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Research Article Review

Research Article Review

Sample Answer 

Research Article Review

Article Review on Obesity and Stroke


The article under review is titled ‘Risk of ischemic stroke in metabolically healthy obesity: A nationwide population-based study.’ There is an increasing prevalence of stroke and obesity worldwide. Even though obesity is a risk factor in stroke development, it is unknown if metabolically healthy obese people are at an elevated risk of developing ischemic stroke. Obesity and metabolic syndromes commonly co-exist and are implicated in an increased risk of cardiovascular incidents and undesirable health results (Lee et al., 2018). Obesity can be defined as excess body fat deposition in the body, and it is associated with excess body weight. It has an association with increased mortality and cardiovascular incidents. Obesity is measured using the Body Mass Index (BMI), fat mass, and waist-to-hip ratio. Obesity can be defined as a BMI above 30kg/m2. However, metabolically healthy obese have a chance of having a better cardiovascular prognosis than other obese individuals.

There has been decreased mortality of stroke, but it is still a major health burden. A stroke is a cardiovascular event in patients with coronary heart disease (Lee et al., 2018). The risk of developing ischemic stroke and coronary heart disease may not be the same. Some previous research articles found that metabolically healthy obese were at increased risk of stroke, while others found no difference in risk between metabolically healthy normal weight and metabolically healthy obese (Gaiţă & Moşteoru, 2017). There is conflicting data on whether an increased risk of developing a stroke is associated with metabolically healthy obesity. The study aimed to examine the increased risk of ischemic stroke associated with metabolic health status and obesity.


Three hundred fifty-four thousand eighty-four adults from the Korean National Health Insurance Service who were enrolled in 2004-2008 were followed up to check if they had any ischemic stroke incidents till 2013. The participants who did meet any metabolic syndrome criteria were defined as ‘metabolically healthy.’ The sample was then divided into four groups depending on metabolic status and obesity. The groups were metabolically healthy normal weight, metabolically unhealthy normal weight, metabolically healthy obese, and metabolically unhealthy obese. Individuals with the previous diagnosis in the past three years were excluded from this study. Participants who were older than 20 years and more obese were also excluded from the study. The other exclusion criteria were underweight individuals with a BMI of less than 18.5kg/m2. This is because underweight individuals have an increased risk of mortality and morbidity than normal-weight individuals. This study was approved by the Seoul National University Hospital Institutional Review Board and adhered to Helsinki’s Declaration.

The endpoint of the study was the development of newly diagnosed ischemic stroke. The differences between the four groups were tested using variance analysis for the continuous variables, while the categorical variables were analyzed using the chi-square tests. All statistical analyses were performed using SPSS version 22 and SAS version 9.2


The results were presented in table and graph forms. Ischemic stroke was newly diagnosed in 1.4% of individuals who participated in the study. The stroke incidence for the metabolically normal healthy weight was 0.56, metabolically unhealthy normal weight at 2.61, metabolically healthy obese at 0.61, and metabolically unhealthy obese at 2.76. Even though the risk for developing stroke was significantly increased in the metabolically unhealthy groups, it was not increased in metabolically unhealthy obese compared to the metabolically healthy normal-weight individuals. Obesity did not increase the risk for stroke. In metabolically healthy individuals, obesity did not increase the risk for ischemic stroke, regardless of the severity of obesity. Obesity significantly increases the risk of stroke in metabolically unhealthy individuals.

Strengths and Limitations of the Study

The study’s strengths were that the sample was large, which would represent the Korean population. This assessment was also done in seven years, enough to elicit desirable results. Health records for all participants were available, and hence it was very easy to detect the primary outcome. There was also a strict definition of the different metabolic groups; hence, correlating them with the primary outcome was easy. The final strength was that the study focused on a single outcome, the development of ischemic stroke.

The study’s weaknesses and comorbidities were identified using diagnosis codes, which relied on whether the physician had keyed in the right codes. Second, only cholesterol levels were available; they did analyze the HDL levels. Since the study follow-up was done over seven years, it mats difficult to know if the stroke developed after the seven years. The sample consisted only of Koreans; hence the results may be biased toward one ethnicity.


Obesity increases the risk of developing ischemic events in unhealthy metabolic individuals and not in the metabolically healthy. Obesity is particularly dangerous in people with metabolic risk factors, so maintaining normal weight to reduce their risk is crucial. The study also showed that metabolically unhealthy obese people did not have an increased risk of developing a stroke. If physicians understand the correlation of metabolic states with the risk of stroke, they can better help their patients manage their weight. Metabolically unhealthy individuals also have increased stroke; hence, controlling the metabolic risk factors is essential.


Gaiţă, D., & Moşteoru, S. (2017). Metabolically healthy versus unhealthy obesity and risk for diabetes mellitus and cardiovascular diseases. Cardiovascular Endocrinology6(1), 23-26.

Lee, H., Choi, E., Lee, S., Kim, Y., Han, K., & Oh, S. (2018). Risk of ischemic stroke in metabolically healthy obesity: A nationwide population-based study. PLOS ONE13(3), e0195210.


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Research Article Review



IT SHOULD BE ORIGINAL RESEARCH FROM A REPUTABLE JOURNAL – NOT NIH info pages, CDC info pages, or popular magazines such as Scientific American, etc.


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