{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T15:03:02Z","timestamp":1785510182628,"version":"3.56.0"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T00:00:00Z","timestamp":1785456000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The simultaneous presence of obesity and malnutrition, termed the double burden of malnutrition (DBM), has become a growing public health challenge. However, little is known about how the DBM influences patients with acute ischemic stroke (AIS) who receive intravenous thrombolysis (IVT). We aimed to investigate the associations between obesity and nutritional status and clinical characteristics and clinical outcomes among AIS patients receiving IVT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a single-center, prospective cohort study at a Shanghai hospital, including AIS patients who received alteplase IVT therapy from January 2018 to December 2022. Patients were categorized into four distinct subgroups based on body mass index-based obesity and nutritional status, as assessed using the Controlling Nutritional Status score: (1) nourished non-obese; (2) malnourished non-obese; (3) nourished obese; and (4) malnourished obese. The primary endpoints of the study were poor outcomes and all-cause mortality within 3\u202fmonths, while the secondary outcomes were early neurological deterioration (END) and hemorrhagic transformation (HT).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The overall stroke cohort consisted of 6,892 AIS admissions, of which 366 patients receiving IVT were included in this study. The median age was 68\u202f\u00b1\u202f12\u202fyears, and 239 subjects (65.3%) were men. A total of 52.7% of patients were malnourished, and greater malnutrition severity independently predicted worse clinical outcomes after thrombolysis. During the follow-up period, the malnourished obese group had the highest rates of poor outcomes and END, followed by the malnourished non-obese, nourished obese, and nourished non-obese groups (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05). After adjusting for confounding factors in a multivariate logistic regression analysis, the malnourished obese group showed significantly elevated risks of poor outcomes (odds ratio [OR], 2.850 [1.061\u20137.650];\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.038) and END (OR, 19.158 [2.324\u2013157.935];\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.006), using the nourished non-obese group as the reference group.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Malnutrition affected more than half of AIS patients undergoing IVT, including those with obesity. Patients with malnutrition were associated with worse clinical outcomes, especially those with moderate-to-severe malnutrition. Notably, patients with concurrent obesity and malnutrition exhibited the most unfavorable 3-month clinical profiles across all four subgroups.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2026.1864875","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T14:14:43Z","timestamp":1785507283000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of coexisting obesity and malnutrition on the clinical outcomes of acute ischemic stroke patients treated with intravenous thrombolysis: a cohort-based study"],"prefix":"10.3389","volume":"13","author":[{"given":"Huicong","family":"Niu","sequence":"first","affiliation":[{"name":"Department of Neurology, Minhang Hospital, Fudan University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuechun","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Minhang Hospital, Fudan University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Neurology, Minhang Hospital, Fudan University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziwen","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Minhang Hospital, Fudan University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xueyu","family":"Mao","sequence":"additional","affiliation":[{"name":"Department of Neurology, Minhang Hospital, Fudan University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiliang","family":"Xia","sequence":"additional","affiliation":[{"name":"Department of Neurology, Minhang Hospital, Fudan University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Chu","sequence":"additional","affiliation":[{"name":"Department of Geriatrics, Shanghai Geriatric Medical Center","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,31]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1269","DOI":"10.1016\/S0140-6736(18)31269-8","article-title":"Prevention of stroke: a global perspective","volume":"392","author":"Pandian","year":"2018","journal-title":"Lancet"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e028778","DOI":"10.1161\/JAHA.122.028778","article-title":"Heart rate variability parameter changes in patients with acute ischemic stroke undergoing intravenous thrombolysis","volume":"12","author":"Qu","year":"2023","journal-title":"J Am Heart 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First validation in a hospital population","volume":"20","author":"Ignacio de Ul\u00edbarri","year":"2005","journal-title":"Nutr Hosp"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1111\/bjh.16743","article-title":"Prognostic utility of a geriatric nutritional risk index in combination with a comorbidity index in elderly patients with diffuse large B cell lymphoma","volume":"192","author":"Lee","year":"2021","journal-title":"Br J Haematol"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.3390\/nu14071337","article-title":"Baseline objective Malnutritional indices as immune-nutritional predictors of long-term recurrence in patients with acute ischemic stroke","volume":"14","author":"Han","year":"2022","journal-title":"Nutrients"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/S0140-6736(03)15268-3","article-title":"Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies","volume":"363","year":"2004","journal-title":"Lancet"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1127","DOI":"10.7326\/M24-0161","article-title":"Body mass index thresholds for Asians: a race correction in need of correction?","volume":"177","author":"Bajaj","year":"2024","journal-title":"Ann Intern Med"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"2937","DOI":"10.1681\/ASN.2006040368","article-title":"Modified glomerular filtration rate estimating equation for Chinese patients with chronic kidney disease","volume":"17","author":"Ma","year":"2006","journal-title":"J Am Soc Nephrol"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1779","DOI":"10.2147\/NDT.S366851","article-title":"Malnutrition and the risk of early neurological deterioration in elderly patients with acute ischemic stroke","volume":"18","author":"Bao","year":"2022","journal-title":"Neuropsychiatr Dis Treat"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.3390\/nu13113671","article-title":"Alpha(1)-acid glycoprotein and dietary intake in end-stage renal disease patients","volume":"13","author":"Maraj","year":"2021","journal-title":"Nutrients"},{"key":"ref27","doi-asserted-by":"crossref","first-page":"2202761","DOI":"10.1080\/0886022X.2023.2202761","article-title":"Association of serum thymosin beta4 with malnutrition-inflammation-atherosclerosis syndrome in peritoneal dialysis patients: a cross-sectional study","volume":"45","author":"Tian","year":"2023","journal-title":"Ren Fail"},{"key":"ref28","doi-asserted-by":"crossref","first-page":"1450","DOI":"10.1161\/01.STR.0000074037.49197.8C","article-title":"Poor nutritional status on admission predicts poor outcomes after stroke: observational data from the FOOD trial","volume":"34","year":"2003","journal-title":"Stroke"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1016\/S0140-6736(19)32497-3","article-title":"Dynamics of the double burden of malnutrition and the changing nutrition reality","volume":"395","author":"Popkin","year":"2020","journal-title":"Lancet"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1565","DOI":"10.1093\/eurheartj\/ehv486","article-title":"The role of obesity in atrial fibrillation","volume":"37","author":"Nalliah","year":"2016","journal-title":"Eur Heart J"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"678","DOI":"10.1186\/s12872-025-05107-7","article-title":"Malnutrition increases the risk of atrial fibrillation","volume":"25","author":"Huang","year":"2025","journal-title":"BMC Cardiovasc Disord"},{"key":"ref32","doi-asserted-by":"publisher","DOI":"10.3390\/nu15194195","article-title":"Role of malnutrition in atrial fibrillation: a prospective study including individuals \u2265 75 years of age","volume":"15","author":"G\u00f6\u00e7er","year":"2023","journal-title":"Nutrients"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"834","DOI":"10.1016\/j.numecd.2020.12.003","article-title":"The impact of malnutrition on atrial fibrillation recurrence post ablation","volume":"31","author":"Zhu","year":"2021","journal-title":"Nutr Metab Cardiovasc Dis"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"e1003661","DOI":"10.1371\/journal.pmed.1003661","article-title":"Associations of obesity and malnutrition with cardiac remodeling and cardiovascular outcomes in Asian adults: a cohort study","volume":"18","author":"Chien","year":"2021","journal-title":"PLoS Med"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"e009340","DOI":"10.1161\/circoutcomes.122.009340","article-title":"Long-term prognosis of patients with coexisting obesity and malnutrition after acute myocardial infarction: a cohort study","volume":"16","author":"Kong","year":"2023","journal-title":"Circ Cardiovasc Qual Outcomes"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"e0171334","DOI":"10.1371\/journal.pone.0171334","article-title":"Obesity paradox in stroke-myth or reality? 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