Does the obesity paradox predict functional outcome in intracerebral hemorrhage?

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Being overweight or mildly obese has been associated with a decreased risk of death or hospitalization in patients with cardiovascular disease. Similarly, overweight patients admitted to an intensive care unit (ICU) have improved survival up to 1 year after admission. These counterintuitive observations are examples of the “obesity paradox.” Does the obesity paradox exist in patients with intracerebral hemorrhage (ICH)? In this study the authors examined whether there was an association between obesity and functional outcome in patients with ICH.


The authors analyzed 202 patients admitted to the neurological ICU (NICU) who were prospectively enrolled in the Columbia University ICH Outcomes Project between September 2009 and December 2012. Patients were categorized into 2 groups: overweight (body mass index [BMI] ≥ 25 kg/m2) and not overweight (BMI < 25 kg/m2). The primary outcome was defined as survival with favorable outcome (modified Rankin Scale [mRS] score 0–3) versus death or severe disability (mRS score 4–6) at 3 months.


The mean age of the patients in the study was 61 years. The mean BMI was 28 ± 6 kg/m2. The mean Glasgow Coma Scale score was 10 ± 4 and the mean ICH score was 1.9 ± 1.3. The overall 90-day mortality rate was 41%. Among patients with a BMI < 25 kg/m2, 24% (17/70) had a good outcome, compared with 39% (52/132) among those with a BMI ≥ 25 kg/m2 (p = 0.03). After adjusting for ICH score, sex, do-not-resuscitate code status, and history of hypertension, being overweight or obese (BMI ≥ 25 kg/m2) was associated with twice the odds of having a good outcome compared with patients with BMI < 25 kg/m2 (adjusted odds ratio 2.05, 95% confidence interval 1.03–4.06, p = 0.04).


In patients with ICH admitted to the NICU, being overweight or obese (BMI ≥ 25 kg/m2) was associated with favorable outcome after adjustment for established predictors. The reason for this finding requires further study.

ABBREVIATIONS BMI = body mass index; CI = confidence interval; DNR = do not resuscitate; GCS = Glasgow Coma Scale; ICH = intracerebral hemorrhage; ICHOP = Intracerebral Hemorrhage Outcomes Project; IVH = intraventricular hemorrhage; mRS = modified Rankin Scale; NICU = neurological intensive care unit; OR = odds ratio.

Article Information

Correspondence Stephan A. Mayer, Department of Neurology, Henry Ford Health System, 2799 W Grand Ave., Detroit, MI 48202. email:

INCLUDE WHEN CITING Published online December 8, 2017; DOI: 10.3171/2017.5.JNS163266.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.



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    Distribution of 90-day mRS outcomes according to BMI. The primary outcome measure was assessed using the mRS, a functional outcome scale. The 7 outcome categories are 0 (no symptoms), 1 (no significant disability despite symptoms and able to perform all usual duties and activities), 2 (slight disability; unable to perform all previous activities but able to look after own affairs without assistance), 3 (moderate disability; requires some help, but able to walk without assistance), 4 (moderately severe disability; unable to walk without assistance and unable to attend to own bodily needs without assistance), 5 (severe disability; bedridden, incontinent, and requires constant nursing and attention), and 6 (death). Figure is available in color online only.





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