ABSTRACT
Purpose
The impact of nutritional status on post-stroke outcomes remains controversial, particularly regarding the opposing effects of undernutrition and obesity on recovery. This study investigated how these nutritional conditions influence functional and nutritional outcomes among hospitalized ischaemic stroke survivors.
Methods
A retrospective study analyzed 160 adults with radiologically confirmed ischaemic stroke admitted to a Brazilian tertiary hospital. Nutritional status was classified by WHO BMI criteria (undernutrition: BMI < 18.5 kg/m2; obesity: BMI ≥ 30 kg/m2). Outcomes included discharge/death, length of stay, symptoms/disability (mRS), neurological deficit, food intake, bedridden, respiratory support and enteral nutrition use. Logistic regression models were mutually adjusted for obesity or undernutrition status, depending on the outcome analyzed, to estimate their independent effects.
Results
Undernutrition (n = 36) showed strong associations with disability (adjusted OR 6.64, 95% CI 2.19–20.14), symptomatic presentation (aOR 2.84, 1.16–6.94) and reduced food intake (aOR 5.69, 2.28–14.21). Obesity (n = 30) was independently linked to higher disability risk after adjustment (aOR 3.32, 1.02–10.80). Estimated marginal probabilities (vs. normal/overweight BMI reference group) revealed that undernourished patients had 47.7% disability risk (vs. 12.1% in nourished) and obese patients 39.2% (vs. 16.2% in non-obese).
Conclusions
Undernutrition and obesity independently predict worse functional recovery and nutritional outcomes post-stroke, with undernutrition additionally compromising food intake. The so-called obesity paradox was not sustained after mutual adjustment. Findings underscore the importance of: (1) early nutritional screening, (2) intensified support for undernourished patients and (3) tailored rehabilitation strategies for obese individuals.
Journal of Human Nutrition and Dietetics, Volume 39, Issue 2, April 2026. Read More