Neck circumference as a simple screening measure for identifying overweight and obese patients

Charcoal Suspension Tattoo: A New Technique for Intraoperative Detection of Small Tumors of the Parotid Gland

OBJECTIVE

The current surgical trend in the treatment of pleomorphic adenomas of the parotid gland is to limit the extent of resection. This raises the need to correctly identify the mass within the normal parenchyma so as to avoid dissecting the entire superficial lobe of the gland. We describe ultrasound-guided tattooing as a technique to facilitate identification and excision of parotid pleomorphic adenomas.

METHODS

We reviewed 23 consecutive patients with pleomorphic adenoma of the parotid gland. All patients underwent ultrasound-guided tattooing of the lesions with a charcoal suspension. Baseline tumor and patients' characteristics, major and minor complications, and subjective tolerance to the procedure were recorded. We assessed the number of intralesionally marked masses and the percentage of intraoperatively detected marked lesions.

RESULTS

The injection was well tolerated. No major complications were recorded. In 2 cases (9%), a transient increase in lesion size was observed. No other minor complications were encountered. Charcoal was found inside the tumor in 19 cases (83%). In 4 cases (17%), it was found in the tissues above the lesion. Twenty-three lesions were intraoperatively detected (100%) and dissected.

CONCLUSION

Charcoal suspension tattooing is safe and well tolerated for the detection of small pleomorphic adenomas during parotid surgery.

Association of Neck Circumference with Obesity in Female College Students

BACKGROUND:

Obesity levels have been dramatically increased in the United Arab Emirates over the last few years. High levels of body Mass Index, waist circumference, and percent of total body fat as a measure of obesity have found to be related to cardiovascular risk factors and other diseases. Neck circumference is a new tool that has been linked to obesity. However, no studies in UAE have been conducted yet.

AIM:

The purpose of this study was to measure the obesity levels in a college population and to correlate them with NC and other anthropometrical indexes.

METHODS AND SUBJECTS:

Two hundred forty three (243) female students aged 18-25 were conveniently selected to participate in the study. Anthropometrical indexes were obtained from all subjects e after fasting.

RESULTS:

The prevalence of overweight and obesity together was found to be 28.4 % (n = 69). Pearson correlation showed that WC, NC and BF (%) were significantly positively related to obesity, (r = 0.790; r = 0.758; r = 0.767, p < 0.001), respectively. In multiple regression analysis, only NC (Beta: 1.627, 95 %CI: 0.370, 2.846, p < 0.001) and WC (Beta: 0.464, 95 %CI: 0.135, 0.664, p < 0.001) were found to be independently associated with obesity.

CONCLUSION:

NC was found to be independently associated with obesity levels in Emirati college students.

Heart rate variability in shift workers: responses to orthostatism and relationships with anthropometry, body composition, and blood pressure

In order to investigate the response of heart rate variability (HRV) components to postural change and their association with cardiovascular risk factors in shift workers, a cross-sectional study with 438 Brazilian males rotating shift workers was done. Anthropometric, body composition, and clinical measures were collected. Electrocardiogram was recorded for 3 minutes, in the supine and orthostatic position, and HRV components were extracted. Descriptive analyses showed that mean values of body mass index, waist circumference (WC), waist-to-height ratio, visceral fat area (VFA), and blood pressure (BP) were higher than the reference values. In the regression model, age, WC, VFA, and systolic BP showed negative association with HRV components. These findings suggest the need for determining effective strategies for the evaluation and promotion of health among shift workers focused on the altered variables.

Association of neck circumference and high blood pressure in children and adolescents: a case-control study

Background

High blood pressure (BP) is a serious, common and growing global public health problem. The aim of this study was to evaluate the associations between high NC (neck circumference) alone and in combinations with BMI (body mass index), WC (waist circumference), and high BP among Lithuanian children and adolescents aged 12 to 15 years.

Methods

An epidemiological case–control study was performed between May 2012 and November 2013. NC, WC, hip circumference (HC), mid-upper arm circumference (MUAC), body height, weight, and BP were measured. The participants with high BP (≥90th percentile) were screened on two separate occasions. Data on NC, WC, HC, MUAC, BMI, body adiposity index (BAI), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), and BP were analyzed in 1947 children and adolescents aged 12–15 years. Age- and sex-adjusted odds ratios (aORs) with 95 % confidence intervals (CI) for the associations were estimated using multivariate logistic regression models.

Results

The prevalence rates of prehypertension (BP ≥90th– < 95th percentile) and hypertension (BP ≥95th percentile) was 6.3 and 25.1 %, respectively. The overall prevalence of high NC (if NC was in the ≥90th percentile), overweight/obesity (as measured by BMI), and abdominal overweight/obesity (if WC was in the ≥75th percentile) were 14.3, 15.8, and 13 %, respectively. After adjustment for age and sex, NC in the ≥90th percentile was significantly associated with an increased risk of elevated BP (prehypertension: aOR = 2.99; 95 % CI, 1.88–4.77; hypertension aOR = 4.05; 95 % CI, 3.03–5.41, and prehypertension/hypertension aOR = 3.75; 95 % CI, 2.86–4.91), compared to the participants with NC in the <90th percentile. Overweight/obesity and abdominal overweight/obesity were also significantly associated with an elevated BP. The combinations including both risk factors (high NC with overweight/obesity, and high NC with abdominal overweight/obesity) showed higher aORs than those with either risk factor alone.

Conclusions

High NC alone—but particularly in combinations with overweight/obesity and abdominal overweight/obesity—was associated with an increased risk of high BP.

Neck Circumference as a Predictive Indicator of CKD for High Cardiovascular Risk Patients

BACKGROUND

Neck circumference (NC) is an anthropometric measure of obesity for upper subcutaneous adipose tissue distribution which is associated with cardiometabolic risk. This study investigated whether NC is associated with indicators of chronic kidney disease (CKD) for high cardiometabolic risk patients.

METHODS

A total of 177 consecutive patients who underwent the outpatient departments of cardiology were prospectively enrolled in the study. The patients were aged >20 years with normal renal function or with stages 1-4 CKD. A linear regression was performed using the Enter method to present an unadjusted R(2), standardized coefficients, and standard error, and the Durbin-Watson test was used to assess residual independence.

RESULTS

Most anthropometric measurements from patients aged ≧ 65 were lower than those from patients aged < 65, except for women's waist circumference (WC) and waist hip ratio. Female NC obtained the highest R(2) values for 24 hr CCR, uric acid, microalbuminuria, hsCRP, triglycerides, and HDL compared to BMI, WC, and hip circumference. The significances of female NC with 24 hr CCR and uric acid were improved after adjusted age and serum creatinine.

CONCLUSIONS

NC is associated with indicators of CKD for high cardiometabolic risk patients and can be routinely measured as easy as WC in the future.

Retrospective study using MRI to measure depths of acupuncture points in neck and shoulder region

OBJECTIVES

There are safety issues associated with acupuncture treatment. Previous studies regarding needling depth of acupuncture points revealed inconsistent results due to vague depth definition, acupuncture point localisation and measuring tools. The objective of this study is to find and compare the differences of the mean depths of 11 acupuncture points in the neck and shoulder region between subjects, with variables including gender and body mass index (BMI).

SETTING

This study was conducted at a single medical center in Taiwan.

PARTICIPANTS

Three hundred and ninety-four participants were included in this study. Participants were grouped according to gender and BMI. Acupuncture points were localised by WHO standard and measured by MRI.

OUTCOME MEASURES

The distance from the needle insertion point (surface of the skin) to any tissues that would cause possible/severe complications.

RESULTS

Mean depths of 11 points were obtained in groups of different BMI and gender. Mean depths of all participants regardless of BMI and gender are as follows, in centimetres: GB21=5.6, SI14=5.2, SI15=8.8, GV15=4.9, GV16=4.6, GB20=5.0, ST9=1.6, SI16=1.8, SI17=2.4, TE16=3.1, LI18=1.3. Participants with higher BMI had greater measured depths in both gender groups. Male participants had larger mean depths than female participants regardless of BMI except in SI17 and LI18. When taking BMI into consideration, depths in male participants are greater than in female participants in most of the points except the following: GB21, TE16 in obesity group; ST9 in underweight and obesity group; SI16 in ideal body weight, overweight and obesity group; SI17, LI18 in each group.

CONCLUSIONS

Participants with higher BMI had greater measured depths and males tended to have greater depths in most of the points. Clinical practitioners are recommended to consider this information to prevent complications when applying acupuncture treatment to their patients.

Observational study of sleep, respiratory mechanics and quality of life in patients with non-cystic fibrosis bronchiectasis: a protocol study

INTRODUCTION

Bronchiectasis is a chronic disorder characterised by permanent and irreversible abnormal dilation of the bronchi and bronchioles, primarily caused by repeated cycles of pulmonary infections and inflammation, which lead to reduced mucociliary clearance and to the excessive production of sputum. Patients with non-cystic fibrosis bronchiectasis may be predisposed to hypoxemia during sleep, or to symptoms that may lead to arousals and thereby reduce the quality of life, because of the irreversible dilation of the bronchi and the presence of secretions and airflow obstruction.

METHODS AND ANALYSIS

For this cross-sectional observational study, patients with a clinical diagnosis of non-cystic fibrosis bronchiectasis will be recruited from the Bronchiectasis Clinic of the Pneumology Department of the Santa Casa de Misericordia Hospital and the Federal University of São Paulo (São Paulo, Brazil). Patients of either sex will be included if high-resolution CT of the thorax and classic sweat test confirms they have non-cystic fibrosis bronchiectasis, are between 18 and 80 years old, use long-acting bronchodilators, are clinically stable for a least 1 month, agree to participate in the study and they sign a statement of informed consent. The first part of the study will involve a clinical evaluation, maximal respiratory pressures, spirometry and the Saint George's Respiratory Questionnaire. The Sleep Laboratory of the Master's and Doctoral Postgraduate Program in Rehabilitation Sciences of the Nove de Julho University (São Paulo, Brazil) will perform the polysomnographic studies, Berlin Questionnaire, Epworth Sleepiness Scale, waist and neck circumferences, modified Mallampati classification and tonsil index.

ETHICS AND DISSEMINATION

This protocol has been approved by the Human Research Ethics Committees of Santa Casa de Misericordia Hospital (process number 178/2012) and Human Research Ethics Committee of Nove de Julho University (process number 370474/2010). All participants will sign a statement of informed consent. The study findings will be published in peer-reviewed journals and presented at conferences.

Exploratory Study Examining Clinical Measures of Adiposity Risk for Predicting Obesity in Adolescents with Physical Disabilities

OBJECTIVE

The purposes of this study were to assess the accuracy of clinical measures for predicting adiposity when compared with a criterion standard of body fat percentage measured by dual-energy X-ray absorptiometry and to determine the most appropriate cut points for classifying obesity for each measure in adolescents with physical disability.

DESIGN

Body mass index, triceps skinfolds, and waist, arm, and leg circumferences were collected on 29 adolescents aged 14-17 yrs with spinal cord injury, cerebral palsy, or spina bifida. Percentage of body fat was measured using dual-energy X-ray absorptiometry. Multiple linear regression models were used to assess the ability of measures to predict percentage of body fat. Receiver operating characteristic curves were used to identify optimal cut points for each measure.

RESULTS

Although all clinical measures correlated with body fat as measured by dual-energy X-ray absorptiometry, current cut points are not adequate in this group. Using a body mass index of 20 kg/m (boys) and 19 kg/m (girls) was optimal but still misclassified a significant number of participants as nonobese in this group. Using the optimal cut points for waist circumference, which were 83 cm (boys) and 78 cm (girls), was the best predictor.

CONCLUSIONS

Body mass index, triceps skinfolds, and waist, leg, and arm circumferences are valid measures for estimating obesity in adolescents with physical disability, but further research is needed to validate disability-specific cut points.

The Association between Subclinical Hypothyroidism and Epicardial Adipose Tissue Thickness

Background and Objectives

Subclinical hypothyroidism (SH) is considered to be a potential risk factor for cardiovascular disease. Epicardial adipose tissue (EAT) thickness is also closely related to cardiovascular disorders. The aim of this study was to evaluate whether SH is associated with higher EAT thickness.

Subjects and Methods

Fifty-one consecutive patients with SH and 51 healthy control subjects were prospectively enrolled into this trial. Thyroid hormone levels, lipid parameters, body mass index, waist and neck circumference, and EAT thickness measured by echocardiography were recorded in all subjects.

Results

Mean EAT thickness was increased in the SH group compared to the control group (6.7±1.4 mm vs. 4.7±1.2 mm, p<0.001). EAT thickness was shown to be correlated with thyroid stimulating hormone level (r=0.303, p=0.002). Multivariate logistic regression analysis revealed that EAT thickness was independently associated with SH {odds ratio (OR): 3.87, 95% confidence interval (CI): 1.92-7.78, p<0.001; OR: 3.80, 95% CI: 2.18-6.62, p<0.001}.

Conclusion

Epicardial adipose tissue thickness is increased in patients with SH compared to control subjects, and this increase in EAT thickness may be associated with the potential cardiovascular adverse effects of SH.

Measurement of neck circumference and its correlation with body composition in a sample of students in São Paulo, Brazil

PURPOSE

The purpose of this study was to verify the correlation between neck circumference (NC) and body mass index (BMI) in children, and to determine NC percentiles for Brazilian children.

METHODS

The subjects of this cross-sectional study were students between the ages of 6 and 19 years from five schools in São Paulo, Brazil. Clinical and anthropometric data were collected from the students from April 2011 to June 2012. NC was measured at the level of the cricoid cartilage. We calculated Pearson correlation coefficients between NC and other indices of obesity with Sigma Stat 3.5. NC percentiles were produced using the LMS (lambda, mu, and sigma) method (STATA 12.0).

RESULTS

Among 2,794 students, 49.9% were male. NC was significantly correlated with age, BMI, waist circumference (WC), and body fat percentage (%BF). The NC of boys was greater than that of girls. The NC curves of smoothed 3rd, 10th, 25th, 50th, 75th, 90th, and 97th percentiles were constructed by age and sex.

CONCLUSIONS

NC can be used in the assessment of obesity in childhood. There was a positive correlation between NC and BMI, WC and %BF. This study was the first to provide NC percentiles for children in Brazil.

Elevated neck circumference and associated factors in adolescents

Background

Upper body subcutaneous fat, estimated by neck circumference (NC), may present greater metabolic risk than visceral fat. The aim of this study was to determine cutoff values for NC in adolescents that identify overweight and obesity, the prevalence of elevated NC, and its association with associated factors.

Methods

Cross-sectional study with adolescents from public schools in São Paulo. Anthropometric variables, blood pressure and pubertal stage were collected. Cutoff values for NC were determined by Receiver Operating Characteristic curves. A binary logistic regression was used to determine relationships between NC and associated factors.

Results

Among 1668 adolescents studied, 54.92% were female. The cutoff values of NC in girls and boys that identified overweight were 31.25 and 34.25 cm, and obesity, 32.65 and 37.95 cm, respectively, and the prevalence of adolescents with high NC was 32.63% in females and 37.63% among males. NC for overweight was observed that there was an association with sex, weight, body mass index, arm, waist and thigh circumferences, pubertal stages and body fat percent (BF%). NC for obesity was found association with gender, weight, arm and thigh circumferences, and BF% (p < 0.001).

Conclusion

It was concluded that there is high prevalence of elevated NC and higher risks for this outcome considering overweight and obesity, sex, weight, arm and thigh circumferences, BF%, besides being an easy and simple measure for use in clinical practice.

Neck circumference, along with other anthropometric indices, has an independent and additional contribution in predicting fatty liver disease

BACKGROUND AND AIM

Previous studies have indicated that neck circumference is a valuable predictor for obesity and metabolic syndrome, but little evidence is available for fatty liver disease. We examined the association of neck circumference with fatty liver disease and evaluated its predictive value in Chinese adults.

METHODS

This cross-sectional study comprised 4053 participants (1617 women and 2436 men, aged 20-88) recruited from the Health Examination Center in Guangzhou, China between May 2009 and April 2010. Anthropometric measurements were taken, abdominal ultrasonography was conducted and blood biochemical parameters were measured. Covariance, logistic regression and receiver operating characteristic curve analyses were employed.

RESULTS

The mean neck circumference was greater in subjects with fatty liver disease than those without the disease in both women and men after adjusting for age (P<0.001). Logistic regression analysis showed that the age-adjusted ORs (95% CI) of fatty liver disease for quartile 4 (vs. quartile 1) of neck circumference were 7.70 (4.95-11.99) for women and 12.42 (9.22-16.74) for men. After further adjusting for other anthropometric indices, both individually and combined, the corresponding ORs remained significant (all P-trends<0.05) but were attenuated to 1.94-2.53 for women and 1.45-2.08 for men. An additive interaction existed between neck circumference and the other anthropometric measures (all P<0.05). A high neck circumference value was associated with a much greater prevalence of fatty liver disease in participants with both high and normal BMI, waist circumference and waist-to-hip ratio values.

CONCLUSIONS

Neck circumference was an independent predictor for fatty liver disease and provided an additional contribution when applied with other anthropometric measures.

Association of neck circumference as an indicator of upper body obesity with cardio-metabolic risk factors among first degree relatives of diabetes patients

Background:

The aim of the present study was to determine the relation between neck circumferences (NC), as an indicator of upper body obesity, with anthropometric and cardio-metabolic factors among the first degree relatives of diabetes patients.

Materials and Methods:

This cross-sectional study was performed on first degree relatives of diabetes patients (n = 213). Weight, height, waist circumference (WC), hip circumference (HC), systolic blood pressure (SBP), diastolic blood pressure (DBP) and NC were measured. Laboratory data included oral glucose tolerance test (OGTT) results, high density lipoprotein (HDL), low density lipoprotein, triglyceride (TG) and total cholesterol.

Results:

There was no difference in NC among different results of OGTT in men or women. Factors including weight, body mass index (BMI), WC and HC were strongly associated with NC in both genders (r = 0.420-0.711). NC was weakly associated with SBP in women (r = 0.195) and moderately with DBP in men (r = 0.314). Regarding lipid profile, HDL and TG were associated with NC only in women (r = −0.268-0.325).

Conclusions:

NC has a significant correlation with gender and anthropometric variables including BMI, weight and waist and HCs in both men and women but it does not differ significantly in patients with different status in OGTT.

Neck circumference as a potential marker of metabolic syndrome among college students

OBJECTIVE

to relate neck circumference with metabolic syndrome and its criteria among college students.

METHOD

cross-sectional study conducted with 702 college students in Fortaleza, CE, Brazil from September 2010 to June 2011. Socio-demographic data, waist circumference and neck circumference were collected together with blood pressure, fasting blood sugar, triglyceride levels, and HDL-C.

RESULTS

1.7% of the studied sample presented metabolic syndrome. Of these, 58.3% presented altered neck circumference (p<0.006). As neck circumference decreases, pressure levels improve (p<0.001). Additionally, college students with high fasting blood sugar (p=0.003) and high triglyceride levels (p<0.001) presented higher values of neck circumference.

CONCLUSION

neck circumference is a potential predictive marker in the detection of metabolic syndrome and its components among college students.

Compartmental neck fat accumulation and its relation to cardiovascular risk and metabolic syndrome

BACKGROUND

Neck circumference is a predictor of cardiovascular disease (CVD) risk. However, detailed assessment of neck fat has not been explored, and the contribution from individual neck fat compartments to CVD risk is unknown.

OBJECTIVE

The objective was to measure neck adipose tissue (NAT) compartments and examine relations with CVD risk markers, with the hypothesis that neck adipose tissue (NAT) accumulation preferentially involves specific compartments that contribute differently to metabolic risk.

DESIGN

We retrospectively studied 303 subjects with successfully treated malignancies or benign etiologies [151 women, 152 men; mean (± SD) age: 55 ± 17 y; mean body mass index (BMI; in kg/m(2)): 28 ± 6] who underwent whole-body positron emission tomography/computed tomography. NAT was measured at the level of the C5 vertebral body, subdivided into posterior (NATpost), subcutaneous (NATsc), and perivertebral (NATperivert) compartments. Data on CVD risk factors (BMI, abdominal circumference, visceral and abdominal subcutaneous adipose tissue, blood pressure, serum lipids, and fasting plasma glucose) were collected. We compared NAT compartments across lean, overweight, and obese groups and performed multivariate regression models correlating NAT with CVD risk factors. Receiver operating characteristic curve and prevalence ratio analyses were performed to examine the association of NAT compartments with metabolic syndrome.

RESULTS

NATpost and NATsc were more consistently associated with cardiometabolic risk, especially in women, correlating with visceral adipose tissue (P < 0.0001) and triglycerides (P < 0.001) and a nearly 1.5-fold increase in the prevalence ratio for metabolic syndrome after adjustment for age and BMI (P < 0.05). NATsc was most abundant in women, whereas intermuscular compartments (NATpost and NATperivert) were higher in men. In both sexes, NATpost and NATperivert showed the largest increment between lean and obese subjects.

CONCLUSIONS

Neck fat compartments expand differently with increasing adiposity, correlate with CVD risk factors, and are associated with metabolic syndrome, most notably NATpost and NATsc in women. Although neck circumference remains an important method to assess metabolic risk, cross-sectional NAT assessment provides further insight into fat accumulation in the neck. This trial was registered at clinicaltrials.gov as NCT02205021.

Is neck circumference measurement an indicator for abdominal obesity? A pilot study on Turkish Adults

BACKGROUND

Neck circumference (NC) measurement is one of the simple screening measurements which can be used as an index of upper body fat distribution to identify obesity.

OBJECTIVES

The aim of this study was to determine the relationship between neck circumferences and obesity.

METHODS

A total 411 volunteer adults participated in this study (174 men, 237 women). A questionnaire which consisted of anthropometric measurements and demographic features was used. Patients with NC ≥37 cm for men and ≥34 cm for women require evaluation of overweight status.

RESULTS

The percentages of the men and women with BMI ≥ 25 kg/m(2) were 55.2% and 27.0% respectively and with high neck circumferences were 85.1% and 38.8%, respectively. The percentages of the men and women with high waist circumference were 31.6% and 79.3%, respectively. In both gender there were positive significant correlations between neck circumference, body weight (men, r=0.576; women, r=0.702; p=0.000), waist circumferences (men, r=0.593; women r=0.667; p=0.000), hip circumferences (men, r=0.568; women, r=0.617; p=0.000) and BMI (men, r=0.587; women, r=0.688; p=0.000).

CONCLUSIONS

This study indicates that NC was associated with body weight, BMI, waist and hip circumferences and waist/hip ratio for men and women. A significant association was found between NC and conventional overweight and obesity indexes. NC was associated with waist/hip ratio for men and women.

The value of neck circumference (NC) as a predictor of non-alcoholic fatty liver disease (NAFLD)

Aims

To analyze the correlation between neck circumference (NC) and non-alcoholic fatty liver disease (NAFLD) and compare the predictive value of NC for NAFLD with that of other simple anthropometric measures and other biochemical profiles.

Methods

2761 subjects, undergoing a medical check-up at the Changhai Hospital between October 01, 2012 and November 30, 2012, were recruited to the study. NC, other simple anthropometric measures, and biochemical profiles were analyzed.

Results

NC in NAFLD subjects with or without elevated ALT were 38.94 ± 2.62 cm and 37.21 ± 3.06 cm respectively, which was significantly higher than that in subjects with other metabolic disorders (NC: 35.33 ± 3.03 cm) and in normal controls (NC: 32.60 ± 2.37) (both P < 0.001). NC in women with NAFLD increased by 1 cm and fasting insulin (FINS) and homeostasis model assessment-insulin resistance (HOMA-IR) increased by 1.87 mIU/L and 1.43, respectively. Compared with other anthropometric measures, neck circumference-height ratio (NHtR) had a significant impact both on the incidence of NAFLD. After adjustment for sex, abdominal obesity and other influencing factors, the incidence of NAFLD still tended to positively correlate with NC. Optimal cut-off points of NC and NHtR for predicting NAFLD in males were 37.25 cm and 0.224, respectively, and such points in females were 32.90 cm and 0.208, respectively.

Conclusion

NC was wider in NAFLD patients than in healthy subjects and other metabolic disorder sufferers. NC and NHtR could be used as simple predictive tools for NAFLD.

Neck circumference and cardio- metabolic syndrome

BACKGROUND

Only few studies about neck circumference (NC) as a measure of cardio metabolic syndrome available from India. Study was conducted to establish an association between neck circumference and cardio metabolic syndrome.

MATERIAL AND METHODS

Cross-sectional study was conducted in a tertiary care hospital in South India. NCEP: ATPIII 2001 guideline was used for diagnosis of Cardio-metabolic syndrome among subjects. Neck circumference was measured and it was correlated with Cardio-metabolic syndrome.

RESULTS

Mean neck circumference was found to be 36.5 cms. Cardio-metabolic syndrome was present in 272 participants, of which 100 were females and 172 males. Among females 82(82%) had neck circumference >34cms, 18(18%) had <34cms and among males 117(68%)had NC >37cms and 55(32%) had NC<37cms. All individual parameter of cardio metabolic risk factor, i.e., BMI, waist circumference, hip circumference, systolic blood pressure, diastolic blood pressure, FBS, HDL & TG except waist/hip ratio were correlating with abnormal neck circumference when compared with those with normal neck circumference.

CONCLUSION

Neck circumference with metabolic syndrome correlated better among females than males. Men with NC >37 cm and women with NC >34 cm are more prone for cardio metabolic syndrome and require additional evaluation. Measurement of NC is a simple, time saving, and least invasive measurement tool.

Head fat is a novel method of measuring metabolic disorder in Chinese obese patients

BACKGROUND

Body adiposity, especially ectopic fat accumulation, has a range of metabolic and cardiovascular effects. The aim of this study was to investigate the association between head fat and metabolic values in Chinese obese patients.

METHODS

Data of this cross-sectional study from 66 obese patients were collected. Fat distribution was measured by dual-energy X-ray absorptiometry, and data of body weight, body mass index (BMI), neck circumference (NC), waist circumference (WC), hip circumference (HC), visceral index, basal metabolism (BM), glucose metabolism, lipid levels, uric acid (UA) had been collected.

RESULTS

1) Head fat was significantly associated with BMI, WC, HC, visceral index, BM, total fat and total fat excluding head fat in both males and females (p<0.05). Head fat was positively correlated with upper limb fat, trunk fat, weight, fasting plasma C peptide, fasting plasma insulin and UA in women(p<0.05), and the association was not statistically significant in male (p>0.05). Head fat was positively corrected with NC in males (p<0.05) but not females (p>0.05). There was no significant correlation between head fat and fasting plasma glucose, total choleslerolemia, triglyceridemia, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and free fat acid in either gender (p>0.05). 2) Receiver operating characteristic analysis showed that a head fat of 1925.6 g and a head fat of 1567.85 g were the best cut-off values to determine subjects with low high-density lipoprotein cholesterol and hyperuricemia respectively.

CONCLUSIONS

Head fat accumulation was closely associated with increased body fat, hyperinsulinemia, hyperuricemia, and impared lipid profile, suggesting it might be used as an indicator for dyslipidemia and hyperuricemia.

Polymorphisms of the methylenetetrahydrofolate reductase gene (C677T and A1298C) in nulliparous women complicated with preeclampsia

OBJECTIVE

To determine the prevalence of C677T and A1298C Single-nucleotide polymorphisms (SNPs) of the MTHFR gene in nulliparous women complicated with preeclampsia (PE).

METHODS

One hundred fifty gestations complicated with PE and their corresponding controls without the disease were recruited for the genotyping of C677T and A1298C polymorphisms of the MTHFR gene using restriction fragment length polymorphism polymerase chain reaction. Secondarily, homocysteine (HCy) plasma levels were measured in preeclamptic women displaying the CC genotype of the A1298C polymorphism (homozygous) and compared to HCy levels determined among controls with the normal AA genotype for the A1298C variant.

RESULTS

Only the mutant CC genotype of the A1298C polymorphism was associated to higher risk of presenting PE, as frequency of this genotype was significantly higher among cases than controls (15.3% versus 0.7%, p < 0.05). All PE women with a neck circumference ≥32 cm presented the mutant CC A1298C polymorphism as compared to none among preeclamptics with a lower neck circumference (p = 0.0001). Women with the mutant CC A1298C SNP displayed higher plasma HCy levels as compared to controls with normal AA A1298C genotype (8.4 ± 2.6 versus 7.5 ± 2.7 mmoL/L p = 0.04).

CONCLUSION

Prevalence of the CC mutant genotype of the A1298C polymorphism was higher among PE women. This mutation among PE women was related to increased neck circumference and higher HCy levels. Future research should aim at linking these gestational findings with obesity and cardiovascular risk.

Neck circumference as a measure of neck fat and abdominal visceral fat in Chinese adults

Background

Visceral adipose tissue (VAT) is a unique pathogenic fatty deposit, in that it is closely correlated with risk of cardiovascular diseases. The present study is to investigate the usefulness of neck circumference (NC) to indicate VAT.

Methods

Participants aged 35 to 75 years who had taken abdomen and neck computer tomography (CT) examination were included in this study. Neck adipose tissue, abdominal VAT and subcutaneous adipose tissue (SAT) areas, as well as sagittal abdominal diameter (SAD) were measured by CT. Body anthropometrics and metabolic parameters including blood glucose, lipid profiles and blood pressure were also measured.

Results

A lower abdomen CT examination was carried out on a total of 177 patients (87 male and 90 female) with a mean age of 59 years. Of the 177 participants, 15 men and 15 women also took a neck CT examination. With a comparable age and BMI, neck adipose area was correlated with abdominal VAT area significantly in men (r = 0.57, p = 0.028) and women (r = 0.53, p = 0.041). NC is positively correlated with VAT both in men (r = 0.49, p < 0.001) and women (r = 0.25, p = 0.012). Meanwhile, SAD is the best predictor for visceral fat both in men (r = 0.83, p < 0.001) and women (r = 0.73, p < 0.001). Body mass index (BMI), waist circumference (WC), and waist to height ratio (WHtR) correlated significantly with VAT both in men and women (r = 0.68, 0.42, 0.46 in men and 0.50, 0.23, 0.39 in women, p < 0.001), while waist hip ratio (WHR) displayed the weakest least correlation in men (r = 0.32, p = 0.001) and no correlation in women (r = 0.08, p = 0.442). Additionally, BMI was more strongly correlated with VAT than NC in both sexes (both p < 0.01).

Conclusion

Significant correlation between NC and VAT was present in Chinese men and women, which may be accounted by the fact that neck fat area is significantly correlated with abdominal VAT. Meanwhile, SAD is the best predictor for visceral fat in the Chinese population.

Neck circumference as predictor of excess body fat and cardiovascular risk factors in adolescents

OBJECTIVE: To verify whether neck circumference can predict cardiovascular risk factors and excess body fat in adolescents. METHODS: This cross-sectional study included male and female adolescents aged 10 to 14 years from Viçosa, Minas Gerais. The following data were collected: anthropometric measurements, blood pressure, percentage of body fat according to dual energy X-ray absorptiometry, and levels of fasting glucose, fasting insulin, triglycerides, total cholesterol, high-density lipoprotein, and low-density lipoprotein. The anthropometric measurements were used for calculating indices and assessing nutritional status. The receiver operating characteristic curve tested whether neck circumference could predict cardiovascular risk. We also investigated how neck circumference related to the study parameters. The significance level was set at 5% (p<0.05). RESULTS: A total of 260 adolescents were assessed of which 50.4% (n=131) were females, 20.4% (n=53) had excess body weight according to the body mass index-for-age index, and 42.7% (n=111) had excess body fat. Blood pressure (3.9%, n=10) and all biochemical parameters were affected, varying from 1.9% (n=5) for glucose to 65% (n=169) for total cholesterol. Neck circumference correlated with body fat, waist circumference, hip circumference, weight, height, body mass index, waist-to-height ratio, homeostasis model of assessment - insulin resistance, fasting insulin, blood pressure, and high-density lipoprotein (<0.05). It predicted excess body fat and changes in fasting insulin and blood pressure in both sexes, blood glucose and high-density lipoprotein in females, and triglycerides in males (area under the curve >0.5; p<0.05, varying from 0.610 for high-density lipoprotein to 0.817 for blood pressure). CONCLUSION: Neck circumference was capable of predicting excess fat and cardiovascular risk factors in adolescents.

Neck circumference is not associated with subclinical atherosclerosis in retired National Football League players

BACKGROUND

Neck circumference (NC) is associated with metabolic syndrome (MetS) in the general population. It is not known if NC is associated with MetS and subclinical atherosclerosis in retired National Football League (NFL) players.

HYPOTHESIS

We hypothesized that NC is associated with MetS and subclinical atherosclerosis (assessed as coronary artery calcium [CAC] and carotid artery plaque [CAP]) in retired NFL players.

METHODS

NC was measured midway between the midcervical spine and midanterior neck in 845 retired NFL players. CAC presence was defined as total CAC score >0. CAP was defined as carotid plaque of at least 50% greater than that of the surrounding vessel wall, with a minimal thickness of at least 1.2 mm on carotid ultrasound. Logistic regression analysis was used for the association of NC with CAC or CAP.

RESULTS

Of the participants, 21% had MetS. CAC and CAP were present in 62% and 56%, respectively. Those with MetS had a higher median NC than those without MetS (17 vs 16 inches, P < 0.0001). NC was not associated with the presence of CAC or CAP in an unadjusted model and after adjusting for age, race, and cardiometabolic risk factors (odds ratio [OR]: 1.11, 95% confidence interval [CI]: 0.94-1.31 for CAC; OR: 0.96, 95% CI: 0.82-1.12 for CAP per 1-standard deviation increase in NC [3.8 inches]). The results were similar when the predictor variable was NC indexed to body mass index.

CONCLUSIONS

In retired NFL players with a high prevalence of CAC and CAP, NC was not associated with coronary or carotid subclinical atherosclerosis. NC may not be the most appropriate risk marker for atherosclerosis.

Accuracy of Neck Circumference in Classifying Overweight and Obese US Children

Objective. To evaluate classification accuracy of NC and compare it with body mass index (BMI) in identifying overweight/obese US children. Methods. Data were collected from 92 children (boys: 61) aged 7 to 13 over a 2-year period. NC, BMI, and percent of body fat (BF%) were measured in each child and their corresponding cut-off values were applied to classify the children as being overweight/obese. Classification accuracy of NC and BMI was systematically investigated for boys and girls in relation to true overweight/obesity categorization as assessed with a criterion measure of BF% (i.e., Bod Pod). Results. For boys, Cohen's κ (0.25), sensitivity (38.1%), and specificity (85.0%) of NC were smaller in comparison with Cohen's κ (0.57), sensitivity (57.1%), and specificity (95.0%) of BMI in relation to BF% categorization. For girls, Cohen's κ (0.45), sensitivity (50.0%), and specificity (91.3%) of NC were smaller in comparison with Cohen's κ (0.52), sensitivity (50.0%), and specificity (95.7%) of BMI. Conclusion. NC measurement was not better than BMI in classifying childhood overweight/obesity and, for boys, NC was inferior to BMI. Pediatricians and/or pediatric researchers should be cautious or wary about incorporating NC measurements in their pediatric care and/or research.

The relationship between neck circumference and pregnancy-induced hypertension in the third trimester pregnant women

OBJECTIVE

The purpose of this study was to evaluate the relationship between neck circumference (NC) and pregnancy-induced hypertension (PIH) in the third trimester pregnant women.

METHODS

The study included 126 women who were in the third trimester pregnancy. All subjects completed a standard sleep questionnaire, anthropometric measurements and ultrasonic testing.

RESULTS

Pregnant women with NC ≥34.7 cm had significantly higher frequency of PIH than pregnant women with NC <34.7 cm (35.6% versus 2.5%, χ(2 )= 25.863, p = 0.000).

CONCLUSIONS

The increase of NC was independent risk factor for PIH in the third trimester pregnant women.

An Average Body Circumference Can Be a Substitute for Body Mass Index in Women

Introduction. Significant correlations between BMI and some body circumferences have been previously reported. In this study we investigated if the average of the sum of eight body circumferences can be a substitute for BMI. Patients and Methods. BMI and eight body circumferences (neck, waist, hip, arm, forearm, wrist, thigh, and ankle) were measured in 193 apparently healthy women aged 20-83, and within a wide range of BMI. Women with BMI ≤ 24.9 were designated as normal, with BMI 25-29.9 as overweight and with BMI ≥ 30 as obese. The relationship of the average body circumference (ABC) of the sum of the eight circumferences, and of each individual circumference with BMI, was evaluated. Results. ABC had the strongest correlation with BMI (r = 0.95, P < 0.001) among all the circumferences tested. Hip circumference had the strongest correlation with BMI (r = 0.89, P < 0.001) among the circumferences of individual body sites. Receiver-Operator Characteristic analysis showed that women with ABC > 44.0 cm could be recognized as having BMI ≥ 25 with sensitivity 90.2% and specificity 88.5%, while women with ABC > 47.1 cm could be diagnosed as having BMI ≥ 30 with sensitivity 92.2% and specificity 91.5%. Conclusion. An average body circumference strongly correlated with BMI in women and can serve as a surrogate of BMI.

Neck circumference is a valuable tool for identifying metabolic syndrome and obesity in Chinese elder subjects: a community-based study

OBJECTIVE

We aim to explore the relationship of neck circumference to metabolic syndrome (MetS) and obesity in Chinese elders and to establish cut-off points of the neck circumference for MetS and obesity.

METHODS

Cross-sectional analysis for a population sample of 2092 individuals aged over 65 years, representative of East China elders. MetS was identified according to the 2004 Chinese Diabetes Society criteria.

RESULTS

Neck circumference was correlated with body mass index (r = 0.70, p = 0.000 in men, and r = 0.73, p = 0.000 in women) and waist circumference (waist circumference; r = 0.70, p = 0.000 in men, and r = 0.72, p = 0.000 in women). According to neck circumference quartile, the prevalence of MetS and its components were increased significantly from Q1 to Q4 (p for trend <0.001) in both genders. Binary logistic regression analysis revealed that both waist circumference and neck circumference were independent predictors of Mets, with odds ratios (95% confidence interval) 1.11 (1.08-1.15; p = 0.044) and 1.17 (1.07-1.28; p = 0.000), respectively, in men and 1.08 (1.05-1.10; p = 0.000) and 1.31 (1.21-1.42; p = 0.000), respectively, in women. As for obesity, the significant independent indicators in both genders were also waist circumference and neck circumference (all p < 0.01). In the receiver operating characteristic curves, both the optimal cut-off points of neck circumference for MetS and obesity were 38 cm in men and 35 cm in women.

CONCLUSIONS

The neck circumference, as waist circumference, is also a valuable tool for identifying MetS and obesity, with established cut-off points for the prediction of MetS and obesity in Chinese elders.

Waist circumference is the best index for obesity-related cardiovascular disease risk in individuals with spinal cord injury

Obesity is an important identifier of cardiovascular disease (CVD) risk, but is challenging to determine accurately in individuals with spinal cord injury (SCI). Body mass index (BMI) is used worldwide as a simple indicator of obesity, but is difficult to measure in individuals with SCI. Furthermore, standard BMI cutoffs underestimate obesity in this population. Therefore, we aimed to identify the best marker of obesity in individuals with SCI, considering both practicality, and ability to detect adiposity and CVD risk. Five anthropometric measures were evaluated: BMI; waist circumference (WC); waist-to-height ratio (WHtR); waist-to-hip ratio; and neck circumference. We evaluated relationships between these measures and abdominal and total body-fat percentage, seven cardiovascular metabolic risk factors (fasting insulin, glucose, glucose tolerance, triglycerides, high-density lipoprotein, low-density lipoprotein, and total cholesterol), and the Framingham risk score. BMI, WC, and WHtR were correlated with abdominal fat percentage. WC and WHtR were correlated with five metabolic risk factors as well as the Framingham risk score. WC is a more practical measure for an SCI population. The optimal cutoff for identifying adverse CVD risk in individuals with SCI was identified as WC ≥94 cm, with 100% sensitivity and 79% specificity. We propose that WC is a simple, more sensitive alternative to BMI in this population that is easy to use in multiple settings. The cutoff provides a simple tool to predict adverse CVD risk profiles that can be used to guide risk management, as well as as a practical aid for individuals with SCI to maintain a healthy body composition.

DALI: Vitamin D and lifestyle intervention for gestational diabetes mellitus (GDM) prevention: an European multicentre, randomised trial - study protocol

Background

Gestational diabetes mellitus (GDM) is an increasing problem world-wide. Lifestyle interventions and/or vitamin D supplementation might help prevent GDM in some women.

Methods/design

Pregnant women at risk of GDM (BMI≥29 (kg/m²)) from 9 European countries will be invited to participate and consent obtained before 19+6 weeks of gestation. After giving informed consent, women without GDM will be included (based on IADPSG criteria: fasting glucose<5.1mmol; 1 hour glucose <10.0 mmol; 2 hour glucose <8.5 mmol) and randomized to one of the 8 intervention arms using a 2×(2×2) factorial design: (1) healthy eating (HE), 2) physical activity (PA), 3) HE+PA, 4) control, 5) HE+PA+vitamin D, 6) HE+PA+placebo, 7) vitamin D alone, 8) placebo alone), pre-stratified for each site. In total, 880 women will be included with 110 women allocated to each arm. Between entry and 35 weeks of gestation, women allocated to a lifestyle intervention will receive 5 face-to-face, and 4 telephone coaching sessions, based on the principles of motivational interviewing. The lifestyle intervention includes a discussion about the risks of GDM, a weight gain target <5kg and either 7 healthy eating ‘messages’ and/or 5 physical activity ‘messages’ depending on randomization. Fidelity is monitored by the use of a personal digital assistance (PDA) system. Participants randomized to the vitamin D intervention receive either 1600 IU vitamin D or placebo for daily intake until delivery. Data is collected at baseline measurement, at 24–28 weeks, 35–37 weeks of gestation and after delivery. Primary outcome measures are gestational weight gain, fasting glucose and insulin sensitivity, with a range of obstetric secondary outcome measures including birth weight.

Discussion

DALI is a unique Europe-wide randomised controlled trial, which will gain insight into preventive measures against the development of GDM in overweight and obese women.

Trial registration

ISRCTN70595832

Neck circumference as a simple tool for identifying the metabolic syndrome and insulin resistance: results from the Brazilian Metabolic Syndrome Study

OBJECTIVE

To investigate the relationship of the neck circumference (NC) with the metabolic syndrome (MetS) and insulin resistance (IR) in a large Brazilian population-based sample, within a wide range of adiposity and glucose tolerance, and to establish cut-off values of the NC for MetS and IR.

CONTEXT

The NC correlates with cardiovascular risk factors, IR and components of MetS. Upper-body subcutaneous (sc) fat, as estimated by the NC, is associated with cardiovascular risk factors as much as abdominal fat, which is usually estimated by the waist circumference (WC). There are few epidemiological population-based studies on the clinical significance of the NC to MetS and IR.

DESIGN

This is a cross-sectional study.

PATIENTS

About 1053 Brazilian adults (18-60 years).

MEASUREMENTS

Patients with BMI 18.5-40.0 kg/m(2), with normal glucose tolerance or type 2 diabetes (T2DM), were submitted to anthropometric measurements including waist circumference (WC), NC and BMI. Abdominal visceral fat (VF) was assessed by ultrasound. Insulin sensitivity (IS) was assessed by euglycaemic-hyperinsulinaemic clamp (10% of total sample) and HOMA-IR. Spearman correlations were used to evaluate the association between NC and IR and MetS risk factors. Receiver operating characteristic (ROC) curves were used for gender-specific cut-off values for the prediction of IR and MetS. Binary logistic regression analysis was used to assess the chance of developing IR or MetS according to the enlargement of NC and WC.

RESULTS

The sample consisted of 28.6% men, with a mean age of 39.4 (12 years). T2DM diagnosis was present in 306 individuals, of whom 34% were men. NC correlated with WC and BMI in both men and women (P < 0.001). In both genders, NC showed a positive correlation with triglycerides, fasting glucose, fasting insulin and HOMA-IR, and NC had a negative association with high-density lipoprotein (HDL). NC and IS showed a moderate negative correlation. A significant correlation was demonstrated between VF and NC. In the ROC curves, NC presented the largest AUC for IR in women (P < 0.001), while NC presented a large AUC for MetS in both genders.

CONCLUSIONS

Neck circumference measurements are an alternative and innovative approach for determining body fat distribution. The NC is positively associated with MetS risk factors, IR and VF, with established cut-off values for the prediction of MetS and IR.

Neck circumference as an independent predictive contributor to cardio-metabolic syndrome

Background

The predictive potentials of neck circumference (NC) for cardio-metabolic risks remain uncertain. The aim of this study was to investigate whether NC independently contributes to the prediction of cardio-metabolic risks beyond body mass index (BMI), waist circumference (WC) and waist to hip ratio (WHpR) in a large Chinese population.

Methods

A total of 4201 participants (2508 men and 1693 women) aged 20-85 were recruited from the Health Examination Centre between May 2009 and April 2010, anthropometric indices, biochemical and clinical parameters were measured. Receiver operating characteristic, partial correlation and logistic regression analyses were employed to evaluate the association of the anthropometric indices to cardio-metabolic risks separately by gender.

Results

Neck circumference was positively correlated with SBP and DBP (r=0.250 and 0.261), fasting blood glucose (FBP) (r=0.177), TG (r=0.240), TC (r=0.143) and LDL-C (r=0.088) and negatively correlated with HDL-C (r=-0.202) in males (all P<0.01). Similar results were found in females with the exception of TC. The AUCs of NC for metabolic abnormalities ranged from 0.558 (Increased LDL-C) to 0.683 (MS-rf) in men and 0.596 (Increased LDL-C) to 0.703 (MS-rf) in women (P<0.01). The NC of ≥37 cm for men and ≥33 cm for women were the best cut-off points for metabolic syndrome. The adjusted ORs (95% CIs) of NC in men and women respectively were 1.29 (1.12-1.48) and 1.44 (1.20-1.72) for metabolic syndrome risk factors (MS-rf), 1.15 (1.01-1.32) and 1.22 (1.03-1.46) for high BP, 1.16 (1.02-1.33) and 1.42 (1.18-1.71) for increased TG, and 1.26 (1.06-1.50) and 1.32 (1.06-1.65) for increased FBP; the adjusted OR of NC in women for decreased HDL-C was 1.29 (1.10-1.51).

Conclusions

Neck circumference was significantly associated with cardio-metabolic risk factors and independently contributed to the prediction of cardio-metabolic risks beyond the classical anthropometric indices in adults of China.

Is the neck circumference an emergent predictor for inflammatory status in obese adults?

BACKGROUND

Plasminogen Activator Inhibitor 1 (PAI-1) is a prothrombotic adipokine involved in the coagulation cascade and fibrinolysis that associated with proinflammatory adipokines may increase the risk related to obesity. Anthropometric measures are commonly used in clinical practice and, currently, neck circumference (NC) has been used as a marker of cardiovascular risk that can favour inflammatory factors.

OBJECTIVE

To verify the possible correlations between prothrombotic and pro/anti-inflammatory markers with anthropometric measurements in obese.

SUBJECTS AND METHODS

  A total of 43 obese adults were enrolled. The variables include body mass, stature, body mass index (BMI), NC, chest circumference (CC), abdominal circumference (AC), hip circumference (HC), blood pressure and blood collection used to assess the level of adipokines.

RESULTS

The sample was stratified by BMI. PAI-1 levels were positively correlated with body mass (r=0.31, p=0.04), NC (r=0.43, p=0.004), CC (r=0.40, p=0.004), AC (r=0.37, p=0.01), diastolic blood pressure (r=0.35, p=0.03), leptin/adiponectin ratio (r=0.36, p=0.01) and negatively correlated with adiponectin (r=-0.34, p=0.02). In stepwise multiple linear regression analysis, NC showed to be an independent predictor to PAI-1 when adjusted for gender and BMI, according to the age (β=0.47, p=0.02 and β=0.42, p=0.02 respectively).

CONCLUSION

In conclusion, NC could be suggested as an independent predictor higher PAI-1. This association can be a new screening of persons at an enhanced cardiovascular risk and inflammation in this obese population, so useful in clinical practice.

Neck circumference is correlated with triglycerides and inversely related with HDL cholesterol beyond BMI and waist circumference

BACKGROUND

Neck circumference, beyond a measure of obesity, is a unique fat depot with increasing significance. This study aimed to investigate the association between neck circumference and biomarkers, indicators of cardiovascular risk.

METHODS

During 2009, 490 volunteers (46 ± 16 years, 40% men) were consecutively enrolled to the study (participation rate 85%). Biochemical analyses were performed through established procedures, and after 12-h fasting and glucose, total cholesterol, high-density lipoprotein and low-density lipoprotein cholesterol, triglycerides, cystatin C, uric acid and high-sensitivity C-reactive protein were measured. Anthropometric, lifestyle and dietary characteristics were also recorded to account for potential confounders. Additive linear and logistic regression models were used to evaluate the association between neck circumference and biomarkers of cardiometabolic risk.

RESULTS

A positive association between neck circumference and systolic and diastolic blood pressure, glucose, triglycerides, uric acid and high-sensitivity C-reactive protein, and a negative association with high-density lipoprotein cholesterol were revealed (all ps < 0.05); models were adjusted for age, gender, years of school, smoking, physical activity status, MedDietScore and alcohol intake. The relationship between neck circumference and high-density lipoprotein cholesterol, glucose, triglycerides and uric acid remained significant when models were further stratified by body mass index class and abnormal waist circumference.

CONCLUSION

Neck circumference was found to be a powerful indicator of atherogenic dyslipidaemia above and beyond central obesity indicators.

Neck circumference correlates with tumor size and lateral lymph node metastasis in men with small papillary thyroid carcinoma

BACKGROUND/AIMS

Obesity is correlated with numerous diseases, including thyroid cancer, but the clinical significance of obesity with regard to the clinical characteristics of thyroid cancer remains unclear. Neck circumference is an index of upper-body adipose tissue distribution.

METHODS

In total, 401 patients with papillary thyroid carcinoma (PTC) measuring ≤ 2 cm were included. Neck circumference was measured horizontally at the level just below the thyroid cartilage on preoperative neck computed tomographic images.

RESULTS

Neck circumference correlated significantly with tumor size in men (p = 0.001) but not in women (p = 0.930). Body mass index (BMI) did not significantly correlate with tumor size in either sex. Neck circumference was significantly larger in men with lateral lymph node (LN) metastasis than in those without (p = 0.004). Neck circumference and BMI did not differ significantly in women according to other factors such as tumor size, multifocality, extrathyroid extension, and LN metastasis. Tumor size and the prevalence of lateral LN metastasis in men tended to increase in the middle/large neck circumference subgroup compared with those in the low neck circumference subgroup. Multivariate logistic regression analysis revealed that neck circumference (p = 0.009) was a predictor for the presence of lateral LN metastasis in men. BMI was not a predictive factor for lateral LN involvement in either sex.

CONCLUSIONS

Neck circumference, an indicator of central or visceral obesity but not BMI, may be associated with some prognostic factors in men with small PTC.

The influence of obesity on the assessment of carotid intima-media thickness

BACKGROUND

The assessment of carotid intima-media thickness (CIMT) may improve cardiovascular risk prediction. The optimal protocol for CIMT measurement is unclear. CIMT may be measured in the common carotid artery (CCA), carotid bifurcation (CB), and internal carotid artery (ICA), but measurements from CB and ICA are more difficult to obtain. We studied the influence of body mass index (BMI) and atheroma plaques on the capacity to obtain CIMT measurements at different carotid sites.

METHODS

Using an automatic system, CIMT was measured in 700 subjects aged 45-75, in the near and far walls of CCA, CB, and ICA bilaterally. The presence of atheroma plaques, BMI and vascular risk factors were recorded.

RESULTS

CIMT measurements in CCA were possible in all except one subject. It was not possible to obtain CIMT measurements at CB or ICA in 24.1% of normal weight and 58.8% of obese subjects. The likelihood of obtaining CIMT measurement at all carotid sites decreased as the BMI increased. Atheroma plaques in a carotid segment did not preclude CIMT measurement at this site.

CONCLUSIONS

CIMT measurements in distal carotid segments are more challenging in obese subjects. Measuring CIMT at CCA remains feasible in obese subjects and should be the primary endpoint in these subjects. Nevertheless, CB and ICA measurements, when feasible, would improve risk classification.

Prevalence of sleep abnormalities and their association among hypothyroid patients in an Indian population

OBJECTIVE

To estimate the prevalence of sleep abnormalities and their association with hypothyroidism and metabolic risk factors in a relatively lean urban South Indian population.

METHODS

This population-based, cross-sectional study was carried out in the urban population of Chennai, one of the largest metropolitan cities of India. Phase 1 was conducted in the field and involved a door-to-door survey of 26,000 individuals. In phase 2, every tenth subject recruited in phase 1 (n=2600) was invited to our centre for detailed anthropometric and biochemical measurements. For the current study, a subset of 358 subjects with positive family history of hypothyroidism was randomly selected. A validated questionnaire assessing various sleep abnormalities (snoring, daytime sleepiness, lack of refreshing sleep and number of hours of sleep) was administered. Anthropometric and biochemical measurements were obtained to assess metabolic risk factors including thyroid status.

RESULTS

Snorers were more often male, older, smokers and had higher BMI, neck circumference, blood pressures, and hypothyroidism. Out of 358 patients, 133 had impaired thyroid function (37.1%) and 64 patients had both snoring and impaired thyroid function (17.8%). Subjects with daytime sleepiness had higher BMI and neck obesity. The overall prevalence of snoring and daytime sleepiness was 52% and 64%, respectively. Both sleep measures were associated with hypothyroid status. Metabolic syndrome was significantly associated with snoring even after adjusting for age, sex, family history of hypothyroidism, physical activity, smoking and alcohol.

CONCLUSIONS

The prevalence of snoring and daytime sleepiness is high among urban South Indians who are relatively lean. Both disorders are associated with hypothyroidism, although these associations were stronger in those with obesity. Based on our case prevalence and the other reports cited previously, we can reasonably conclude that thyroid screening of sleep clinic patients is essential.

Neck circumference as a novel parameter to determine metabolic risk factors in obese children

BACKGROUND

To establish the association between neck circumference and cardiometabolic risk factors and to determine the utility of the neck circumference as a parameter in predicting children at cardiometabolic risk.

MATERIALS AND METHODS

Five - hundred and eighty-one children (461: overweight/obese, 120: normal body mass index) aged between 5 and 18 years were enrolled. Neck circumference, waist circumference, blood pressure and fasting plasma glucose, insulin, total cholesterol, triglyceride and high-density lipoprotein (HDL) cholesterol were recorded, and the homeostasis model assessment for insulin resistance score was calculated.

RESULTS

Neck circumference was negatively correlated with HDL cholesterol and positively correlated with all other parameters, with the exception of fasting plasma glucose in pubertal boys and girls and total cholesterol in pubertal girls. Linear regression analysis by designating neck circumference as a dependent variable revealed that insulin and TG levels in prepubertal boys and blood pressure and TG levels in pubertal boys were positively correlated with neck circumference. We found that diastolic blood pressure and insulin were positively correlated, while HDL levels were negatively correlated with neck circumference in prepubertal girls. Systolic blood pressure and insulin were positively correlated with neck circumference in pubertal girls. The cut-off value for neck circumference, as an indicator for metabolic syndrome (MS), was calculated as 36 cm in boys and 35 cm in girls.

CONCLUSIONS

Neck circumference measurement was shown to be associated with cardiometabolic risk factors in children. We suggest the use of neck circumference as a novel, simple, practical and reliable anthropometric index in predicting children at risk for cardiometabolic diseases.

Neck circumference: a useful screening tool of cardiovascular risk in children

OBJECTIVE

Early identification of cardiovascular risk factors consists an essential target for public health. The current study aims to examine the association between neck circumference and several cardiovascular risk factors and to compare it with well-established anthropometric indices.

METHODS

Demographic, anthropometric (body weight and height, waist, hip and neck circumference [WC, HC and NC, respectively]), biochemical (total cholesterol, high-density lipoprotein [HDL] cholesterol, low-density lipoprotein [LDL] cholesterol, triglycerides [TG], fasting plasma glucose and serum insulin), clinical (pubertal stage, systolic and diastolic blood pressure [SBP and DBP, respectively]) and lifestyle (dietary intake, physical activity level) data were collected from 324 children (51.5% boys; 48.5% girls) aged 9-13 in Greece. Body mass index z-score (BMI z-score), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), homeostasis model assessment (HOMA-IR), quantitative insulin sensitivity check index (QUICKI) and fasting glucose to insulin ratio (FGIR) were calculated.

RESULTS

All indices (BMI z-score, NC, WC, HC, WHR and WHtR) were correlated with SBP, HDL and insulin-related indices (insulin, HOMA-IR, QUICKI and FGIR) and all indices except WHR with TG. LDL was correlated with BMI z-score, WC, WHR and WHtR, whereas DBP was correlated with BMI z-score, WC, HC and WHtR. In multivariate analysis, HDL, TG, SBP, insulin, HOMA-IR, QUICKI and FGIR were associated with all anthropometric indices; DBP with WC, HC, NC and WHtR; LDL with BMI z-score, WC, HC and WHtR.

CONCLUSIONS

NC is associated with most cardiovascular disease risk factors. These associations are comparable with those observed for BMI z-score, WC, HC, WHR and WHtR. NC could be a simple, alternative screening tool of cardiovascular risk in children.

Anthropometric Predictors of High Risk of Obstructive Sleep Apnea Syndrome in a Rural Population

Objective. To evaluate which anthropometric parameter better predicts the high risk of obstructive sleep apnea syndrome (OSA) in a rural population. Material and Method. 254 subjects were enrolled. We measured weight, height, waist circumference (WC) and neck circumference (NC) and calculated body mass index (BMI), waist-to-height ratio (WHtR) and neck circumference/height ratio (NC/Height). The risk of OSA was assessed by using Berlin Questionnaire. Results. Subjects with high risk of OSA had a significant higher BMI, WC, WHtR, NC, and NC/Height. A higher percentage of those with large WC (≥80cm and ≥94cm for women and men, respectively) (p<0.001), WHtR ≥0.5 (p<0.001), NC ≥40cm (p=0.004), NC/Height ratio ≥0.23 (p=0.002) had a high risk of OSA. Using ROC curves of anthropometric parameters studied we found that WHtR was the best predictor for high risk of OSA, with AUC of 0.760, 95% CI: 0.699 to 0.815. Conclusions. WHtR was the best predictor for high risk of OSA as assessed by the Berlin Questionnaire.

Design and results of the pretest of the IDEFICS study

BACKGROUND

During the preparatory phase of the baseline survey of the IDEFICS (Identification and prevention of dietary- and lifestyle-induced health effects in children and infants) study, standardised survey procedures including instruments, examinations, methods, biological sampling and software tools were developed and pretested for their feasibility, robustness and acceptability.

METHODS

A pretest was conducted of full survey procedures in 119 children aged 2-9 years in nine European survey centres (N(per centre)=4-27, mean 13.22). Novel techniques such as ultrasound measurements to assess subcutaneous fat and bone health, heart rate monitors combined with accelerometers and sensory taste perception tests were used.

RESULTS

Biological sampling, physical examinations, sensory taste perception tests, parental questionnaire and medical interview required only minor amendments, whereas physical fitness tests required major adaptations. Callipers for skinfold measurements were favoured over ultrasonography, as the latter showed only a low-to-modest agreement with calliper measurements (correlation coefficients of r=-0.22 and r=0.67 for all children). The combination of accelerometers with heart rate monitors was feasible in school children only. Implementation of the computer-based 24-h dietary recall required a complex and intensive developmental stage. It was combined with the assessment of school meals, which was changed after the pretest from portion weighing to the more feasible observation of the consumed portion size per child. The inclusion of heel ultrasonometry as an indicator of bone stiffness was the most important amendment after the pretest.

DISCUSSION

Feasibility and acceptability of all procedures had to be balanced against their scientific value. Extensive pretesting, training and subsequent refinement of the methods were necessary to assess the feasibility of all instruments and procedures in routine fieldwork and to exchange or modify procedures that would otherwise give invalid or misleading results.