Obesity and Diabetes Mellitus as Predictors of Mortality in Patients with Stroke: A Meta Analysis
Abstract
Background: Stroke is the leading cause of death and disability throughout the world. Based on studies in the United States (US), a person experiences a stroke every 40 seconds and every 4 minutes someone dies. The problem of comorbidity or the presence of more than one disease is the risk of stroke. This causes a person with comorbidities to have a higher risk of mortality than stroke patients without comorbidities. This study aims to examine the effect of obesity and diabetes mellitus as predictors of mortality in stroke patients.
Subjects and Method: This was a meta-analysis and systematic review. The articles were obtained from Google Scholar, PubMed, Springer Link, Clinical key, and ProQuest databases. The articles have been published from 2010-2019. Keywords to search for articles are as follows: "comorbidity and stroke", "comorbidity and mortality and stroke and cross sectional study", "comorbidity and mortality and stroke and adjusted odd ratio", "comorbidity or stroke", "comorbidity or mortality or stroke or cross sectional study ", "comorbidity or mortality or stroke or adjusted odd ratio". The articles studied are full text articles with observational study design. Articles are collected using PRISMA diagram, and analyzed using the Review Manager application 5.3.
Results: Obesity (aOR = 1.51; 95% CI = 1.03 to 2.21; p = 0.030) and diabetes mellitus (aOR = 1.75; 95% CI = 1.33 to 2.29; p <0.001) are predictors of mortality in stroke patients.
Conclusion: Obesity and diabetes mellitus are predictors of mortality in stroke patients.
Keywords: obesity, diabetes mellitus, stroke
Correspondence: Karlinda. Masters Program in Public Health Sciences, Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: karlindalinda8@gmail.com. Mobile: +6282278924093
Indonesian Journal of Medicine (2019), 4(4): 383-393
https://doi.org/10.26911/theijmed.2019.04.04.12
References
Akpalu J, Yawson AE, Osei poku F, Atiase Y, Yorke E, Adjei P, et al. (2018). Stroke outcome and determinants among patients with and without diabetes in a tertiary hospital in Ghana. Hindawi, 2018: 1–9. https://doi.org/10.1155/2018/7521351
Andrade D, Cristina F, Guevara PE, Lebrão ML (2012). Correlates of the incidence of disability and mortality among older adult Brazilians with and without diabetes mellitus and stroke. BioMed Central, 12 (361): 2–10. https://doi.org/10.1186/1471245812361
Anulus A, Murti B, Prasetya H (2019). Risk Factors of HIV among Male Military Personnels: A Meta Analysis. Am J Health Behav, 4(3): 178–188. Journal of Health Promotion and Behavior (2019), 4(3): 178-188. https://doi.org/10.26911/thejhpb.2019.04.03.03
Barba R, Marco J, Ruiz J, dan Zapaterogaviria A (2015). The obesity paradox in stroke: Impact on mortality and short term readmission. J Stroke Cerebrovasc Dis, 24(4): 766–770. https://doi.org/10.1016/j.jstrokecerebrovasdis.-2014.11.002
Bell DSH (1994). Stroke in the Diabetic Patient. Diabetes Care, 17(3): 213–219. https://doi.org/10.23 37/diacare.17.3.213
Benavente OR, White CL, Pearce L, Pergola P, Roldan A, Benavente MF, Hart RG (2011). The secondary prevention of small subcortical strokes (SPS3) study. International Journal of Stroke, 6 (2): 164–175. https://doi.org/10.1111/j.17474949.2010.00573.x
Biessels GJ, Cristino NA, Rutten GJ, Hamers FPT, Erkelens DW, Gispen WH (1999). Neurophysiological changes in the central and peripheral nervous system of streptozotocindiabetic rats. course of development and effects of insulin treatment. Brain, 122 (4): 757–768. https://doi.org/10.1093/brain/122.4.757
Bravata DM, Myers LJ, Reeves M, Cheng EM, Baye F, Ofner S, Damush T (2019). Processes of care associated with risk of mortality and recurrent stroke among patients with transient ischemic attack and nonsevere ischemic stroke. JAMA Netw, 2 (7): 1–13. https://doi.org/10.1001/jamanetworkopen.2019.6716
CDC (2017). Women and stroke. Am J Public Health. Retrieved from https://www.cdc.gov/stroke/docs/Women_Stroke_Factsheetpdf
D' Souza AL, Rajkumar C, Cooke J, Bulpitt CJ (2002). Probiotics in prevention of antibiotic associated diarrhoea: Meta analysis. BMJ, 324: 1361-1867
Doehner W, Schenkel J, Anker SD, Springer J, Audebert HJ (2013). Over weight and obesity are associated with improved survival, functional outcome, and stroke recurrence after acute stroke or transient ischaemic attack: observations from the TEMPiS trial. Eur Heart J, 34(4): 268–277. https:// doi.org/10.1093/eurheartj/ehs340
Donnell MJO, Xavier D, Liu L, Zhang, Chin SL, Rao melacini P, Foscal L (2010). Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the interstroke study): a case control study. Lancet, 376: 112– 123. https://doi.org/10.1016/S01406736(10)60834-3
Feigin VL, Forouzanfar MH, Krishnamurthi R, Mensah GA, Bennett DA, Moran AE, Ezzati M (2014). Global and regional burden of stroke during 1990- 2010: Findings from the Global Burden of Disease Study 2010. NIH Public Access, 383(9913): 245–254. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4181600/
Fischer U, Arnold M, Nedeltchev K, Ra S, dan Kappeler L (2006). Impact of co morbidity on ischemic stroke outcome. Acta Neurol Scand, 113: 108–113. https://doi.org/10.1111/j.16000404.2005.00551.x
GBD dalys dan Hale Collaborators (2015). Global, regional, and national disability adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990 – 2013: Quantifying the epidemiological transition. Lancet, 1–47. https://doi.org/10.1016/S0140-6736- (15)61340-X
GBD Mortality (2014). Global, regional, and national age – sex specific all-cause and cause specific mortality for 240 causes of death, 1990–2013: A systematic analysis for the global burden of disease study 2013. Lancet, 385: 117–1-71. https://doi.org/10.1016/S0140-6736-(14)61682-2
Hernandez AV, Kaw R, Pasupuleti V, Bina P, Ioannidis JPA, Bueno H (2013). Association between obesity and postoperative atrial fibrillation in patients undergoing cardiac operations: A systematic review and meta-analysis. J Thorac Cardiovasc Surg, 1–13. https://doi.org/10.1016/j.athoracsur.2013. 04.029
Hill KM, West RM, Hewison J, House AO (2009). The stroke outcomes study 2 (SOS2): A prospective, Analytic cohort study of depressive symptoms after stroke. J Cardiovasc Dis, 9. https://doi.org/10.1186/14712261922
Ideta TR, Lim E, Nakagawa K, Koenig MA (2018). Racial and ethnic disparities in hospital mortality among ischemic stroke patients in Hawaii. J Stroke Cerebrovasc Dis, 27(6): 1458–1465. https://doi.org/10.1016/j.jstrokecerebrovasdis.2017.12.042
Jia Q, Zhao X, Wang C, Wang Y, Yan Y, Li H, Wang Y (2011). Diabetes and poor outcomes within 6 months after acute ischemic stroke: The china national stroke registry. Stroke, 42 (10): 2758–2762. https://doi.org/10.1161/STROKEAHA.111.621649
Kaarisalo MM, Raiha I, Sivenius J, Immonen Raiha P, Lehtonen A, Sarti C, Salomaa V (2005). Diabetes worsens the outcome of acute ischemic stroke. Diabetes Res Clin Pract, 69(3):293–298. https://doi.org/10.1016/j.diabres.2005.02.001
Keaver L, Webber L, Dee A, Shiely F, Marsh T, Balanda K, Perry I (2013). Application of the UK foresight obesity model in Ireland: The health and economic consequences of projected obesity trends in Ireland. PLoS One, 8(11): 1–8. https://doi.org/10.1371/journal.pone.0079827
Kongbunkiat K, Kasemsap N, Travanichakul S, Thepsuthammarat K, Tiamkao S, Sawanyawisuth K (2014). Hospital mortality from atrial fibrillation associated with ischemic stroke: A national data report. International J Neurosci Res 1–5. https://doi.org/10.3109/00207454.2014.986266
Mozaffarian D, Bejjamin E, Go A, Arnett D, Blaha M, Cushman M, Turner M (2016). Heart disease and stroke statistics 2016 update. Am J Public Health, 1–23. https://doi.org/10.1161/CIR.0000000000000350
Murti B (2018). Prinsip dan Metode Riset Epidemiologi (Edisi V). Surakarta: Pascasarjana Ilmu Kesehatan Masyarakat Universitas Sebelas Maret
Nelson MLA, Mckellar KA, Yi J, Kelloway L, Cott C, Hall R (2017). Topics in stroke rehabilitation stroke rehabilitation evidence and comorbidity: A systematic scoping review of randomized controlled trials. Top Stroke Rehabil, 1– 7. https://doi.org/10.1080/10749357.2017.1282412.
Otiniano ME, Du XL, Ottenbacher K, Markides KS (2003). The effect of diabetes combined with stroke on disability, self rated health, and mortality in older Mexican Americans: Retrieved from the Hispanic EPESE. Arch Phys Med Rehabil, 84 (5): 725–730.https://doi.org/10.1016/s0003-9993(03)04941-9.
Price AJ, Wright FL, Green J, Balkwill A, Kan SW, Yang TO, Reeves GK (2018). Differences in risk factors for 3 types of stroke. Neurology, 90(4): 298–306. https://doi.org/10.1212/WNL.0000000000004856.
Ramadany AF, Pujarini LA, Candrasari A (2013). Hubungan diabetes melitus dengan kejadian stroke iskemik di RSUD Dr. Moewardi Surakarta tahun 2010 (The relationship of diabetes mellitus with the incidence of ischemic stroke at Dr. Hospital Moewardi Surakarta in 2010). Biomedik, 5(2): 11–16. https://doi.org/10.23917/biomedika.v5i2.264
Reklaitiene R, Tamosiunas A, Virviciute D, Baceviciene M, Luksiene D (2012). Trends in prevalence, awareness, treatment, and control of hypertension, and the risk of mortality among middle aged Lithuanian urban population in 1983 – 2009. BMC Cardiovasc Disord, 12: 68. Retrieved from https://bmccardiovascdisord.biomedcentral.com/articles/10.1186/1471-2-261-12-68
Ryu WS, Lee SH, Kim CK, Kim BJ, Yoon BW (2011). Body mass index, initial neurological severity and longterm mortality in ischemic stroke. J Stroke Cerebrovasc Dis, 32(2): 170–176. https://doi.org/10.1159/000328250
Scherbakov N, Dirnagl U, Doehner W (2011). Body weight after stroke lessons from the obesity paradox. Stroke, 42(12): 3646–3650. https://doi.org/10.1161/STROKEAHA.111.619163
Sun Y, Toh MPHS (2009). Impact of diabetes mellitus (DM) on the healthcare utilization and clinical outcomes of patients with stroke in Singapore. alue Health Reg Issues, 12(3). https://doi.org/10.1111/j.15244733-.2009.00639.x
Sweetnam D, Holmes A, Tennant KA, Zamani A, Walle M, Jones P, Brown CE (2012). Diabetes impairs cortical plasticity and functional recovery following Ischemic stroke. J Neurosci Res, 32(15): 5132–5143. https://doi.org/10.1523/JNEUROSCI.5075-11.2012.
Wayunah W, Saefulloh M (2017). Analisis faktor yang berhubungan dengan kejadian stroke di Rumah Sakit Indramayu (Analysis of factors related to the incidence of stroke at Indramayu Hospital). Jurnal Pendidikan Keperawatan Indonesia, 2(2): 65. https://doi.org/10.17509/jpki.v2i2.4741
Widayati P, Rahardjo SS, Widyaningsih V (2016). Meta Analysis on the Effect of Zinc on Reducing Diarrhea Episode in Toddlers. 183–191.
Wijiwinarsih A, Susilawati TN, Murti B (2019). The Effect of Exclusive Breastfeeding on Wasting in Children Under Five: A Meta Analysis Study. Matern Child Health J , 4(2): 87–96. https://doi.org/10.26911/thejmch.2019.04.02.04
WHO (2014). Global status report on noncommunicable diseases. Retrieved from http://www.searo.who.int/nepal/documents/noncommunicable_diseases/ncd_global_status_report_2014.pdf
WHO (2016). Global report on diabetes. Retrieved from https://apps.who.int/iris/bitstream/handle/10665/204874/WHO_NMH_NVI_16.3_eng.pdf?sequence=1
Yeo SH, Wai Y, Yau P (2019). Temporal trends and predictors of drug utilization and outcomes in first ever stroke patients: A population based study using the Singapore stroke registry. CNS Neurol Disord Drug Targets, 2–25. https://doi.org/10.1007/s40263-019-00648-w
Zhao L, Du W, Zhao X, Liu L, Wang C, Wang Y, Xu Y (2014). Favorable functional recovery in overweight ischemic stroke survivors: Findings from Retrieved from the China National Stroke Registry. J Stroke Cerebrovasc Dis, 23(3): 201–206. https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.10.002
Zhou M, Offer A, Yang G, Smith M, Hui G, Whitlock G, Chen Z (2008). Body mass index, blood pressure, and mortality from stroke: A nationally representative prospective study of 212,000 Chinese men. Am Heart J, 39(3): 753–759. https://doi.org/10.1161/STROKEAHA.107.495374
