ArticleFrontiers in nutrition2026
Impact of coexisting obesity and malnutrition on the clinical outcomes of acute ischemic stroke patients treated with intravenous thrombolysis: a cohort-based study.
Article in Frontiers in nutrition, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The simultaneous presence of obesity and malnutrition, termed the double burden of malnutrition (DBM), has become a growing public health challenge. However, little is known about how the DBM influences patients with acute ischemic stroke (AIS) who receive intravenous thrombolysis (IVT). We aimed to investigate the associations between obesity and nutritional status and clinical characteristics and clinical outcomes among AIS patients receiving IVT. Methods: We conducted a single-center, prospective cohort study at a Shanghai hospital, including AIS patients who received alteplase IVT therapy from January 2018 to December 2022. Patients were categorized into four distinct subgroups based on body mass index-based obesity and nutritional status, as assessed using the Controlling Nutritional Status score: (1) nourished non-obese; (2) malnourished non-obese; (3) nourished obese; and (4) malnourished obese. The primary endpoints of the study were poor outcomes and all-cause mortality within 3 months, while the secondary outcomes were early neurological deterioration (END) and hemorrhagic transformation (HT). Results: The overall stroke cohort consisted of 6,892 AIS admissions, of which 366 patients receiving IVT were included in this study. The median age was 68 ± 12 years, and 239 subjects (65.3%) were men. A total of 52.7% of patients were malnourished, and greater malnutrition severity independently predicted worse clinical outcomes after thrombolysis. During the follow-up period, the malnourished obese group had the highest rates of poor outcomes and END, followed by the malnourished non-obese, nourished obese, and nourished non-obese groups ( Conclusion: Malnutrition affected more than half of AIS patients undergoing IVT, including those with obesity. Patients with malnutrition were associated with worse clinical outcomes, especially those with moderate-to-severe malnutrition. Notably, patients with concurrent obesity and malnutrition exhibited the most unfavorable 3-month clinical profiles across all four subgroups.
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