• Doris Y P Leung, Eliza M L Wong, Aileen W K Chan, Yong Zhao, and Janet W H Sit.
• The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China. Electronic address: dorisleung@cuhk.edu.hk.
• Lancet. 2016 Oct 1; 388 Suppl 1: S50.

BackgroundRecurrence of stroke is common and it affects quality of life, mobility, and mortality rates of stroke survivors. Previous studies have shown a paradoxical association between body mass index (BMI) and post-stroke mortality, and a dose-dependent association between second-hand smoke (SHS) exposure and risk of stroke. But the associations between BMI, SHS exposure, and stroke recurrence are unclear. We aimed to examine these associations in stroke survivors.MethodsThis cross-sectional survey was done in Xi'an, Shantou, and Chongqing. Student helpers trained by DYPL and YZ obtained information about stroke recurrence, BMI (underweight defined as <18·5 kg/m(2), normal weight as 18·5-23·9 kg/m(2), and overweight/obese as ≥24 kg/m(2)), SHS exposure at home and work, lifestyle (smoking, alcohol drinking, physical activity, and food consumption patterns), and demographic details with a locally validated instrument. Bivariate analyses identified potential confounders. We used logistic regression to assess associations of obesity and SHS exposure with stroke recurrence after adjustment for confounding variables. This study was approved by the Joint Chinese University of Hong Kong-New Territories East Cluster Clinical Research Ethics Committee, and respondents provided informed consent.FindingsWe included surveys completed between April 1, 2012, and Dec 31, 2013, from 503 stroke survivors (325 [65%] male, mean age 66·9 years [SD 11·7]). 202 (40%) participants reported previous stroke recurrence. Logistic regression analysis adjusted by sex, age, diabetes, and hypertension showed that, compared with patients who were normal weight, patients who were underweight were more likely to have stroke recurrence (odds ratio [OR] 3·12, 95% CI 1·39-6·97; p=0·006) while patients who were overweight or obese had a similar risk (0·85, 0·57-1·28; p=0·435). SHS exposure at work and at home were not associated with stroke recurrence in this study (0·60, 0·34-1·06; p=0·146).InterpretationUnderweight patients are at increased risk of recurrent stroke whereas obese patients have similar risk as their normal weight counterparts. Optimal weight management should be promoted as part of secondary prevention and stroke rehabilitation.FundingThe Nethersole School of Nursing, The Chinese University of Hong Kong (NUR-CV1102).Copyright © 2016 Elsevier Ltd. All rights reserved.

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