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Objective: To investigate whether the "obesity paradox" in acute ischemic stroke (AIS) is a masking effect of metabolic lipid reserves. We evaluated the independent and opposing associations of body weight status and admission triglycerides (TG) with 90-day functional outcomes to distinguish the structural burden of obesity from metabolic health. Methods: ) groups. The primary endpoint was an excellent functional outcome modified Rankin Scale (mRS) 0-1 at 90 days. Multivariable logistic regression and inverse probability weighting (IPW) were employed to isolate the independent effects of weight status and TG levels. Results: 0.019). These opposing associations remained robust in IPW sensitivity analyses. Conclusion: The "obesity paradox" in AIS appears to be a masking effect driven by TG reserves. Once disentangled from metabolic benefits, overweight and obesity emerge as independent risk factors for poorer recovery. These findings support a phase-specific metabolic management strategy: mitigating the physical and systemic burdens of obesity while ensuring sufficient TG levels within the physiological range to support neural repair during the acute window.
Xie et al. (Mon,) studied this question.