 赵华玲, et al. (2018) 体质量指数与脑梗死的相关性研究 %J 山西医药杂志 [J] 47(09): 987–990

  40. 姜立清, 孙兆青, 郑黎强, et al (2007) 辽宁农民体重指数 腰围与脑卒中患病关系的流行病学调查 %J 山西医药杂志 [J] (10): 870–873

  41. 马翠, 李岩, 李熙东, et al (2013) 不同肥胖指标及糖尿病与缺血性脑卒中关系 %J 中国公共卫生 %J Chin J Public Health [J] 29(10): 1502–1505

  42. Shiozawa M, Kaneko H, Itoh H et al (2021) Association of Body Mass Index with ischemic and hemorrhagic stroke [J]. Nutrients 13(7):2343

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Huang J, Liu L, Yu YL et al (2021) Relationship between body mass index and ischaemic stroke in Chinese elderly hypertensive patients [J]. Postgrad Med J 97(1146):217–221

    PubMed  Google Scholar 

  44. Zhang P, Yan XL, Qu Y et al (2021) Association between abnormal body weight and stroke outcome: a meta-analysis and systematic review [J]. Eur J Neurol 28(8):2552–2564

    Article  PubMed  Google Scholar 

  45. Kwon H, Yun JM, Park JH et al (2021) Incidence of cardiovascular disease and mortality in underweight individuals [J]. J Cachexia Sarcopenia Muscle 12(2):331–338

    Article  PubMed  PubMed Central  Google Scholar 

  46. Li CW, Yu K, Shyh-Chang N et al (2019) Circulating factors associated with sarcopenia during ageing and after intensive lifestyle intervention [J]. J Cachexia Sarcopenia Muscle 10(3):586–600

    Article  PubMed  PubMed Central  Google Scholar 

  47. Du Y, Oh C, No J (2018) Associations between sarcopenia and metabolic risk factors: a systematic review and meta-analysis [J]. J Obes Metab Syndr 27(3):175–185

    Article  PubMed  PubMed Central  Google Scholar 

  48. Adabag S, Vo TN, Langsetmo L et al (2018) Frailty as a risk factor for cardiovascular versus noncardiovascular mortality in older men: results from the MrOS sleep (outcomes of sleep disorders in older men) study [J]. J Am Heart Assoc. https://doi.org/10.1161/JAHA.118.008974

    Article  PubMed  PubMed Central  Google Scholar 

  49. Veronese N, Sigeirsdottir K, Eiriksdottir G et al (2017) Frailty and risk of cardiovascular diseases in older persons: the age, gene/environment susceptibility-Reykjavik study [J]. Rejuvenation Res 20(6):517–524

    Article  PubMed  PubMed Central  Google Scholar 

  50. Lu M, Ye W, Adami HO et al (2006) Prospective study of body size and risk for stroke amongst women below age 60 [J]. J Intern Med 260(5):442–450

    Article  CAS  PubMed  Google Scholar 

  51. Pajunen P, Jousilahti P, Borodulin K et al (2011) Body fat measured by a near-infrared interactance device as a predictor of cardiovascular events: the FINRISK’92 cohort [J]. Obesity (Silver Spring, Md) 19(4):848–852

    Article  Google Scholar 

  52. Yatsuya H, Folsom AR, Yamagishi K et al (2010) Race- and sex-specific associations of obesity measures with ischemic stroke incidence in the Atherosclerosis Risk in Communities (ARIC) study [J]. Stroke 41(3):417–425

    Article  PubMed  PubMed Central  Google Scholar 

  53. Strazzullo P, D’Elia L, Cairella G et al (2008) Systematic review of the effects of excess body weight and obesity on the incidence of ischemic and Hemorrhagic stroke [J]. Circulation 118(18):S915–S916

    Google Scholar 

  54. Zhang X, Shu XO, Gao YT et al (2009) General and abdominal adiposity and risk of stroke in Chinese women [J]. Stroke 40(4):1098–1104

    Article  PubMed  PubMed Central  Google Scholar 

  55. 内山真一郎, 赵美眯 (2004) 肥胖与脑缺血 [J]. 日本医学介绍, (03): 130–131

  56. Li Y, Yatsuya H, Iso H et al (2019) Body Mass Index and risks of incident ischemic stroke subtypes: the Japan Public Health Center-based prospective (JPHC) study [J]. J Epidemiol 29(9):325–333

    Article  PubMed  PubMed Central  Google Scholar 

  57. Lovren F, Teoh H, Verma S (2015) Obesity and atherosclerosis: mechanistic insights [J]. Can J Cardiol 31(2):177–183

    Article  PubMed  Google Scholar 

  58. Aguilar-Valles A, Inoue W, Rummel C et al (2015) Obesity, adipokines and neuroinflammation [J]. Neuropharmacology 96(Pt A):124–134

    Article  CAS  PubMed  Google Scholar 

  59. Kernan WN, Inzucchi SE, Sawan C et al (2013) Obesity: a stubbornly obvious target for stroke prevention [J]. Stroke 44(1):278–286

    Article  PubMed  Google Scholar 

Download references

Funding

This study was supported by [Natural Science Foundation of Gansu Province] (Grant Numbers [20JR10RA603]), [The Fundamental Research Funds for the Central Universities] (Grant Numbers [lzujbky-2020-10, lzujbky-2021-33]), [National Research Training Program of Gansu provincial hospital] (Grant Numbers [19SYPYA-4]), [The Research Funds for the school of nursing of Lanzhou University] (Grant Numbers [LZUSON202002]) and [National Social Science Foundation Project] (Grant Numbers [20CGL053]).

Author information

Author notes

  1. Xinyu Wang and Yanan Huang contributed equally to this work and should be considered co-first authors.

Authors and Affiliations

  1. Evidence-Based Nursing Center, School of Nursing of Lanzhou University, Lanzhou, China

    Xinyu Wang, Yanan Huang, Yanru Chen, Tingting Yang, Wenli Su, Xiaoli Chen, Fanghong Yan, Lin Han & Yuxia Ma

  2. Department of Nursing, Gansu Provincial Hospital, Lanzhou, Gansu Province, China

    Xiaoli Chen, Lin Han & Yuxia Ma

  3. School of Nursing, Lanzhou University, No.28, West Yan Road, Chengguan District, Lanzhou, Gansu Province, China

    Xinyu Wang, Yanan Huang, Yanru Chen, Tingting Yang, Wenli Su, Xiaoli Chen, Fanghong Yan, Lin Han & Yuxia Ma

Authors
  1. Xinyu Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yanan Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yanru Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tingting Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wenli Su
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xiaoli Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Fanghong Yan
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Lin Han
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yuxia Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by XW, YH, YC, TY, WS, and XC. The first draft of the manuscript was written by XW and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Lin Han or Yuxia Ma.

Ethics declarations

Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

The manuscript does not contain clinical studies or patient data.

Appendix

Appendix

Our search strategies are as follows: (PubMed, for example).

#1 "Stroke"[MeSH Terms].

#2 "Stroke"[Title/Abstract] OR "Strokes"[Title/Abstract] OR "Apoplexy"[Title/Abstract] OR "acute stroke*"[Title/Abstract] OR "acute cerebrovascular accident*"[Title/Abstract] OR "brain vascular accident*"[Title/Abstract] OR "cerebral stroke*"[Title/Abstract] OR "cerebrovascular accident*"[Title/Abstract] OR "cerebrovascular apoplexy"[Title/Abstract] OR "cerebrovascular stroke*"[Title/Abstract] OR "ischemic stroke"[Title/Abstract] OR "cerebral infarction"[Title/Abstract] OR "brain infarction"[Title/Abstract] OR "cerebral hemorrhage"[Title/Abstract] OR "cerebrovascular events"[Title/Abstract].

#3 = #1 or #2.

#4 "Body Mass Index"[MeSH Terms].

#5 "body mass index"[Title/Abstract] OR "BMI"[Title/Abstract] OR "quetelet index"[Title/Abstract] OR "quetelet s index"[Title/Abstract] OR "quetelets index"[Title/Abstract] OR "Thinness"[Title/Abstract] OR "Underweight"[Title/Abstract] OR "Leanness"[Title/Abstract] OR "ideal body weight"[Title/Abstract] OR "ideal body weight*"[Title/Abstract] OR "normal weight*"[Title/Abstract] OR "normal body weight*"[Title/Abstract] OR "ideal body mass*"[Title/Abstract] OR "ideal body mass index"[Title/Abstract] OR "Overweight"[Title/Abstract] OR "over weight*"[Title/Abstract] OR "overweight*"[Title/Abstract] OR "Obesity"[Title/Abstract] OR "obese"[Title/Abstract] OR "fat"[Title/Abstract] OR "adipos*"[Title/Abstract] OR "obes*"[Title/Abstract] OR "weight loss"[Title/Abstract].

#6 = #4 or #5.

#7 = #3 and #6.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, X., Huang, Y., Chen, Y. et al. The relationship between body mass index and stroke: a systemic review and meta-analysis. J Neurol 269, 6279–6289 (2022). https://doi.org/10.1007/s00415-022-11318-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-022-11318-1

Keywords

Search

Navigation