Why the study?
Measures of central obesity such as WHR and WWI may better capture relevant adiposity than BMI, but prospective data in stroke populations remain limited.
Do central adiposity markers (WWI, WHR) predict functional outcome and stroke recurrence better than BMI in patients with first-ever mild-to-moderate ischemic stroke?
Do central adiposity markers (WWI, WHR) predict functional outcome and stroke recurrence better than BMI in patients with first-ever mild-to-moderate ischemic stroke?
The weight-adjusted waist index (WWI), a measure of central obesity, is a superior prognostic marker for poor functional outcome at one year after mild-to-moderate ischemic stroke compared to BMI or waist-to-hip ratio.
Should not yet change stroke practice; leaves open whether WWI is causal or modifiable for functional recovery.
Background and aims Body mass index (BMI) is widely used to assess obesity; however, measures of central obesity, including waist-to-hip ratio (WHR) and the weight-adjusted waist index (WWI), may better capture relevant adiposity and serve as superior prognostic markers for outcomes. Prospective data on WHR and WWI in stroke populations remain limited. We examined the associations of WHR and WWI, compared with BMI, with one-year functional outcome after ischemic stroke and recurrent stroke risk over three years. Methods Data from the PROSCIS-B study (Prospective Cohort With Incident Stroke Berlin) were analyzed. Functional outcome at one year was assessed using the modified Rankin Scale (mRS) and dichotomized into favorable (mRS 0–1) versus unfavorable (mRS 2–6). BMI, WHR, and WWI were analyzed as dichotomous variables (BMI>30kg/m2; WHR>0.90 in men and >0.85 in women; WWI≥11.33). Multivariable logistic regression models were adjusted for age, sex, stroke severity & etiology, and vascular risk factors. For stroke recurrence, adjusted Cox proportional hazards models were applied. Results A total of 557 patients with first-ever ischemic stroke were included (mean age 68 years; 38.4% women; median NIHSS 2). WWI was independently associated with unfavorable functional outcome at one year (OR 1.8; 95% CI 1.2–2.8; p=0.01). No significant associations were observed for BMI or WHR. Over three years of follow-up, 40 recurrent strokes occurred, with no significant associations for any adiposity measure. Conclusions WWI, but not BMI or WHR, was indepently associated with poorer functional outcome after ischemic stroke, supporting the prognostic relevance of central obesity measures. Conflict of interest Thomas Liman, nothing to disclose
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Kaestner et al. (2026) studied this question.
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