The impact of body composition on functional recovery, mortality, and survival: a systematic review of research conducted in a cohort of stroke survivors

Background The phrase obesity paradox after stroke appears to be a recent phenomenon and was first coined in the early 2000s; thereafter, there has been a growing controversy about the phenomenon, with many studies in favor and a few others against it. Notably, obesity a major risk factor for stroke is now regarded as global pandemic. The purpose of this study was to carry out a systematic review on the impact of body weight on functional recovery, mortality, and survival among stroke survivors. Methods We searched PubMed and Google scholar from January 2011 to 2022. Studies were recruited if they reported the impact of body weight on functional recovery, mortality, and survival among stroke survivors. Results A total of 284,699 subjects (30-studies) were included, and 2 were RCTs and a nested case–control study. Seventeen ( n = 197,833, two on intravenous thrombolysis- IVT ), and two studies ( n = 2565) on body weight and outcome among stroke patients receiving insulin were in support of the obesity paradox. Nine studies ( n = 79,451, four on IVT) were against the obesity paradox. For body weight and outcome of ischemic stroke patients treated with IVT, a total of six studies ( n = 2940) four against and two in support of the obesity paradox. In addition, two studies ( n = 4124) reported on WHR, WC, and BMI on mortality and outcome. Conclusions Overall, the odds were in favor of the obesity paradox among stroke patients with their first-time stroke with no report on second-time stroke. The underweight patients showed the worst unfavorable outcome and mortality. Insulin resistance is a major factor underpinning the presence of a paradox among stroke patients with diabetes receiving treatment with insulin therapy. We recommend that the nutritional status of stroke patients be taken into consideration during management. More studies especially on RCT should be conducted to determine the impact of body weight other that BMI on mortality and functional recovery among stroke survivor of African descent.