A J-shaped relation of BMI and stroke: Systematic review and dose–response meta-analysis of 4.43 million participants

Abstract Background and aim Many studies have shown increased risk of stroke with greater adiposity as measured by body mass index (BMI), but questions remain about the shape of the dose–response relation. We conducted a systematic review and meta-analysis of prospective studies to clarify the strength and shape of the dose–response relation between BMI and risk of stroke. Methods and results PubMed and Embase databases were searched for articles published up to May 11, 2018. Random-effects generalized least-squares regression models were used to estimate study–specific dose–response association, and restricted cubic splines were used to model the association. We included reports of 44 prospective cohort studies describing 102 466 incident cases among 4 432 475 participants. With a 5-unit increment in BMI, the summary relative risk for stroke incidence was 1.10 (95% confidence interval, 1.06 to 1.13; I 2  = 88.0%). The dose–response relation was J-shaped ( P non-linearity 2 ), but was increased within the high BMI range (>25 kg/m 2 ). Conclusion Both overweight and obesity increase the risk of stroke with a J-shaped dose–response relation, and the nadir of the curve was observed at BMI 23–24 kg/m 2 .