Journal of Thrombosis and Thrombolysis

, Volume 44, Issue 2, pp 238–244 | Cite as

Comparison of body mass index, waist circumference, and waist-height ratio in predicting functional outcome following ischemic stroke

  • Kyusik Kang
  • Wong-Woo Lee
  • Jung-Ju Lee
  • Jong-Moo Park
  • Ohyun Kwon
  • Byung Kun KimEmail author


Although a positive association between body mass index (BMI) and stroke incidence has been reported, having a higher BMI is known to be advantageous in surviving and recovering from stroke. The association between adiposity and stroke incidence is more evident for measures of abdominal obesity than for general obesity. The aim of our study was to compare BMI, waist circumference, and waist-height ratio (WHR) as predictors of 3-month functional outcome in stroke patients. The BMI, waist circumference, and WHR of acute stroke patients were divided into sex-specific quartiles. A total of 605 female and 727 male patients were included. For BMI, male patients in the second quartile were more likely to have a favorable functional outcome compared with those in the lowest quartile (adjusted OR 1.64, 95% CI 1.02–2.62). For waist circumference (adjusted OR for top quartile vs. lowest quartile 1.79, 95% CI 1.14–2.82) and WHR (adjusted OR for second quartile vs. lowest quartile 1.99, 95% CI 1.22–3.25), male patients in the two top quartiles were more likely to have a favorable functional outcome compared with those in the respective lowest quartile. BMI and WHR showed similar relationships to a favorable functional outcome, with a favorable functional outcome occurring most often among male patients in the second quartiles. In women, however, obesity was not related to functional outcome. In conclusion, general obesity measured by BMI and abdominal obesity measured by WHR showed similar effects on the functional outcome after stroke in men.


Functional outcome Ischemic stroke Obesity Prognosis 



This study was supported by a grant of the Korea Health 21 R&D Project, Ministry of Health, Welfare and Family Affairs, Republic of Korea (HI10C2020).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study formal consent is not required.


  1. 1.
    Song YM, Sung J, Davey Smith G, Ebrahim S (2004) Body mass index and ischemic and hemorrhagic stroke: a prospective study in Korean men. Stroke 35:831–836. doi: 10.1161/01.STR.0000119386.22691.1C CrossRefPubMedGoogle Scholar
  2. 2.
    Yatsuya H, Toyoshima H, Yamagishi K, Tamakoshi K, Taguri M, Harada A, Ohashi Y, Kita Y, Naito Y, Yamada M, Tanabe N, Iso H, Ueshima H (2010) Body mass index and risk of stroke and myocardial infarction in a relatively lean population: meta-analysis of 16 Japanese cohorts using individual data. Circ Cardiovasc Qual Outcomes 3:498–505. doi: 10.1161/CIRCOUTCOMES.109.908517 CrossRefPubMedGoogle Scholar
  3. 3.
    Katsnelson M, Rundek T (2011) Obesity paradox and stroke: noticing the (fat) man behind the curtain. Stroke 42:3331–3332. doi: 10.1161/STROKEAHA.111.632471 CrossRefPubMedGoogle Scholar
  4. 4.
    Kim Y, Kim CK, Jung S, Yoon BW, Lee SH (2015) Obesity-stroke paradox and initial neurological severity. J Neurol Neurosurg Psychiatry 86:743–747. doi: 10.1136/jnnp-2014-308664 CrossRefPubMedGoogle Scholar
  5. 5.
    Saini M, Saqqur M, Shuaib A (2014) Body mass index and acute ischemic stroke outcomes. Int J Stroke 9:618–623. doi: 10.1111/ijs.12168 CrossRefGoogle Scholar
  6. 6.
    Zhao L, Du W, Zhao X, Liu L, Wang C, Wang Y, Wang A, Liu G, Xu Y (2014) Favorable functional recovery in overweight ischemic stroke survivors: findings from the China National Stroke Registry. J Stroke Cerebrovasc Dis 23:e201–e206. doi: 10.1016/j.jstrokecerebrovasdis.2013.10.002 CrossRefPubMedGoogle Scholar
  7. 7.
    Page JH, Rexrode KM, Hu F, Albert CM, Chae CU, Manson JE (2009) Waist-height ratio as a predictor of coronary heart disease among women. Epidemiology 20:361–366. doi: 10.1097/EDE.0b013e31819f38f1 CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Walker SP, Rimm EB, Ascherio A, Kawachi I, Stampfer MJ, Willett WC (1996) Body size and fat distribution as predictors of stroke among US men. Am J Epidemiol 144:1143–1150. doi: 10.1093/oxfordjournals.aje.a008892 CrossRefPubMedGoogle Scholar
  9. 9.
    Bodenant M, Kuulasmaa K, Wagner A, Kee F, Palmieri L, Ferrario MM, Montaye M, Amouyel P, Dallongeville J (2011) Measures of abdominal adiposity and the risk of stroke: the MOnica Risk, Genetics, Archiving and Monograph (MORGAM) study. Stroke 42:2872–2877. doi: 10.1161/STROKEAHA.111.614099 CrossRefPubMedGoogle Scholar
  10. 10.
    Kim BJ, Han MK, Park TH, Park SS, Lee KB, Lee BC, Yu KH, Cha JK, Kim DH, Lee J, Lee SJ, Ko Y, Park JM, Kang K, Cho YJ, Hong KS, Cho KH, Kim JT, Kim DE, Lee JS, Jang MS, Broderick JP, Yoon BW, Bae HJ (2014) Current status of acute stroke management in Korea: a report on a multicenter, comprehensive acute stroke registry. Int J Stroke 9:514–518. doi: 10.1111/ijs.12199 CrossRefPubMedGoogle Scholar
  11. 11.
    van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J (1988) Interobserver agreement for the assessment of handicap in stroke patients. Stroke 19:604–607. doi: 10.1161/01.STR.19.5.604 CrossRefPubMedGoogle Scholar
  12. 12.
    Chiquete E, Ruiz-Sandoval JL, Murillo-Bonilla L, Leon-Jimenez C, Ruiz-Madrigal B, Martinez-Lopez E, Roman S, Panduro A, Ramos A, Cantu-Brito C (2013) Central adiposity and mortality after first-ever acute ischemic stroke. Eur Neurol 70:117–123. doi: 10.1159/000350762 CrossRefPubMedGoogle Scholar
  13. 13.
    Examination Committee of Criteria for ‘Obesity Disease’ in Japan, Japan Society for the Study of Obesity (2002) New criteria for ‘obesity disease’ in Japan. Circ J 66:987–992. doi: 10.1253/circj.66.987 CrossRefGoogle Scholar
  14. 14.
    Zhou BF (2002) Predictive values of body mass index and waist circumference for risk factors of certain related diseases in Chinese adults-study on optimal cut-off points of body mass index and waist circumference in Chinese adults. Biomed Environ Sci 15:83–96PubMedGoogle Scholar
  15. 15.
    Einstein FH, Atzmon G, Yang XM, Ma XH, Rincon M, Rudin E, Muzumdar R, Barzilai N (2005) Differential responses of visceral and subcutaneous fat depots to nutrients. Diabetes 54:672–678. doi: 10.2337/diabetes.54.3.672 CrossRefPubMedGoogle Scholar
  16. 16.
    Boyett D, Magnuson T, Schweitzer M (2016) Metabolic changes following bariatric surgery. In: Cameron JL, Cameron AM (eds) Current surgical therapy. 12th edn. Elsevier, Philadelphia, PA, pp 802–806Google Scholar
  17. 17.
    Ryu WS, Lee SH, Kim CK, Kim BJ, Yoon BW (2010) Effects of low serum triglyceride on stroke mortality: a prospective follow-up study. Atherosclerosis 212:299–304. doi: 10.1016/j.atherosclerosis.2010.05.006 CrossRefPubMedGoogle Scholar
  18. 18.
    Tanne D, Molshatzki N, Merzeliak O, Tsabari R, Toashi M, Schwammenthal Y (2010) Anemia status, hemoglobin concentration and outcome after acute stroke: a cohort study. BMC Neurol 10:22. doi: 10.1186/1471-2377-10-22 CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Petitti DB, Freedman DA (2005) Invited commentary: how far can epidemiologists get with statistical adjustment? Am J Epidemiol 162:415–418 (discussion 419–420). doi: 10.1093/aje/kwi224 CrossRefPubMedGoogle Scholar
  20. 20.
    Vauthey C, de Freitas GR, van Melle G, Devuyst G, Bogousslavsky J (2000) Better outcome after stroke with higher serum cholesterol levels. Neurology 54:1944–1949. doi: 10.1212/WNL.54.10.1944 CrossRefPubMedGoogle Scholar
  21. 21.
    Bornstein SR, Licinio J, Tauchnitz R, Engelmann L, Negrao AB, Gold P, Chrousos GP (1998) Plasma leptin levels are increased in survivors of acute sepsis: associated loss of diurnal rhythm, in cortisol and leptin secretion. J Clin Endocrinol Metab 83:280–283. doi: 10.1210/jcem.83.1.4610 CrossRefPubMedGoogle Scholar
  22. 22.
    Weir CJ, Sattar N, Walters MR, Lees KR (2003) Low triglyceride, not low cholesterol concentration, independently predicts poor outcome following acute stroke. Cerebrovasc Dis 16:76–82. doi: 10.1159/000070119 CrossRefPubMedGoogle Scholar
  23. 23.
    Terry RB, Wood PD, Haskell WL, Stefanick ML, Krauss RM (1989) Regional adiposity patterns in relation to lipids, lipoprotein cholesterol, and lipoprotein subfraction mass in men. J Clin Endocrinol Metab 68:191–199. doi: 10.1210/jcem-68-1-191 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Kyusik Kang
    • 1
  • Wong-Woo Lee
    • 1
  • Jung-Ju Lee
    • 1
  • Jong-Moo Park
    • 1
  • Ohyun Kwon
    • 1
  • Byung Kun Kim
    • 1
    Email author
  1. 1.Department of Neurology, Nowon Eulji Medical CenterEulji UniversitySeoulRepublic of Korea

Personalised recommendations