Association of Obesity and Metabolic Health Status with Cerebral Small-Vessel Disease in Stroke-Free Individuals.

Aim: We investigated the association of obesity and metabolic health status with cerebral small-vessel disease (SVD), a predictor of stroke, in stroke-free participants during brain health checkups.

Methods: An observational cross-sectional study was conducted on 6,088 stroke-free participants who underwent brain magnetic resonance imaging (MRI). Abdominal obesity was defined as a waist circumference ≥ 90 cm for men and ≥ 80 cm for women. A metabolically healthy status was defined as having none of the three components of metabolic syndrome, except abdominal obesity. The total SVD scores were derived from four MRI markers: silent lacunar infarcts, cerebral microbleeds, moderate-to-severe white-matter hyperintensity, and enlarged perivascular spaces.

Results: The mean age of participants was 55±12 years old. Obesity was prevalent in 50% of the patients. The prevalence of a total SVD score ≥ 2 (moderate-to-severe SVD) was 348 (6%), which was elevated in metabolically unhealthy individuals regardless of obesity status. Compared with the metabolically healthy non-obese group, the metabolically unhealthy non-obese (odds ratio [OR] 2.08, [95% confidence interval {CI}, 1.33-3.27]) and metabolically unhealthy obese (OR 2.62, [95% CI, 1.70-4.04]) groups had a higher multivariable-adjusted risk for a total SVD score ≥ 2. Similar results were obtained for obesity defined as a body mass index ≥ 25 kg/m² instead of abdominal obesity.

Conclusions: Abdominal and general obesity alone were not associated with high total SVD scores in stroke-free individuals. Metabolically unhealthy status, especially high blood pressure and hyperglycemia, are significant risk factors for moderate-to-severe SVD.