Severe underweight and cerebral microbleeds
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Severely low and/or high body mass index (BMI) has been associated with intracerebral hemorrhage (ICH) risk in several large cohorts. The aim of this study is to assess the relationship between BMI and the presence of cerebral microbleeds. The presence and number of microbleeds were assessed on three-dimensional T2*-weighted gradient-recalled-echo sequence on magnetic resonance imaging (MRI). The inclusion criteria were participants aged >40 years old without aneurysmal subarachnoid hemorrhage and any type of cerebral vascular malformations. BMI was categorized into severe underweight (<17.0 kg/m2), mild underweight (17.0–18.4 kg/m2), normal range (18.5–24.9 kg/m2), overweight (25.0–29.9 kg/m2), and obese (≥30.0 kg/m2). Multivariate analyses were adjusted for age, sex, hypertension, smoking, alcohol, stroke subtype, severity of periventricular hyperintensities and deep white matter hyperintensities, and dementia. Additionally, we conducted stratification analyses by age, ICH, smoking habit, or history of any kind of cancer, respectively. A total of 384 participants (232 males, 152 females; mean age 67.5 years) met our inclusion criteria. Overall mean BMI was 22.8 ± 3.6 kg/m2. On multivariate analyses, severe underweight carried a significantly higher risk for cerebral microbleeds (3.48, 1.06–11.4) compared with normal range BMI, even after stratification in the subgroup aged ≥60 years (7.23, 1.57–33.2), nonsmokers (4.75, 1.10–20.5), noncancer subgroup (5.66, 1.31–24.5), and non-ICH subgroup (3.81, 1.14–12.7). We found that severe underweight was an independent significant risk factor for presence of cerebral microbleeds, even after effect of aging, smoking, or preexisting illness was eliminated.
KeywordsCerebral microbleeds Body mass index Underweight Magnetic susceptibility Magnetic resonance imaging
We would like to thank the patients for participating in this study. In addition we acknowledge the officers of Shiga Medical Center for Adults who managed baseline survey of clinical data. This research was supported by research funds intended to promote the hospital functions of the Japan Labor Health and Welfare Organization.
Conflicts of interest
Dr. Yamada and co-authors declare no disclosure and no conflicts of interest. He is the corresponding author for this study and the principal investigator. None of the authors received any royalties.
All human studies must state that they have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.
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