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Background  To investigate the relationship between different classes of obesity and stroke, we conducted a stratified Mendelian randomization (MR) study.    Methods  The body mass index (BMI) data of 263,407 Europeans with three classes of obesity (obesity class I, 30 kg/m 2  ≤ BMI &amp;lt; 35 kg/m 2 ; obesity class II, 35 kg/m 2  ≤ BMI &amp;lt; 40 kg/m 2 ; obesity class III, 40 kg/m 2  ≤ BMI) were extracted from the Genetic Investigation of ANthropometric Traits (GIANT) consortium. Summary-level data of stroke and its subtypes [ischemic stroke (IS) and intracerebral hemorrhage (ICH)] were obtained from the genome-wide association study (GWAS) meta-analysis, which was performed by the MEGASTROKE consortium. MR methods were used to identify the causal relationships.    Results  The MR analysis revealed that both obesity class I [odds ratio (OR) = 1.08, 95% CI: 1.05–1.12,  p  = 1.0 × 10 -5 ] and obesity class II (OR = 1.06, 95% CI: 1.03–1.09,  p  = 1 × 10 -4 ) were significantly positively related to IS, while obesity class III was not (OR = 1.01, 95% CI: 0.96–1.06,  p  = 0.65). In contrast to IS, there was no class of obesity associated with ICH risk. Further examination of the relationship between obesity classification and IS subtypes revealed that certain degrees of obesity were related to large artery stroke (LAS) (OR = 1.14, 95% CI: 1.04–1.24,  p  = 2.8 × 10 -3  for class I; OR = 1.08, 95% CI: 1.01–1.16,  p  = 0.002 for class II) and cardioembolic stroke (CES) (OR = 1.11, 95% CI: 1.02–1.20,  p  = 0.02 for class I; OR = 1.08, 95% CI: 1.02–1.15,  p  = 0.007 for class II).    Conclusions  A higher risk of IS, but not ICH, could be linked to obesity classes I and II. A strong association between LAS and CES and obesity was observed among all IS subtypes in the obese population.

Deciphering the Irregular Risk of Stroke Increased by Obesity Classes: A Stratified Mendelian Randomization Study