Published online May 26, 2026. doi: 10.12998/wjcc.v14.i15.118960
Revised: March 15, 2026
Accepted: April 7, 2026
Published online: May 26, 2026
Processing time: 116 Days and 13.1 Hours
Metabolically healthy obesity (MHO) is defined as obesity without coded hypertension, diabetes, and hyperlipidemia. The impact of MHO on acute ischemic stroke (AIS) outcomes is uncertain. We examined the burden of MHO on AIS hospitalization outcomes.
To evaluate whether MHO is associated with differences in in-hospital outcomes among adult patients hospitalized with AIS across various age groups (18-44 years and 45-64 years), sexes, and racial/ethnic subgroups, using a nationwide propensity score-matched analysis.
In this observational study, the National Inpatient Sample (2020) was queried for AIS patients with vs without MHO. Adult AIS patients were analyzed across age groups (18-44 years and 45-64 years), sexes, and racial/ethnic subgroups to determine if MHO was associated with in-hospital outcomes. A propensity score-matched analysis (1:1) was used to compare baseline characteristics, comorbidities, in-hospital outcomes, and healthcare resource utilization between the MHO and non-MHO AIS cohorts.
Among 62675 AIS hospitalizations, 5135 (8.2%) had MHO. After propensity matching across the groups, there were 4935 patients with and without MHO. The MHO cohort had more males (38.8% vs 37.4%) and fewer rural hospital admissions (5.8% vs 7.0%, P = 0.02) compared with the non-MHO cohort. MHO patients exhibited higher rates of baseline comorbidities such as hypothyroidism (9.9% vs 6.9%) and chronic obstructive pulmonary disease (16.6% vs 14.2%). However, in-hospital mortality was similar between the groups (13.5% in MHO vs 14.5% in non-MHO patients). Compared with non-MHO AIS patients, there was no significant difference in all-cause mortality in MHO patients (odds ratio = 0.93, 95%CI: 0.70-1.24). Subgroup analyses stratified by age, sex, and race did not demonstrate statistically significant differences in in-hospital mortality, and multivariable models did not identify significant associations between MHO and in-hospital mortality.
This nationwide propensity-matched analysis found that metabolically healthy obesity was not associated with worse short-term in-hospital outcomes among patients hospitalized with acute ischemic stroke. However, these findings should be interpreted cautiously given the claims-based definition of metabolically healthy obesity. Further studies with more granular metabolic and longitudinal data are needed to clarify the long-term clinical implications of metabolically healthy obesity in stroke.
Core Tip: Metabolically healthy obesity (MHO) is increasingly recognized as a distinct obesity phenotype, but its implications in acute ischemic stroke (AIS) remain uncertain. In this nationwide propensity score-matched study using the 2020 National Inpatient Sample, MHO was not associated with worse short-term in-hospital outcomes or higher in-hospital mortality among patients hospitalized with AIS. These findings support a more phenotype-based interpretation of obesity-related risk in stroke, while also highlighting the need for further studies with more granular metabolic and longitudinal data to clarify long-term clinical implications.