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

Evolving perspectives on evaluating obesity: from traditional methods to cutting-edge techniques

Objective: This review examines the evolution of obesity evaluation methods, from traditional anthropometric indices to advanced imaging techniques, focusing on their clinical utility, limitations, and potential for personalized assessment of visceral adiposity and associated metabolic risks.

Methods: A comprehensive analysis of existing literature was conducted, encompassing anthropometric indices (BMI, WC, WHR, WHtR, NC), lipid-related metrics (LAP, VAI, CVAI, mBMI), and imaging technologies (3D scanning, BIA, ultrasound, DXA, CT, MRI). The study highlights the biological roles of white, brown, and beige adipocytes, emphasizing visceral adipose tissue (VAT) as a critical mediator of metabolic diseases.

Conclusion: Although BMI and other anthropometric measurements are still included in the guidelines, indicators that incorporate lipid metabolism information can more accurately reflect the relationship between metabolic diseases and visceral obesity. At the same time, the use of more modern medical equipment, such as ultrasound, X-rays, and CT scans, allows for a more intuitive assessment of the extent of visceral obesity.

Using the predictive model of difficult endotracheal intubation to examine different simulators for airway management training: a pilot cross-sectional observational study

BACKGROUND

In recent years, Taiwan's medical education has increasingly emphasized simulated learning, particularly through advanced manikins designed for procedural training, including endotracheal intubation. Although key indicators and predictive techniques for assessing complexity have been documented, their use in evaluating these manikins remains notably lacking.The aim of this study was to appraise the potential association between our devised scoring system and the actual outcome of intubation procedures. Subsequently, this scoring system could potentially serve as an objective yardstick for quantifying the intricacy of training simulators.

METHODS

Nineteen post-graduate or emergency medicine trainees participated in this study. Intubation training involved four manikins, each with varying difficulty scores based on neck circumference, thyromental distance, airway obstruction, and Mallampati grade 3/4. Training modules included standard, advanced, and small adult intubation. Independent variables were training models and operator skill levels, while dependent variables included intubation time, success rate, tooth injury, gastric insufflation, uninflated cuff mishaps, perceived difficulty (rated 1-5), and laryngoscopy view quality (rated 1-4).

RESULTS AND DISCUSSION

Intubation parameters were recorded for comparison across subgroups. Mean intubation times for models A, B, and D were 42.67 ± 15.32 seconds, 48.73 ± 17.54 seconds, and 50.22 ± 18.40 seconds, with success rates of 89.47%, 78.95%, and 68.42%, respectively. Model 'C' had the highest difficulty score (4.430 points), the longest intubation time (58.84 ± 22.63 seconds, P <.001), and the lowest success rate (57.89%, P <.001), and was rated most difficult by participants. Notably, subsequent intubation attempts showed reduced time and complexity compared to the initial one.In conclusions, our devised scoring metric demonstrated a remarkable congruence with the tangible outcomes of the challenging endotracheal intubation training model. This outcome lends credence to the potential applicability of our formula not only in assessing the intricacy of existing models but also as a guiding benchmark for the innovation and refinement of novel training manikins.

Neck circumference as a metabolic health marker among women with polycystic ovary syndrome (PCOS): a systematic review and meta-analysis

BACKGROUND

Polycystic ovary syndrome (PCOS) is associated with obesity, insulin resistance (IR), metabolic syndrome (MetS), and abnormal fat distribution, especially fat excess in the upper body. Neck circumference (NC) reflects the adiposity accumulation in the upper body and may be a valuable and simple screening tool for metabolic risk among women with PCOS.

METHODS

A systematic review was conducted using PubMed/Medline and Scopus based on the search terms "neck circumference" and "PCOS". Studies that examined associations of NC and anthropometric measurements, blood pressure (BP), lipid values, glucose metabolism, MetS, IR, or related disorders among women with PCOS were included. A meta-analysis was performed to compare NC values between women with PCOS and non-PCOS controls.

RESULTS

Of 139 publications, 13 full texts that met the selection criteria were included in the systematic review. Eight studies had non-PCOS controls and were thus eligible for the meta-analysis. Women with PCOS had significantly larger NC compared to non-PCOS controls (SMD: 0.78, 95% CI: 0.31-1.25, p = 0.0012). We found a positive association between larger NC and higher waist circumference, hip circumference, triglycerides, systolic BP, fasting insulin, and HOMA-IR or lower HOMA%S and higher prevalence of MetS or IR in the majority of the included studies. Neck circumference cut-off values for MetS varied from 33 cm to 34.25 cm and for IR 34.25 cm up to 42 cm among women with PCOS. Most of the studies were done with Asian populations thus limiting applicability of the study results to other ethnicities.

CONCLUSIONS

This meta-analysis demonstrated increased NC among women with PCOS compared to healthy controls. Women with PCOS and larger NC were more insulin resistant and had more MetS-related abnormalities when compared to women with smaller NC with or without PCOS. Data considering NC cut-off values for MetS and IR among women with PCOS are scarce, and further studies are needed, particularly among more varied ethnic populations.

Cashew nut consumption reduces waist circumference and oxidative stress in adolescents with obesity: A randomized clinical trial

Previous evidence suggests that certain types of nuts, when included in a healthy diet pattern, may provide health benefits. Therefore, we hypothesize that the consumption of cashew nuts associated with a healthy diet may enhance antioxidant defenses and improve anthropometric and body composition parameters in individuals with obesity. We conducted a 12-week randomized clinical trial, divided into 4 sessions, involving adolescents randomly assigned to receive either 30 g of roasted cashew nuts together with nutrition education (cashew nut group-CNG) or only nutrition education (control group-CG). The total number of participants who started the study was 142, with 77 in the CNG and 65 in the CG. Data on anthropometry, body composition, and oxidative stress were collected at baseline (0-week) and endpoint (12-week). The main post-intervention findings in the CNG showed decreases in waist circumference (WC), thiobarbituric acid reactive substances (TBARS) and total antioxidant capacity (TAC) at 60 minutes in the CNG, while neck circumference (NC) increased. However, the CG showed an increase in TBARS and percentage of lean body mass (LBM), along with reduction in TAC at 60 minutes. After 12 weeks, the consumption of cashew nuts seemed to assist in WC reduction, even without a decrease in other anthropometric parameters, thereby decreasing the cardiometabolic risk. Furthermore, the consumption of cashew nuts demonstrated the ability to decrease overall oxidative damage as assessed by TBARS, a finding that reinforces the effects of this nut consumption against systemic oxidative stress associated with obesity.

Sphingosine-1-phosphate in the regulation of diabetes mellitus: a scientometric study to an in-depth review

Diabetes is a significant global health issue, causing extensive morbidity and mortality, and represents a serious threat to human health. Recently, the bioactive lipid molecule Sphingosine-1-Phosphate has garnered considerable attention in the field of diabetes research. The aim of this study is to comprehensively understand the mechanisms by which Sphingosine-1-Phosphate regulates diabetes. Through comprehensive bibliometric analysis and an in-depth review of relevant studies, we investigated and summarized various mechanisms through which Sphingosine-1-Phosphate acts in prediabetes, type 1 diabetes, type 2 diabetes, and their complications (such as diabetic nephropathy, retinopathy, cardiovascular disease, neuropathy, etc.), including but not limited to regulating lipid metabolism, insulin sensitivity, and inflammatory responses. This scholarly work not only unveils new possibilities for using Sphingosine-1-Phosphate in diabetes treatment but also offers fresh insights and recommendations for future research directions to researchers.

The challenges of assessing adiposity in a clinical setting

To tackle the burden of obesity-induced cardiometabolic disease, the scientific community relies on accurate and reproducible adiposity measurements in the clinic. These measurements guide our understanding of underlying biological mechanisms and clinical outcomes of human trials. However, measuring adiposity and adipose tissue distribution in a clinical setting can be challenging, and different measurement methods pose important limitations. BMI is a simple and high-throughput measurement, but it is associated relatively poorly with clinical outcomes when compared with waist-to-hip and sagittal abdominal diameter measurements. Body composition measurements by dual energy X-ray absorptiometry or MRI scans would be ideal due to their high accuracy, but are not high-throughput. Another important consideration is that adiposity measurements vary between men and women, between adults and children, and between people of different ethnic backgrounds. In this Perspective article, we discuss how these critical challenges can affect our interpretation of research data in the field of obesity and the design and implementation of clinical guidelines.

A cross-sectional study evaluating grip strength and associated factors in Turkish nurses and nursing students

BACKGROUND

Grip strength is an important indicator of muscle strength. Nursing job demands physical power, which is related to their muscle strength. However, studies on nurses' grip strength remains lacking.

OBJECTIVE

This study aims to examine the differences in grip strength between staff nurses and nursing students and to identify factors associated with grip strength in nursing sample.

METHOD

This study was designed as descriptive and analytical. Data collected from nursing students and staff nurses in Turkiye, from May 1 to September 30, 2022. A total of 200 staff nurses and 200 nursing students participated. Data tool included a participant information form, the Perceived Stress Scale-4 (PSS-4), and the Nordic Musculoskeletal Questionnaire (NMQ). Moreover, researchers assessed the anthropometric measurements using the same scale and grip strength using a digital hand dynamometer.

RESULTS

There was no significant difference in grip strength of staff and student nurses. 48.8% of participants met or exceeded Turkish normative values. 79.5% of staff nurses and 66.0% of nursing students reported musculoskeletal issues in the last 12 months. Height, waist-to-hip ratio, and neck circumference was found to be significant predictors of grip strength, explaining 57% of the variance.

CONCLUSION

Grip strength was similar between staff nurses and nursing students, despite differences in age, BMI, and musculoskeletal issues. Height, waist-to-hip ratio, and neck circumference are key predictors of grip strength in this Turkish nursing sample. Understanding the factors influencing grip strength can help in designing targeted interventions to maintain and improve muscle strength in nursing professionals.

The impact of anthropometric parameters and sonographic characteristics on the choice of biopsy method for thyroid nodules: Fine-needle aspiration versus non-aspiration biopsy

Objective

The accurate diagnosis of thyroid nodules is crucial for effective management and the detection of malignancy. Fine-needle aspiration biopsy (FNAB) and fine-needle non-aspiration biopsy (FNNAB) are widely used techniques for evaluating thyroid nodules. In this study, we aimed to investigate the impact of anthropometric parameters and sonographic characteristics on the choice between FNAB and FNNAB in terms of diagnostic yield.

Material and Methods

This retrospective and cross-sectional analysis involved 188 cases with a total of 225 thyroid nodules. Each nodule initially underwent either FNAB or FNNAB and if the initial biopsy did not yield a diagnostic result, the nodule was re-biopsied using the alternate technique. Ultrasound was used to evaluate the nodules, with a focus on echogenicity, calcifications, size, vascularity, and the presence of a halo sign. Both FNAB and FNNAB were performed using a 25-gauge needle, with the only difference being the application of suction.

Results

FNAB demonstrated a higher diagnostic rate for nodules with a taller-than-wide shape (anteroposteriorto-transverse ratio ≥1), nodules sized 10-40 mm, nodules with volumes <0.5 cc, and hypoechoic nodules (P < 0.001 for all). FNAB also outperformed FNNAB in the assessment of the right-sided, inferior, and posterior nodules (P < 0.001), nodules with and without calcification (P = 0.041 and P = 0.020, respectively), and nodules with type 1 and type 2 vascularity patterns (P = 0.006 and P = 0.017, respectively). FNAB was effective in obese individuals (Body mass index ≥40 kg/m2), males with a waist circumference of <94 cm, females with a waist circumference of ≥80 cm, and females with a neck circumference of ≥34 cm (P = 0.011, P = 0.044, P = 0.029, and P = 0.008, respectively).

Conclusion

Anthropometric parameters and sonographic characteristics influenced the diagnostic yield of FNAB and FNNAB, with FNAB generally demonstrating superior results. Given the importance of obtaining an accurate diagnostic result from fine-needle biopsy, clinicians should consider both the sonographic features of the nodule and the anthropometric measurements of the patient when selecting a biopsy technique.

Relationship Between Zinc, Selenium, and Magnesium Status and Markers of Metabolically Healthy and Unhealthy Obesity Phenotypes

Our objective was to investigate the relationship between zinc, selenium, and magnesium status and markers of metabolically healthy and unhealthy obesity phenotypes. This was a cross-sectional study with 140 women: metabolically healthy obese women (n = 35), metabolically unhealthy obese women (n = 28), and normal-weight women (n = 77). We have calculated the body mass index, waist-hip ratio, waist-height ratio and some adiposity indices. Additionally, we evaluated endocrine-metabolic parameters and estimated the dietary intake of energy, macronutrients, zinc, selenium, and magnesium. The mineral concentrations in plasma, erythrocytes, and urine were assessed. In obese patients, there was a significant decrease in dietary zinc, selenium, and magnesium intake per kilogram of body weight, as well as lower mineral concentrations in both plasma and erythrocytes. Additionally, these patients exhibited higher urinary mineral levels compared to the control group, regardless of whether they had healthy or unhealthy phenotypes. We observed a significant correlation between deficiencies in zinc, selenium, and magnesium and obesity-associated metabolic disorders, including dyslipidemias and redox status disturbances. This study highlights a connection between deficiencies in zinc, selenium, and magnesium and metabolic disorders linked to obesity, including dyslipidemias, alterations in redox status, and thyroid hormonal dysfunction.

Body composition of extreme performers in the US Marine Corps

BACKGROUND

The creation of highly muscled and strong fighters is a recurring theme in human performance enhancement concepts. Physical readiness standards, intended to prevent obesity in the military, produce contradictory objectives, hounding large individuals to lose weight because of confusion between body size and body composition. Through selection, specialised training and policy exceptions the US Marine Corps has successfully developed a unique group of large (body mass index (BMI) >30 kg/m2) and strong individuals, the body bearers (BB) who carry coffins of Marines to their final resting place.

METHODS

We examined the relationship between adiposity and body size from nine male BB (age 25.0±2.1, height: 1.84±0.04 (1.80-1.92) m, BMI: 33.0±2.1 (30-37) kg/m2). Body composition was assessed by dual-energy X-ray absorptiometry (DXA), bioelectrical impedance (BIA) and tape measured abdominal circumference (AC)-based equations and from three-dimensional scanning (3DS).

RESULTS

Measures were made of fat-free mass (FFM): 90.5±7.0 (82.0-106.7) kg, where FFM included total body water: 62.8±5.0 (55.8-71.8) L, representing 69±2 (67-73) % of FFM, along with calculated FFM index: 26.8±2.4 (24.4-32.9) kg/m2). DXA measures were made for bone mineral content 4.1±0.4 (3.5-4.9) kg, bone mineral density (BMD) 1.56±0.10 (1.37-1.76) g/cm2 and %BF 19.5±6.6 (9.0-27.8). Additional measures of percent body fat (%BF) were made by AC: 20.3±2.9 (15.2-24.6), BIA: 23.7±6.4 (9.8-29.2) and 3DS: 25.5±4.7 (18.9-32.2). AC %BF reasonably matched DXA %BF, with expected overprediction and underprediction at low and high DXA %BF. BIA %BF was affected by deviations from assumed FFM hydration (72%-73%).

CONCLUSION

These men are classified as obese by BMI but carried massive amounts of muscle and bone on their large frames, while presenting a range of %BF irrelevant to strength performance. BMI did not predict obesity and adiposity had no association with muscle mass and strength performance.

Serum γ-glutamyltransferase levels and obesity status changes the risk of prehypertension in Chinese adults

Objective

It's well known that γ-Glutamyltransferase (γ-GGT) and obesity plays an important role in the development of preHT. However, the effect of γ-GGT on preHT in populations with different obesity status remains unclear.

Methods

From February 2014 to January 2018, a total of 20,368 participants were enrolled in this study after excluding those with hypertension and liver diseases. Fasting blood samples were collected to measure γ-GGT and blood lipid levels and glucose indices. Demographic and clinical parameters such as sex, age, height, weight, neck circumference (NC), waist circumference (WC), hip circumference (HC), and body fat ratio (BFR); and information on smoking and alcohol consumption were collected by trained medical professionals.

Results

Participants were divided into three groups based on obesity status. The prevalence of preHT was 83.5 % in the obesity group was higher than that in the overweight group (58.9 %) and the normal group (47.1 %). γ-GGT in different categories of obesity indices were significantly different, and higher obesity indices were found with higher γ-GGT levels. The interaction of γ-GGT and obesity indices such as NC, WC, HC, and BFR on the prevalence of preHT was significant (P = 0.028, 0.002, 0.007, and 0.034, respectively). Serum γ-GGT was found to be positively associated with preHT in participants with normal and overweight body mass indices.

Conclusion

Our results indicate that γ-GGT is a risk factor for preHT in participants who are nonobese, and that the obesity indices NC, WC, HC, BFR, and γ-GGT were contributing factors in increasing the risk of preHT.

Association between neck circumference and glucose tolerance levels at 2-6 months postpartum in women with and without gestational diabetes

Objective

To evaluate the association between neck circumference (NC) measured during pregnancy and markers of glucose metabolism measured 2-6 months postpartum in women with overweight/obesity with and without gestational diabetes (GDM).

Subjects and methods

This prospective study enrolled 100 pregnant women (including 50 with GDM) with pregestational body mass index (BMI) ≥ 25 kg and < 40 kg/m². The cohort was stratified according to NC tertiles during pregnancy. Glucose metabolism was assessed in the postpartum period. The association between NC during pregnancy and markers of glucose metabolism postpartum was tested using linear regression analysis.

Results

Participants with NC in the third tertile, compared with those with NC in the second and first tertiles, had higher levels of glycated hemoglobin (HbA1c; 5.6 ± 0.4% versus 5.4 ± 0.3% versus 5.3 ± 0.2%, respectively, p = 0.006), fasting insulin (13.2 ± 6.6 µIU/mL versus 11.1 ± 5.8 µIU/mL versus 9.5 ± 4.9 µIU/mL, respectively, p = 0.035), homeostasis model for insulin resistance (HOMA-IR; 3.1 ± 1.7 versus 2.5 ± 1.3 versus 2.1 ± 1.2, respectively, p = 0.035) and triglyceride-glucose index (TyG; 4.6 ± 0.2 versus 4.5 ± 0.2 versus 4.5 ± 0.3, respectively, p = 0.010). In crude linear regression analysis, NC measured during pregnancy was significantly associated with levels of fasting plasma glucose, 2-hour glucose, HbA1c, log HOMA-IR, and TyG index. The association remained after adjustment for age, family history of diabetes, and number of pregnancies. When adjusted for pregestational BMI and gestational weight gain, NC remained independently associated with fasting plasma glucose and HbA1c levels.

Conclusion

The NC measured during pregnancy was positively associated with worse glucose metabolic profile in the postpartum among women with obesity/overweight with and without GDM. The NC measurement may be a feasible tool for early identification of women at a higher risk of developing type 2 diabetes mellitus.

Correlation between Subjective Nasal Patency and Nasal Capacity in Young Adults: A Pilot Study with a Prototype Device-A Nasoorospirometer

Background: Nasal airway obstruction (NAO) is characterised by high resistance in the nasal cavity with a collapsible and narrowed upper airway and is an integral part of OSA pathophysiology. The literature demonstrates that the identification of high-risk OSA in the young adult population leads to the prevention of later health consequences. A nasoorospirometer is a prototype device that measures nasal capacity during inspiration. The basis for measurement is a Wheatstone bridge and a thermal anemometer. The parameters are recorded via hot wire anemometry (HTA) with velocity measurements in the airflow field. Therefore, this pilot study aimed to test the feasibility of the device by examining a young adult sample. The secondary aim was to determine whether subjective NAO correlates with nasal capacity and whether NAO corresponds with anthropometric parameters and individual risk of OSA. Methods: A group of 31 participants (mean age 24.9 years) underwent a thorough laryngological examination. The nasoorospirometer was used to measure objective NAO (nasal capacity), the NOSE scale was used to gain subjective NAO evaluation, and the Berlin Questionnaire for the risk of OSA. Results: A correlation analysis confirmed no significant associations between the subjective and objective measures (p > 0.05). Higher BMI and neck circumference are associated with lower NAO and higher nasal patency in the population of young adults (r: 0.32-0.45; p < 0.05). The risk of OSA showed no statistically significant association (p > 0.05). Conclusions: We presented three methods of NAO assessment: subjective participant evaluation, objective nasoosopirometry, and objective laryngological assessment. However, the use of a nasoorospirometer with anthropometric measures in young adults needs to be verified in future studies.

Neck Circumference for Identification of Excess Adiposity in Adolescents with Cancer: A Better Parameter for Use in Clinical Practice?

Purpose: Excess weight in adolescents with cancer during treatment does affect cancer outcomes. Neck circumference (NC), an easygoing anthropometric measure, may present greater metabolic risk, and is associated with excess adiposity. The aim of this study was to identify the prevalence of elevated NC in adolescents with cancer and associated factors. Methods: Cross-sectional study with adolescents aged 10-19 years, under antineoplastic treatment, evaluated from 2015 to 2017, at a Pediatric Oncology Institute's outpatient clinic. Anthropometric parameters were collected, besides diagnosis, sex, and age. The classification of elevated NC was carried out considering cutoff values for adolescents, according to sex and age group. A binary logistic regression was used to determine relationships between NC and associated factors. Results: Among 496 eligible cases, most were male (n = 299, 60.3%). A total of 31.9% of cases had high NC. There is significant and moderate correlation between skinfold thickness (TS) and NC (ρ = 0.6; p = 0.000), and a significant but weak correlation between TS and body mass index (ρ = 0.267; p = 0.000). The adjusted analysis for sex, age group, and type of tumor showed that females are more likely to belong to the high NC category, to have excess adiposity. The age group between 10 and 12 years was the most associated with this outcome (2.795 [0.979-7.977]; p < 0.05). TS is also associated with high NC (1.114 [1.050-1.182]; p < 0.05). Conclusion: It was concluded that there is high prevalence of elevated NC and higher risks for this outcome considering type of tumor, sex, age group, besides being an easy and simple measure for use in clinical practice.

Neck Circumference in Polycystic Ovary Syndrome: A Systematic Review and Bootstrapped Meta-Analysis with GRADE Approach

INTRODUCTION

Our aim was to perform a systematic review and meta-analysis for the association of neck circumference (NC) in polycystic ovary syndrome (PCOS) patients as compared to non-PCOS controls.

METHODS

Primarily the PubMed/MEDLINE database and others such as SCOPUS, Google Scholar, Cochrane Library, were searched up to November 15, 2023 for observational studies comparing NC in PCOS versus non-PCOS women. The mean and SD values of NC and other covariates in PCOS and control groups were extracted by two independent reviewers, and the quality and risk of bias assessment was done using Newcastle-Ottawa Scale. The meta-analysis employed combined standardized mean differences (SMD) with 95% confidence intervals (CI) to compare NC between PCOS patients and controls. The heterogeneity and validity were addressed by subgroup, meta-regression, and sensitivity analyses. We conducted a Bootstrapped meta-analysis using 1,000 and 10,000 simulations to test the accuracy of the obtained results. The certainty of evidence was assessed by the GRADE approach.

RESULTS

Our meta-analysis included 9 observational studies. The PCOS patients showed significantly higher NC values than the non-PCOS controls (SMD: 0.66, 95% CI: 0.41-0.91, p < 0.0001). In the bootstrap meta-analysis, the accuracy of the observed findings was proved (SMD = 0.66, 95% CI = 0.42-0.91) for the NC outcome. No publication bias was detected in the funnel plot analysis using Begg's and Egger's tests. The 95% prediction interval of 0.036-1.28 suggests that the true outcomes of the studies are generally in the same direction as the estimated average outcome. The sensitivity analysis provided the robustness of the outcome, and no single study was overly influential on the pooled estimate.

CONCLUSION

This meta-analysis provides accurate evidence for significantly higher NC values in PCOS as compared to non-PCOS controls. There is no sufficient evidence on the diagnostic accuracy measures for NC in PCOS. Hence, further research on its diagnostic utility in PCOS is needed.

Selenium Biomarkers and Their Relationship to Cardiovascular Risk Parameters in Obese Women

A cross-sectional study was carried out with 210 women divided into a case group (obese, n = 84) and a control group (eutrophic, n = 126). Body weight, height, waist circumference (WC), and hip and neck circumference were measured and the waist-hip ratio and conicity index were calculated. Selenium in plasma, erythrocytes and urine, erythrocyte GPx activity, lipid profile, Castelli I and II indices, and systolic and diastolic blood (DBP) pressure were evaluated. Mean dietary selenium intake (µg/kg/day) and plasma and erythrocyte concentrations were lower in the obese group compared to the healthy group (p < 0.001). while urinary selenium concentrations were higher (p < 0.001). There was a statistical difference between groups regarding cardiovascular risk parameters: waist circumference, neck circumference, waist-hip ratio, conicity index, triacylglycerols (TGC), and lipoproteins rich in triacylglycerols (VLDL-c) (p > 0.05). There was a negative correlation between plasma selenium concentrations and total cholesterol (TC), non-high-density lipoprotein (non-HDL), low-density lipoprotein (LDL-c), and systolic blood pressure (SBP). Urinary selenium correlated negatively with waist circumference and hip circumference and positively with neck circumference, TC, TGC, high-density lipoprotein (HDL-c), non-HDL, and VLDL-c. There was a negative correlation between dietary selenium and waist circumference, waist-hip ratio, neck circumference, conicity index, non-HDL cholesterol, LDL-c, and Castelli indices I and II, as well as a positive correlation with HDL-c and diastolic blood pressure. Women with obesity present changes in their nutritional status related to selenium, as well as increased cardiovascular risk parameters. Thus, the positive role of selenium in protecting the risk of cardiovascular disease is likely.

Rotating shift work time is directly associated with excess body adiposity

OBJECTIVE

To analyze the association between changes in body adiposity and length of service on a schedule of rotating shifts.

METHODS

The study was a cross-sectional investigation conducted during the years 2012, 2015, and 2018, involving individuals engaged in rotating shifts at a company involved in iron ore extraction situated within the Iron Quadrangle region of Minas Gerais and the southeastern region of Pará, Brazil. Sociodemographic and behavioral data were collected along with anthropometric parameters in order to calculate body mass index (BMI) and the waist-to-height ratio (WHtR). For data analysis, a multivariate logistic regression was employed to explore potential associations between indicators of body adiposity and the duration of shift work, employing a hierarchical determination model.

RESULTS

The findings showed that in the multivariate model, controlling for confounding factors, workers with 5 to 10, 10 to 15, and more than 15 years of shift work had 41 to 96% greater odds of being overweight (BMI > 25.0 kg/m2), 71 to 82% of having altered neck circumference (> 40 cm), 33 to 120% of altered WC (>102 cm), and 57 to 214% of having altered WHtR (> 0.5 cm).

CONCLUSION

The findings suggest that time spent in work has a significant effect on anthropometric indicators of body adiposity, especially if the worker has a previously established comorbidity such as dyslipidemia or hypertension and is frequently exposed to night work.

Neck circumference as a potential indicator of pre-sarcopenic obesity in a cohort of community-based individuals

BACKGROUND & AIMS

ESPEN/EASO advocates screening for sarcopenic obesity based on the concomitant presence of an elevated body mass index (BMI) or waist circumference. Neck circumference (NC) is another simple and reliable anthropometric measurement for estimating obesity; however, its ability to detect sarcopenic obesity has not yet been established. The aim of the present study was to explore the association between NC and sarcopenic obesity in a Shanghai community population.

METHODS

The study included 1542 participants (622 men and 920 women) with a mean age of 58 years who underwent an examination for the detection of obesity at baseline in 2013-2014 and received a re-examination in 2015-2016. An automatic bioelectric impedance analyzer was used to estimate body composition, and magnetic resonance imaging was used to measure abdominal fat distribution. The definition of pre-sarcopenic obesity combined low skeletal muscle mass adjusted by weight (SMM/W) with obesity which defined according to overall adiposity or fat distribution as BMI ≥25 kg/m2, fat percentage (fat%) ≥ 25% in men and 30% in women, or visceral fat area (VFA) ≥ 80 cm2, respectively.

RESULTS

In both men and women, subjects with low SMM/W had a higher level of NC than those without (both P < 0.01). In turn, participants with elevated NC had a higher proportion of pre-sarcopenic obesity in both men and women, regardless of adiposity status assessed by BMI, fat%, or VFA (all P < 0.01). During an average follow up of 2.1 years, for each 1 cm increase in NC, multivariable-adjusted hazard ratios of pre-sarcopenic obesity in which adiposity status assessed by high BMI were 1.40 (1.11-1.76) in men and 1.32 (1.13-1.56) in women; in addition, such association remained between NC and pre-sarcopenic obesity assessed by high fat% or high VFA.

CONCLUSION

NC is closely associated with the incidence of sarcopenic obesity, suggesting that it could be helpful for screening sarcopenic obesity in a community-based population.

Association between Neck Circumference and Chronic Kidney Disease in Korean Adults in the 2019-2021 Korea National Health and Nutrition Examination Survey

Chronic kidney disease (CKD) is a major public health problem and a leading cause of cardiovascular disease and death. Early recognition and management of CKD risk factors are necessary to prevent its onset and progression. Neck circumference (NC) is a non-invasive and easily accessible anthropometric measure associated with central obesity and subcutaneous fat accumulation in the upper body. Our study aimed to explore the relationship between NC and the prevalence of CKD using data from the nationally representative Korea National Health and Nutrition Examination Survey (2019-2021). We analyzed data from 10,219 subjects (age > 19 years, no missing values). CKD was defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2. Logistic regression analysis was performed, which revealed a significant association between NC and CKD prevalence even after adjusting for confounding factors, both when NC was considered a continuous variable (OR [95% CI], 1.11 [1.03-1.19]) and in quartiles (Q1 as reference; Q2 OR [95% CI], 1.23 [0.91-1.67]; Q3 OR [95% CI], 1.59 [1.16-2.18]; Q4 OR [95% CI], 1.70 [1.16-2.50]). Our findings suggest that NC could be a simple and effective anthropometric measurement for identifying individuals at risk for CKD.

Resting metabolic rate in healthy Singaporeans: Performance of the Harris-Benedict equation and a new predictive model

Background

Prediction equations for resting metabolic rate (RMR) are valuable in managing patients’ weight; however, no accurate equation exists for Singaporeans.

Objective

To develop and cross-validate a predictive regression equation for RMR in Singaporeans, using indirect calorimetry as the reference method.

Methods

104 healthy Singaporeans (34.3 ± 12.2 years) participated, comprising 34 men and 70 women. Anthropometric measurements and demographics information were obtained from participants. RMR was measured via indirect calorimetry (TrueOne 2400 system). Stepwise regression analysis was used to develop the most parsimonious predictive equation. Performance of the equation was evaluated using ordinary least products (OLP) regression and Bland–Altman analysis, whilst internal cross-validation was performed by use of the predicted residual sum of squares (PRESS) method. To compare the new equation with existing ones, the performance of the Harris-Benedict equation was also evaluated.

Results

The best predictive equation takes the form RMR(kcal) = 918 + 16.5(weight)-135.7(gender) - 1152(Waist-to-height-ratio) +0.014(International Physical Activity Questionnaire Score), where gender = 1 (female) or 0 (male). OLP regression revealed no systematic bias for the new equation. Bland–Altman analysis showed that its total (systematic and random) error was 212 kcal. Internal model validation using the PRESS method revealed minimal reduction in predictive accuracy. In contrast, OLP regression showed a significant pattern of over-prediction by the Harris-Benedict equation (y-intercept = −280 kcal; 95%CI, −100 to −461 kcal).

Conclusions

Our new equation outperformed the Harris-Benedict equation in accurately predicting RMR in Singaporeans. Comprising easily obtained anthropometric and self-reported measures, we envisage its potential relevance in clinical and epidemiological settings.

Predictive factors to estimate the severity of nonalcoholic fatty liver disease in candidates for Roux-en-Y gastric bypass

OBJECTIVES

Non-alcoholic fatty liver disease (NAFLD) is related to obesity, insulin resistance, dyslipidemia, and metabolic syndrome. The increasing prevalence of NAFLD results in a significant number of patients manifesting chronic liver disease over time. The aim of this study was to analyze the predictive factors to estimate NAFLD severity in patients who are candidates for Roux-en-Y gastric bypass.

METHODS

This descriptive observational study was conducted with 136 obese patients who were candidates for Roux-en-Y gastric bypass and had mild, moderate, or severe NAFLD.

RESULTS

Severe NAFLD was more prevalent among the men (P = 0.007), and mild NAFLD was more prevalent among the women (P = 0.007). Hyperferritinemia was observed in the group with severe NAFLD (P = 0.01). Neck circumference and waist-to-height ratio were associated with an increased risk when comparing the groups with mild and severe NAFLD and those with moderate and severe NAFLD (P = 0.023 and P = 0.001, respectively); the alanine aminotransferase (ALT) and aspartate aminotransferase ratio values were >1 (P = 0.002) in the same comparisons. The regression analyses showed that an increase of 1 ng/mL in vitamin D reduced the chances of severe steatosis by 10% (P = 0.043), and an increase of 1 U/L ALT increased the chances of severe steatosis by 13% (P = 0.002).

CONCLUSION

High neck circumference and low waist-to-height ratio values, male sex, hyperferritinemia, increased serum ALT values, and decreased vitamin D levels were related to the risk for severe NAFLD.

Neck Circumference as a Predictor of Insulin Resistance in People with Non-alcoholic Fatty Liver Disease

Background

Insulin resistance is common in individuals with non-alcoholic fatty liver disease (NAFLD). Because insulin resistance is a predictive factor for advanced liver diseases in people with NAFLD, efforts have been made to predict it through anthropometric variables. Recently, neck circumference (NC) has been regarded as a reliable alternative marker for metabolic disorders. This study verified the association between NC and insulin resistance in patients with NAFLD.

Methods

We analyzed data from 847 people with NAFLD who participated in the 2019 Korean National Health and Nutrition Examination Survey. NAFLD was defined by a hepatic steatosis index score of ≥36 points, and insulin resistance was defined by a homeostatic model assessment of insulin resistance score of ≥2.5 points. Participants were divided according to sex-specific NC tertiles (T1, lowest; T2, middle; T3, highest).

Results

In the analysis of the area under the receiver operating characteristic curve (AUC), NC displayed a greater predictive power than body mass index (BMI) for insulin resistance in women (AUC of NC=0.625 vs. AUC of BMI=0.573, P=0.035). NC and the odds ratio (OR) for insulin resistance showed a cubic relationship in both men and women. In the weighted multiple logistic regression analysis, the ORs with 95% confidence intervals for insulin resistance in people with NAFLD in T2 and T3 compared to the reference tertile (T1) were 1.06 (0.47-2.41) and 1.13 (0.41-3.11), respectively, in men and 1.12 (0.64-1.97) and 2.54 (1.19-5.39), respectively, in women, after adjusting for confounding factors.

Conclusion

NC was positively correlated with insulin resistance in women with NAFLD.

The Interconnection between Carotid Intima-Media Thickness and Obesity: Anthropometric, Clinical and Biochemical Correlations

Background and Objectives: Carotid intima-media thickness (CIMT) and obesity are considered independent determinants of cardio- and cerebrovascular events. The aim of our study was to investigate the effect of obesity on CIMT and to define which traditional cardiovascular risk factors correlate the most with CIMT values in patients with obesity. Materials and Methods: Anthropometric measurements were collected for the whole study group, as well as body composition and blood pressure data, and biochemical blood analyses were also performed. Results: Although our study group was significantly older according to vascular compared with chronological age, the mean CIMT values were lower when compared with the reference values. We found a statistically significant correlation of CIMT with chronological and vascular age, systolic blood pressure, fasting glucose, total cholesterol and triglyceride levels, waist-to-hip ratio, waist circumference, body muscle mass and skeletal muscle mass index. Atherosclerotic Cardiovascular Disease (ASCVD) risk assessment and SCORE (Systematic COronary Risk Evaluation) showed significant positive correlations, but there was only a weak correlation of ASCVD with CIMT. Conclusions: To deduce, since no diagnostic tool currently includes body weight as an individual risk factor, further trials are highly needed to determine if SCORE, SCORE2, ASCVD risk assessment or CIMT would be the most accurate and relevant diagnostic tool for prediction of risk for future CV events in patients with obesity.

Primary Hyperparathyroidism: Outcomes of Repeated Imaging After Initial Negative Radiological Localization

BACKGROUND

Radiological localization imaging aids in the identification of abnormal parathyroid glands resulting in primary hyperparathyroidism (PHPT), thereby facilitating minimally invasive parathyroid surgery. Sometimes initial imaging may fail to identify the abnormal gland and imaging may therefore be repeated. This study explored patient outcomes of repeated parathyroid localization imaging, after initial negative gland localization, at a United Kingdom institution.

METHODOLOGY

Data was retrospectively collected and analyzed for patients with PHPT undergoing repeated imaging during a five-year period (2015-2020). The total number of episodes of scanning, types of scans performed, the time interval between scans and the imaging success of gland localization were recorded. We explored the reasons for repeated imaging and attempted to identify any factors that might predict subsequent positive radiological localization.

RESULTS

A total of 45 patients were identified who underwent repeated localizing imaging after first localizing imaging was negative. Of these, 39 did not undergo surgery despite repeat imaging being undertaken; 11 out of these 39 patients (28%) had subsequent positive localization scans. Again, a large proportion of patients were managed conservatively, despite the repeated sets of imaging being done. Patients undergoing three or four sets of repetitive imaging did not have imaging or surgical success.

CONCLUSION

A streamlined parathyroid pathway should be followed whereby patients should be triaged for suitability for surgery prior to repeated imaging. A second set of scans should be offered when patients are unsuitable for conservative management and are willing and fit to undergo surgery. There is no merit to repeating imaging more than twice.

The Visceral Adiposity Index Is a Better Predictor of Excess Visceral Fat in Military Pilots: A Cross-sectional Observational Study

INTRODUCTION

Visceral adipose tissue (VAT) is related to cardiometabolic risk. Estimating it using the visceral adiposity index (VAI) could identify this risk in the Brazilian Air Force (BAF) aviator population. The aim here is to verify the predictive capacity of the VAI for identifying visceral fat areas compared to traditional obesity indicators in BAF pilots.

MATERIALS AND METHODS

Forty male BAF pilots were recruited. The study was conducted in two stages: the first applied a structured questionnaire to characterize the sample and identify sedentary behavior and the second obtained nutritional, anthropometric, and body composition data, carrying out biochemical and magnetic resonance imaging tests and investigating physical activity level in this stage. The comparison of the predictive capacity of the VAI with that of other adiposity indicators (body mass index [BMI], waist circumference, waist-height ratio, waist-hip ratio, and neck circumference) for detecting increased VAT and the determination of the optimal cutoff points for the different adiposity indicators were carried out using receiving operating characteristic (ROC) curves. An association was verified between the adiposity indicators and excess visceral fat using Poisson regression analysis with robust variance.

RESULTS

The VAI presented a better predictive capacity for VAT (area under the ROC curve = 0.941), while the BMI did not present diagnostic accuracy (95% CI < 0.5). The strength of the association with high visceral fat was also greater for the VAI than for the other indicators evaluated.

CONCLUSIONS

The VAI was shown to be a better predictor of excess VAT in relation to the other indicators studied. As it is a more easy-access and lower-cost technique than resonance, it enables greater applicability in tracing and monitoring the visceral obesity of a large contingent of military personnel.

Anthropometric measurements and their association with endothelial function and arterial stiffness of eutrophic individuals and with overweight

Objective

The objective of the study was to assess the association of anthropometric measurements with endothelial function and arterial stiffness of eutrophic individuals and with overweight.

Subjects and methods

A cross-sectional study was carried out with individuals with body mass index (BMI) between 18.5 kg/m2 and < 30 kg/m2, low to intermediate global cardiovascular risk scores, and aged ≥ 18 and < 60 years. We assessed the sociodemographic data, anthropometric variables (body weight, height, circumferences of the waist [WC], neck [NC], hip [HC], sagittal abdominal diameter [SAD], [BMI], waist-to-hip ratio [WHR], and waist-to-height ratio [WHtR]), biochemical parameters (lipid profile and nitric oxide), endothelial function (flow-mediated dilation [FMD], by ultrasound), and arterial stiffness (pulse wave velocity [PWV] and the amplification index [AIx@75] by oscillometry). Thirty-six individuals were included, 18 eutrophic and 18 with overweight, with a mean age of 37.5 ± 10.2 years, mostly at low cardiovascular risk (86.1%), female (80.6%), single (52.8%), employed with formal contracts (44.4%), and with over twelve years of education (88.9%).

Results

The PWV presented positive and moderate correlation with the WC (r = 0.584; P = 0.001), WHR (r = 0.513; P = 0.001), and WHtR (r = 0.590; P = 0.001), and positive and low correlation with the NC (r = 0.372; P = 0.013) and SAD (r = 0.356; P = 0.033). Moreover, no anthropometric parameter presented a correlation with the AIx@75 or the FMD percentage in the total sample.

Conclusion

Our findings show that in eutrophic individuals and with overweight the WC, WHR, WHtR, SAD, and NC were positively correlated with the PWV but not to the endothelial function in the overall sample. These are hypothesis-generating findings and they should be replicated in other studies.

Brazilian guide to nutrition in bariatric and metabolic surgery

PURPOSE

Brazilian nutrition recommendations for bariatric and metabolic surgery aim to provide knowledge, based on scientific evidence, on nutritional practices related to different surgical techniques in the surgical treatment of obesity and metabolic diseases.

MATERIALS AND METHODS

A systematic literature search was carried out with the appropriate MeSH terms using Medline/Pubmed/LiLACS and the Cochrane database, with the established criteria being based on the inclusion of articles according to the degree of recommendation and strength of evidence of the Classification of Recommendations, Evaluation, Development, and Evaluation System (GRADE).

RESULTS

The recommendations that make up this guide were gathered to assist in the individualized clinical practice of nutritionists in the nutritional management of patients with obesity, including nutritional management in the intragastric balloon; pre and postoperative nutritional treatment and supplementation in bariatric and metabolic surgeries (adolescents, adults, elderly, pregnant women, and vegetarians); hypoglycemia and reactive hyperinsulinemia; and recurrence of obesity, gut microbiota, and inflammatory bowel diseases.

CONCLUSION

We believe that this guide of recommendations will play a decisive role in the clinical practice of nutritionists who work in bariatric and metabolic surgery, with its implementation in health services, thus promoting quality and safety in the treatment of patients with obesity. The concept of precision nutrition is expected to change the way we understand and treat these patients.

LOFIT (Lifestyle front Office For Integrating lifestyle medicine in the Treatment of patients): a novel care model towards community-based options for lifestyle change-study protocol

BACKGROUND

A healthy lifestyle is indispensable for the prevention of noncommunicable diseases. However, lifestyle medicine is hampered by time constraints and competing priorities of treating physicians. A dedicated lifestyle front office (LFO) in secondary/tertiary care may provide an important contribution to optimize patient-centred lifestyle care and connect to lifestyle initiatives from the community. The LOFIT study aims to gain insight into the (cost-)effectiveness of the LFO.

METHODS

Two parallel pragmatic randomized controlled trials will be conducted for (cardio)vascular disorders (i.e. (at risk of) (cardio)vascular disease, diabetes) and musculoskeletal disorders (i.e. osteoarthritis, hip or knee prosthesis). Patients from three outpatient clinics in the Netherlands will be invited to participate in the study. Inclusion criteria are body mass index (BMI) ≥25 (kg/m2) and/or smoking. Participants will be randomly allocated to either the intervention group or a usual care control group. In total, we aim to include 552 patients, 276 in each trial divided over both treatment arms. Patients allocated to the intervention group will participate in a face-to-face motivational interviewing (MI) coaching session with a so-called lifestyle broker. The patient will be supported and guided towards suitable community-based lifestyle initiatives. A network communication platform will be used to communicate between the lifestyle broker, patient, referred community-based lifestyle initiative and/or other relevant stakeholders (e.g. general practitioner). The primary outcome measure is the adapted Fuster-BEWAT, a composite health risk and lifestyle score consisting of resting systolic and diastolic blood pressure, objectively measured physical activity and sitting time, BMI, fruit and vegetable consumption and smoking behaviour. Secondary outcomes include cardiometabolic markers, anthropometrics, health behaviours, psychological factors, patient-reported outcome measures (PROMs), cost-effectiveness measures and a mixed-method process evaluation. Data collection will be conducted at baseline, 3, 6, 9 and 12 months follow-up.

DISCUSSION

This study will gain insight into the (cost-)effectiveness of a novel care model in which patients under treatment in secondary or tertiary care are referred to community-based lifestyle initiatives to change their lifestyle.

TRIAL REGISTRATION

ISRCTN ISRCTN13046877 . Registered 21 April 2022.

Are the different cut-off points for sitting time associated with excess weight in adults? A population based study in Latin America

BACKGROUND

Excess weight is increasing worldwide, and in Latin America more than half of the population is excess weight. One of the reasons for this increase has been excessive sitting time. Still, it remains to be seen whether there is an excessive amount of that time in Latin American adults. This study aimed to associate different sitting time cut-off points with the excess weight.

METHODS

Data from the Latin American Study of Nutrition and Health (ELANS), a cross-sectional population-based survey conducted in eight Latin American countries, were used. The excess weight indicators used were body mass index, and waist and neck circumferences. Sitting time was obtained using questionnaires and categorized at different cut-off points. Differences between sitting time categories (< 4 or ≥ 4; < 6 or ≥ 6; and < 8 or ≥ 8 hours/day) and excess weight were obtained by Student's t test for independent samples and the association between sitting time categories and different indicators of excess weight were obtained by logistic regression.

RESULTS

The median of the sitting time was 420 min/day (IQR: 240-600). There were no significant differences between body mass index (kg/m2) and waist circumference (cm) with categories of sitting time. The mean values of neck circumference (cm) were significantly higher in ≥4, ≥6 and ≥ 8 hours/day than < 4, < 6, and < 8 hours/day of sitting time in the pooled sample. Some distinct differences by country were observed. There were significant differences among excess weight by body mass index (63.2% versus 60.8) with < 8 vs ≥8 hours/day of sitting time. The proportion of excess weight by neck circumference was higher in participants who reported ≥4, ≥6, and ≥ 8 hours/day compared to < 4, < 6, and < 8 hours/day of sitting time. Considering ≥8 hours/day of sitting time, higher odds of excess weight were found evaluated by body mass index (OR: 1.10; 95% CI: 1.01, 1.20) and neck circumference (OR: 1.13; CI 95%: 1.03, 1.24) overall.

CONCLUSIONS

Sitting time above 8 hours/day was associated with higher odds of excess weight, even though there were no differences in waist circumference between sitting time categories.

TRIAL REGISTRATION

Clinical Trials NCT02226627. (27/08/2014).

Mid-upper arm circumference and neck circumference to screen for overweight-obesity in young adults in South India

Introduction

There are many anthropometric techniques to screen for overweight-obesity like the body mass index (BMI), waist circumference (WC), and waist-hip ratio (WHR). These may be difficult or less acceptable in community and outpatient settings. We determine the cut-offs of mid-upper arm circumference (MUAC) and neck-circumference (NC) to screen overweight (BMI ≥25 kg/m²), abdominal obesity by waist circumference (WC; men: ≥90 cm; women: ≥80 cm) and high percent body fat (PBF) (men: ≥20%; women: ≥30%) and explore participant preference for various anthropometric methods.

Method

ology: We enrolled 282 medical students in South India and performed anthropometry (height, weight, WC, MUAC and NC), bio-impedance analysis (BIA, Inbody 770) to detect PBF. Receiver operator curves were generated and best cut-offs derived using highest Youden Index (sensitivity + specificity-1).

Results

Of the 282 participants, 83 (29.4%) were overweight, 113 (38.7%) had abdominal obesity and 186 (66%) had higher PBF. The MUAC cut-off was 31.3cm for men (sensitivity: 86%; specificity: 74%) to detect overweight and 31.2 cm (sensitivity: 85%; specificity: 73%) to detect abdominal obesity. The corresponding cut-offs in women were 28.5 cm (sensitivity:88%; specificity: 83%) to detect overweight and 28.3 cm (sensitivity: 74%; specificity: 92%) for abdominal obesity. For NC, the proposed cut-off in men was 36.6 cm (sensitivity: 81%; specificity: 82%) for overweight and 37.1 cm (sensitivity:78%; specificity:82%) for abdominal obesity. In women, this was 31.4 cm for both overweight as per BMI (sensitivity: 88%; specificity: 71%) and for abdominal obesity (sensitivity: 75%; specificity: 81%). Neck circumference was preferred by 225 (79.8%) participants.

Conclusion

Both MUAC and NC can be considered for screening overweight and abdominal obesity with good sensitivity and specificity but their sensitivity and specificity for screening high PFB were not very good. Neck circumference was the most preferred anthropometric method.

Neck circumference and the burden of metabolic syndrome disease: a population-based sample

BACKGROUND

This study aims to verify the association between neck circumference (NC) and metabolic syndrome and establish NC cut-off points to predict metabolic syndrome.

METHODS

Weight, height, NC, waist circumference, body mass index, fasting plasma glucose, HDL cholesterol, triglycerides and blood pressure were measured in a cross-sectional and population-based study with 966 adults. The association between NC and the burden of metabolic syndrome disease was evaluated by multinomial logistic regression. Receiver operating characteristic curves were used to acquire gender-specific cut-off values and predict metabolic syndrome. The NC is a simple anthropometric measurement, has low evaluation costs, can estimate the subcutaneous fat in the upper body and is related to cardiometabolic risks.

RESULTS

NC is an independent predictor of metabolic syndrome burden with high association to women. The syndrome components stratification indicated that the NC of individuals with one component was lower than those with three or more (P = 0.001). Metabolic syndrome prediction cut-off point was a NC of 39.5 cm for men and 33.3 cm for women.

CONCLUSIONS

Increased NC was associated with higher metabolic syndrome risks. This anthropometric parameter can be used as an additional marker for screening cardiovascular risk diseases.

The Predictive Role of the Upper-Airway Adipose Tissue in the Pathogenesis of Obstructive Sleep Apnoea

This study aimed to analyse the thickness of the adipose tissue (AT) around the upper airways with anthropometric parameters in the prediction and pathogenesis of OSA and obstruction of the upper airways using artificial intelligence. One hundred patients were enrolled in this prospective investigation, who were divided into control (non-OSA) and mild, moderately severe, and severe OSA according to polysomnography. All participants underwent drug-induced sleep endoscopy, anthropometric measurements, and neck MRI. The statistical analyses were based on artificial intelligence. The midsagittal SAT, the parapharyngeal fat, and the midsagittal tongue fat were significantly correlated with BMI; however, no correlation with AHI was observed. Upper-airway obstruction was correctly categorised in 80% in the case of the soft palate, including parapharyngeal AT, sex, and neck circumference parameters. Oropharyngeal obstruction was correctly predicted in 77% using BMI, parapharyngeal AT, and abdominal circumferences, while tongue-based obstruction was correctly predicted in 79% using BMI. OSA could be predicted with 99% precision using anthropometric parameters and AT values from the MRI. Age, neck circumference, midsagittal and parapharyngeal tongue fat values, and BMI were the most vital parameters in the prediction. Basic anthropometric parameters and AT values based on MRI are helpful in predicting OSA and obstruction location using artificial intelligence.

A Prospective Study to Correlate Difficult Intubation with Difficult Laryngeal Exposure for Microlaryngeal Surgery using Various Grading Scales of Difficult Intubation

Adequate visualization of the vocal folds is essential for optimal phonosurgery. Pre-operative knowledge of a difficult laryngeal exposure (DLE) can alert the surgeon regarding the need for alternative measures. Our study is based on the hypothesis that a patient who has difficult intubation (DI) is likely to have DLE, thus scales anticipating DI should also anticipate DLE. Our aims were to correlate patients of actual DI on table with patients who had DLE, secondly to assess the ability of grading scales of DI to predict DLE and finally to obtain a cut-off value of neck circumference and length for predicting DLE. This is a prospective, observational study wherein four grading scales; Modified Mallampati Classification (MMC), 3-3-2, Upper lip bite test (ULBT) and Neck Mobility (NM) were used for anticipating DI and correlated with DLE during MLS. Occurrence of actual DI and DLE was correlated. Neck circumference and neck length was correlated with incidence of DLE. Out of 42 patients, 22 were anticipated to have DI (52.38%). Actual incidence of DI was 6 (14.28%) and DLE was 10 (23.80%). Correlation between actual DI and DLE was statistically significant. Of the 4 grading scales, ULBT was significant in predicting DLE. Neck circumference more than 37.5 cm and neck length less than 15.3 cm was significant in anticipating DLE. There is a significant correlation between DI and DLE. A positive ULBT, neck circumference more than 37.5 cms and neck length less than 15.3 cms are independently suggestive of a DLE.

OBSTRUCTIVE SLEEP APNEA SYNDROME RISK IN PATIENTS WITH NON-ALCOHOLIC FATTY LIVER DISEASE IS ASSOCIATED WITH OBESITY AND PRESENCE OF NASH

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) is the most common form of liver disease and refers to a wide spectrum of histological abnormalities ranging from simple steatosis (HE) to non-alcoholic steatohepatitis (NASH), fibrosis, cirrhosis and hepatocellular carcinoma.

OBJECTIVE

To assess the risk of obstructive sleep apnea syndrome (OSAS) and relating it to demographic, biochemical and histological data in patients with non-alcoholic fatty liver disease.

METHODS

Cross-sectional cohort study in individuals with biopsy-proven NAFLD. Anthropometric and biochemical parameters, presence of metabolic syndrome and insulin resistance were evaluated. The Berlin Questionnaire (BQ) was applied to assess the risk of apnea and a food record was requested. Based on the BQ, participants were classified as high or low risk for OSAS. In the correlation of sleep apnea with the severity of NAFLD, presence of nonalcoholic steatohepatitis (NASH) and the degree of liver fibrosis were evaluated. Statistical analysis used the chi-square test, Student's t and bivariate logistic regression; values were expressed as mean ± standard deviation. This research project was approved by the Ethics Committee.

RESULTS

Regarding the parameters evaluated, significant differences were observed between the groups in terms of body mass index (BMI), waist and neck circumference. In the histological evaluation, patients classified as high risk were more likely to have fibrosis and NASH. In bivariate regression, the BMI, presence of fibrosis and steatohepatitis in the biopsy were independently associated with an elevated risk of the syndrome.

CONCLUSION

A high prevalence of risk for OSAS was observed in the studied group, with a higher risk being independently associated with BMI and presence of steatohepatitis, suggesting that it is a factor associated with the severity of the disease.

Incremental significance and sex discrepancies of neck circumference on the odds of ischaemic stroke: a multistage, population-based, cross-sectional study from Northeast China

OBJECTIVES

Accumulated evidence suggests that neck circumference (NC) is associated with cardiometabolic risk factors. However, limited studies are available regarding the association between NC or height normalised NC (neck-to-height ratio (NHR)) and risk of ischaemic stroke (IS) in the Chinese population. Therefore, we aimed at examining the associations between NC or NHR and odds of IS and exploring the discrepancies between men and women.

DESIGN

A multistage cluster cross-sectional study.

SETTING

A population-based study carried out in Northeast China.

METHODS

A cross-sectional study was undertaken in Northeast China between September 2017 and March 2019, involving 7236 men and 11 352 women, respectively. The median age of participants was 60.30 years, ranging from 40 to 97 years. The associations between NC or NHR and odds of IS were calculated using multiple logistic regression models. Dose-response relationships were depicted using restricted cubic spline functions. Reclassification analyses were carried out to determine the incremental significance of NC or NHR on the odds of IS.

RESULTS

In women, NC and NHR were significantly associated with the odds of IS, independent of traditional risk factors and other anthropometric parameters for obesity. The highest quartile of NC and NHR had a 1.60 (95% CI 1.16 to 2.22)-and 1.72 (95% CI 1.23 to 2.41) times higher odds of IS compared with the lowest quartile. Furthermore, the odds of IS increased by 1.10 (95% CI 1.01 to 1.20) and 1.12 (95% CI 1.02 to 1.22) times per 1 SD increase in NC and NHR, respectively. Reclassification analyses showed that the proportion of correct classification increased by 11.5% (95% CI 2.2% to 20.7%) and 22.8% (95% CI 13.5% to 32.0%) after the addition of NC or NHR into established models, respectively. However, the findings could not be replicated in men.

CONCLUSION

NC and NHR might be promising independent indicators for women IS. Their incremental value in the risk stratification of IS enables the individualised prevention of IS in women.

Neck Circumference and Risk of Incident Atrial Fibrillation in the Framingham Heart Study

Background

Increased neck circumference, a proxy for upper‐body subcutaneous fat, is associated with cardiovascular risk and metabolic risk factors, accounting for body mass index (BMI) and waist circumference. The association between neck circumference and incident atrial fibrillation (AF) is unclear. The aim of current study was to evaluate the association between neck circumference and incident AF.

Methods and Results

We selected participants from the Framingham Heart Study aged ≥55 years without diagnosed AF and with available neck circumference, BMI, and waist circumference measurements. We defined high neck circumference as ≥14 inches in women and ≥17 inches in men on the basis of the Contal and O’Quigley changepoint method. We used Fine‐Gray models to estimate subdistribution hazards ratios (sHRs) for the association between neck circumference and incident AF accounting for the competing risk of death. We adjusted models for clinical risk factors. We then additionally adjusted separately for BMI, waist circumference, and height/weight. The study sample included 4093 participants (mean age 64±7 years, 55% female). During 11.2±5.7 mean years of follow‐up, incident AF occurred in 571 participants. High neck circumference was associated with incident AF (sHR for high versus low: 1.58; 95% CI, 1.32–1.90, P<0.0001). The association remained significant after adjustment for BMI (sHR, 1.51; 95% CI, 1.21–1.89; P=0.0003), waist circumference (sHR, 1.47; 95% CI, 1.18–1.83; P<0.0001), and height/weight (sHR, 1.37; 95% CI, 1.09–1.72; P=0.007).

Conclusions

High neck circumference was associated with incident AF adjusting for traditional adiposity measures such as BMI and waist circumference.

Neck circumference and incidence of cerebrovascular disease over 12 years among Korean adults

Objectives

Neck circumference is associated with a distinctive fat storage process that confers additional metabolic risk. Hence, this study aimed to investigate the correlation between baseline neck circumference and the incidence of cerebrovascular disease using a prospective community-based sample of Korean adults over 12 years of follow-up, after controlling for selected covariates.

Methods

Participants with non-cerebrovascular disease were divided into 4 groups (Q1–Q4) based on their baseline neck circumference. Cox proportional hazards analysis was used to calculate hazard ratios and 95% confidence intervals (CIs) to evaluate the relationship between neck circumference and cerebrovascular disease incidence over a 12-year period.

Results

Among this study’s 3,662 participants, 128 (3.50%) developed cerebrovascular disease. The incidence of cerebrovascular disease increased from 2.2% in Q1 to 4.3% in Q2, 2.5% in Q3, and 5.0% in Q4. When compared to Q1, the relative risks of cerebrovascular disease development were 0.57 (95 % CI, 0.25–1.31), 0.86 (95 % CI, 0.38–1.96), and 0.79 (95 % CI, 0.30–2.07) in man and 1.86 (95 % CI, 0.66–5.20), 3.50 (95 % CI, 1.25–9.86), and 4.71 (95 % CI, 1.50–14.77) in woman in Q2, Q3, and Q4, respectively, after adjusting for most risk factors related to cerebrovascular disease.

Conclusion

The relationship between neck circumference and cerebrovascular disease was stronger in woman than in man, indicating potential differences between the sexes. These results are meaningful for evaluating and surveilling neck circumference as a promising tool for identifying subgroups of vulnerable and at-risk populations.

Mini-implant assisted rapid palatal expansion (MARPE) effects on adult obstructive sleep apnea (OSA) and quality of life: a multi-center prospective controlled trial

Introduction

Transverse maxillary deficiency is a high prevalent growth disorder within the adult population that may lead to serious health issues, such as detrimental malocclusions and higher risk of developing obstructive sleep apnea (OSA). Mini-implant assisted rapid palatal expansion (MARPE), as it expands the mid-face and augment the nasal and oral cavities dimensions, may reduce the airflow resistance and thus play an important role on OSA therapy in some patients. The main objective of the present trial is to assess MARPE effects on the sleep and quality of life of non-obese adult OSA patients with transverse maxillary deficiency.

Methods

A total of 32 participants were divided into intervention and control groups. They underwent physical evaluation, Epworth Sleepiness Scale (EES) and Quebec Sleep Questionnaire (QSQ), cone-beam computed tomography (CBCT) and home sleep testing (HST) for OSA before MARPE (T1) and 6 months after the intervention (T2).

Results

Questionnaires EES (daytime sleepiness) and QSQ (OSA-related quality of life) presented significant statistical differences between the groups. We also found clinical and statistical (p < 0.01) differences between the groups regarding the apnea/hypopnea index (AHI), as well as others HST parameters (mean oxygen saturation and snoring duration).

Conclusion

In our sample, MARPE (without any auxiliary osteotomy) showed a good success rate (85%) and promoted important occlusal and respiratory benefits. We observed important daytime sleepiness and OSA-related quality of life improvement, as well as the AHI (65.3%), oxygen saturation and snoring duration.

Comparative analysis of anthropometric indices with serum uric acid in Iranian healthy population

BACKGROUND

The relationship between elevated serum uric acid (SUA) levels and hypertension, metabolic syndrome and cardiovascular disease has been established. In this study, the relation of SUA levels to anthropometric indices, blood cell count and lipid profile was examined.

METHODS

Anthropometric parameters including body-mass index, waist circumference, waist to height ratio, waist to hip ratio, waist to pelvic ratio, neck circumference (NC), body fat mass (BFM), basal metabolic rate (BMR), visceral fat level (VFL) and percent body fat (PBF), along with complete blood cell count, lipid profile and SUA were obtained from 2921 young and middle-aged Iranian healthy subjects. To assess the normality of data, the Kolmogorov-Smirnov test was used. Mann-Whitney, Kruskal-Wallis, Chi-square and Spearman correlation tests were used for evaluating the association between variables. Simple and multiple regression analyses were also performed.

RESULTS

The results of data analysis showed all studied factors were correlated with SUA level except VFL, BFM, and platelet-to-lymphocyte ratio. The highest correlation was with NC, BMR, hematocrits (HCT) and triglycerides (TG). The backward method revealed that TG, LDL, HDL, neutrophil, lymphocyte, platelet, HCT, BMR and skinfold fat thickness were factors related to SUA.

CONCLUSIONS

According to the finding of this study, SUA level is related to anthropometric indices, lipid profile and neutrophil to lymphocyte ratio in healthy population. SUA measurement might be advisable to identify those at increased risk of health problems whom might benefit from further evaluation.

Differences in Demographic and Radiographic Characteristics between Patients with Visible and Invisible T1 Slopes on Lateral Cervical Radiographic Images

Introduction: The T1 slope is important for cervical surgical planning, and it may be invisible on radiographic images. The prevalence of T1 invisible cases and the differences in demographic and radiographic characteristics between patients whose T1 slopes are visible or invisible remains unexplored. Methods: This pilot study aimed to evaluate the differences in these characteristics between outpatients whose T1 slopes were visible or invisible on radiographic images. Patients (n = 60) who underwent cervical radiography, whose T1 slope was confirmed clearly, were divided into the visible (V) group and invisible (I) group. The following radiographic parameters were measured: (1) C2-7 sagittal vertical axis (SVA), (2) C2-7 angle in neutral, flexion, and extension positions. Results: Based on the T1 slope visibility, 46.7% of patients were included in group I. The I group had significantly larger C2-7 SVA than the V group for males (p < 0.05). The C2-7 SVA tended to be larger in the I group, without significant difference for females (p = 0.362). Discussion: The mean C2-7 angle in neutral and flexion positions was not significantly different between the V and I groups for either sex. The mean C2-7 angle in the extension position was greater in the V group. The T1 slope was invisible in males with high C2-7 SVA.

Assessment of the risk of obstructive sleep apnoea among patients with type 2 diabetes and its associated factors using the STOP-BANG questionnaire: A cross-sectional study

Objective

To assess the risk of obstructive sleep apnoea (OSA) and its associated risk factors among patients with type 2 diabetes in southern KSA.

Methods

This was a cross-sectional study conducted at the Armed Forces Hospital in Jazan. The prevalence of OSA was assessed using a validated Arabic translation of the STOP-BANG screening questionnaire. The odds of a higher OSA risk were calculated via regression analysis, according to the measured clinical and demographic variables.

Results

The total number of participants was 306, of which 213 (69.6%) were over the age of 50, 247 (80.7%) were married, and 161 (52.6%) were female. The overall median score of the OSA risk level assessed by the STOP-BANG items was three on a scale of 0–8, of which 193 (63.1%) of the participants in the sample were classified as being at high risk of developing OSA. Several statistically significant associations were identified, where odds ratios (ORs) with a higher OSA risk level were detected according to age, sex, marital status, waist and neck circumference, haemoglobin A1c (HbA1c) and body mass index levels, duration of diabetes, and comorbidity with hypertension (p < 0.05).

Conclusion

The higher risk of OSA identified in our sample of diabetic patients can be related to a high prevalence of obesity, larger neck circumferences, hypertension, and other factors linked to the duration and treatment of diabetes. Additionally, the association between waist circumference, HbA1c, and duration since the diagnosis of diabetes suggests an interaction effect that requires further investigation.

Associations between neck circumference and markers of dysglycemia, non-alcoholic fatty liver disease, and dysmetabolism independent of Body Mass Index in an Emirati population

AIM

Neck circumference (NC) is quick and easy to measure and may be a useful surrogate marker for body composition. We investigated NC as a potential marker of dysglycemia, MetS, and NAFLD.

METHODS

674 individuals were recruited at the Imperial College London Diabetes Centre in a study of sleep apnea prevalence. Of these, 547 (Age 46 ± 11.4 years, Body Mass Index (BMI) 31 ± 6 kg/m², 279 (51%) female, 113 normal glucose tolerance (NGT), 108 Prediabetes, 326 Type 2 diabetes (T2DM)) met all inclusion criteria for analysis. NC was measured at the thyroid cartilage, and collar size was recorded. Analysis was performed using univariate and multivariate linear regression.

RESULTS

Adjusted for BMI, sex, and age, NC was 0.65 ± 0.3 cm greater in prediabetes (p = 0.0331), and 1.07 ± 0.28 cm greater in T2DM, compared with NGT (p = 0.0002). Adjusting for BMI, sex, and glycemic status, 1-cm increase in NC was associated with a 1.04 ± 1.01 U/L (p <0.0001) increase in ALT and, additionally, correcting for statin use, a 0.03 ± 0.01 mmol/L reduction in HDL (p <0.0001) and a 0.1 ± 0.02 increase in TC : HDL. A 1 cm increase in NC was associated with a 1.15 ± 1.02% (p <0.0001) increase in 10-year AHA cardiovascular risk in individuals over 40 years old and a 0.16 ± 0.02 (p <0.0001) increase in NAFLD fibrosis score. The neck circumference was associated with the hazard of new onset of deranged ALT adjusted for age, sex, glycemic status, and BMI (hazard ratio 1.076 (95% CI 1.015-1.14, p = 0.0131) and with the incidence of Fatty Liver Index associated with high probability of NAFLD (hazard ratio 1.153 (95% CI 1.019-1.304), p = 0.0239).

CONCLUSION

NC is associated with dysglycemia, components of the MetS, and factors predictive of NAFLD, but does not appear to independently predict subsequent progression to high risk of liver fibrosis in this predominantly diabetic population.

Neck Circumference is Associated with Metabolic Syndrome Components in Chinese Subjects with Type 2 Diabetes

INTRODUCTION

We aimed to investigate the correlation between neck circumference (NC) and metabolic syndrome (MetS) components in type 2 diabetes (T2DM) patients.

METHODS

This cross-section study included 610 patients with T2DM, including 312 males and 298 females. Height, weight, body mass index (BMI), NC, waist circumference (WC), hip circumference, and blood pressure were measured. Serum glucose, lipid, and uric acid levels were examined. The correlation between NC and anthropometric parameters and metabolic disorders was analyzed. Receiver operating characteristic curve analysis was performed to determine the best NC cutoff value for predicting MetS.

RESULTS

Either in male or female subjects, NC was positively correlated with BMI, WC, waist-to-hip ratio, systolic blood pressure, diastolic blood pressure, and serum triglyceride and uric acid levels and negatively correlated with serum HDL-C levels. NC is an independent influencing factor of female serum uric acid levels (standardized coefficient β = 0.141, t = 2.088, P = 0.038). NC of the MetS group was significantly larger than that of the non-MetS group (male 38.42±3.05 cm vs 36.20±2.90 cm, female 36.14±2.75 cm vs 34.01±2.94 cm, P < 0.001). The NC cutoff value for predicting MetS is 37.3 cm for males and 35.8cm for females. There was no difference between using cutoff points of NC and WC to recognize all MetS components in males and hyperuricemia in females (P>0.05).

CONCLUSION

NC is closely related to BMI, WC, and MetS components in T2DM. The cutoff points of NC can identify all MetS components in males and hyperuricemia in females with the same efficiency as WC.

Relationship Between Lipodystrophy, Body Composition, Metabolic Profile, and Serum Levels of Adipocytokines

Background: Despite the benefits in improving the clinical state of people living with HIV/aids (PLWHA), some side effects associated with the use of antiretroviral therapy (ART) are reported. Redistribution of body fat has been associated with treatment and is characterized by morphological changes, also known as lipodystrophy. The complications of metabolic and morphological changes in these individuals seem to increase the risk of cardiovascular disease. Adipocytokines are proteins that have essential functions in biological processes, in which the levels of these proteins are related to the pathogenesis of metabolic syndrome (MS) and cardiovascular disease. Recent studies have shown that such levels are generally modified in PLWHA, regardless of whether the treatment is established or not. An application of methods for body fat estimation in patients with fat redistribution, as in the case of aids, especially those that quantify body fat by segments, appears to clarify these alterations and plays an important role in the development of multiprofessional treatment. Objectives: This investigation was carried out to compare and correlate body composition, biochemical metabolic parameters, and levels of adipocytokines and cytokines of PLWHA, with and without lipodystrophy, with individuals with negative HIV serology and stratified by sex. Material and Methods: This is a cross-sectional study in which body composition, metabolic and anthropometric changes, and levels of adipocytokines of 110 individuals were assessed. These individuals were paired in sex, age, and body mass index (BMI) and subdivided into three groups: PLWHA with and without a clinical diagnosis of lipodystrophy associated with HIV, and a group control. Results: Collinearity was identified both in the general sample and for genders of the waist-to-height ratio (WHtR) with all anthropometric parameters, except for muscle mass. The results show strong association between IFN-γ and TNF-α both in the general sample and for genders and moderate correlation between leptin and fasting glucose for women; worsening of the triglyceride profile in both women with lipodystrophy compared with the control group and men without lipodystrophy compared with the control group; higher serum TNF-α values among men without lipodystrophy compared to those with HIV-associated lipodystrophy (HALS). Conclusions: The results of this study underline that, considering the manifestations of the syndrome, these patients have a high-risk endocrine metabolic profile for cardiovascular events.

Associations of body shapes with insulin resistance and cardiometabolic risk in middle-aged and elderly Chinese

Background

We aimed to define refined body shapes by using multiple anthropometric traits that represent fat distribution, and evaluate their associations with risk of insulin resistance (IR) and cardiometabolic disorders in a Chinese population.

Methods

We performed a cross-sectional analysis in 6570 community-based participants aged ≥ 40 years. Four body circumferences (neck, waist, hip, and thigh) and their ratios were put simultaneously into an open-source Waikato Environment for Knowledge Analysis platform to select the worthiest indicators in determining IR. The ratio of the top 3 fat distribution indicators was used to define the refined body shapes.

Results

We defined 8 distinct body shapes based on sex-specific combinations of waist-to-hip ratio (WHR), waist-to-thigh ratio (WTR), and waist-to-neck ratio (WNR), which differed in participants’ distribution and risk of IR and related cardiometabolic disorders. In women, as compared to the low WHR-low WTR-low WNR shape, all body shapes were significantly associated with IR and related cardiometabolic disorders; while in men, the low WHR-high WTR-high WNR shape and the higher WHR related shapes were significantly associated with IR and related cardiometabolic disorders. Stratified by WHR, the results were consistent in women; however, no significant associations were detected in men.

Conclusions

We defined 8 distinct body shapes by taking WHR, WTR, and WNR, simultaneously into account, which differed in association with the risk of IR and related cardiometabolic disorders in women. This study suggests that body shapes defined by multiple anthropometric traits could provide a useful, convenient, and easily available method for identifying cardiometabolic risk.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12986-021-00629-1.

Correlation between Neck Circumference and Other Anthropometric Measurements in Eight Latin American Countries. Results from ELANS Study

Neck circumference (NC) is being used to identify the risk of chronic diseases. There is a high prevalence of overweight and obesity in Latin America, and neck circumference is a simple and practical measurement to assess this, especially in primary health centers. We analyzed the correlation between the NC anthropometric indicator and other anthropometric measurements such as BMI and waist circumference (WC) in eight Latin American cities. We applied Pearson's correlation to identify the correlate NC with the other anthropometric variables stratified by sex; the sensitivity (Se) and specificity (Sp) by sex were evaluated according to the cut-off established with the Youden Index. The strongest correlations between NC and WC were found when stratified by sex (women: r = 0.71; men: r = 0.69, respectively) followed by the correlation between NC and BMI (r = 0.65, both sex). NC cut-off points of 39.0 cm in men and 32.9 cm in women identified those individuals with an increased WC and 39.8 and 33.7 cm, respectively, for a substantial increase in WC. For BMI ≥ 25.0 kg/m² for men, the cut-off point was 37.5 cm, and for women, it was 33.1 cm, and for BMI ≥ 30 kg/m², the cut-off points were 39.2 and 34.2 cm, for men and women, respectively. Conclusion: NC proved to be a useful, practical, and inexpensive tool that can be used to identify, evaluate, and monitor overweight and obese individuals.

Neck fat and obstructive sleep apnea in obese adolescents

STUDY OBJECTIVES

Increased neck circumference, a surrogate for the neck fat that can narrow the upper airway in obese individuals, is a risk factor for obstructive sleep apnea syndrome (OSAS) in adults, but the association between neck fat and OSAS in adolescent males and females is unknown. We hypothesized that obese adolescents with OSAS have more neck fat than controls, females more neck fat than males, and that neck fat correlates with obesity and OSAS severity.

METHODS

Obese adolescents with OSAS and obese and normal-weight controls underwent upper airway magnetic resonance imaging, polysomnography, and anthropometrics, including neck circumference measurement. Intra-neck and subcutaneous neck fat measurements were manually segmented and compared among the three groups using ANOVA and between males and females using t-tests. The relationship between polysomnographic parameters and neck fat measurements was assessed in adolescents with OSAS using Pearson correlations.

RESULTS

One-hundred nineteen adolescents (38 females) were studied: 39 obese with OSAS, 34 obese controls, and 46 normal-weight controls. Neck fat was not greater in adolescents with OSAS compared to obese controls (p=0.35), and neck fat volume was not related to OSAS severity (p = 0.36). However, obese adolescents had more neck fat than normal-weight controls (p < 0.001), and neck fat volume correlated with neck circumference (r = 0.53, p < 0.001). Females had significantly greater cross-sectional neck fat than males (p < 0.001).

CONCLUSIONS

While neck fat is associated with obesity and neck circumference in adolescents and is greater in females versus males, it does not appear to correlate with presence and severity of OSAS.

Analysis of anthropometric indicators used in the nutritional assessment of active elderly in the city of Macaé, Rio de Janeiro, Brazil

Introduction: Body composition changes related to aging alter the capacity of predicting risk through anthropometric parameters. Objective: To discuss methodological aspects of anthropometry in active elderly based on associations between Body Mass Index (BMI) and other nutritional indicators. Methods: Cross-sectional study with active elderly from Macaé, Rio de Janeiro, Brazil (2014/2015). Nutritional status was described according to the BMI (Nutritional Screening Initiative, 1994). Linear regression analysis was performed: the outcome variable was BMI and the dependent ones were circumferences of waist, hip, neck, calf, arm and waist-to-hip ratio (WHR). Results: We assessed 173 people (55.5% female; median 71 years old). Calf and neck circumferences and WHR presented low R2 value. Among women, hip (R2=0.825) and waist circumferences (R2=0.729) individually explained much of the variation in BMI; and among men, waist (R2=0.759) and arm circumferences (R2=0.741) performed better. The cut-off points for waist circumference corresponding to the critical BMI value (27 kg/m2) were 87.9 and 96.8 cm, respectively for women and men. In multiple analysis, the association of waist, hip and arm circumferences with BMI remained significant. Conclusion: Circumferences traditionally used to assess adults had higher linear association with BMI than specific indicators for elderly people. The body composition of active elderly can be more similar to adults’ than that of elderly with other profiles. The waist circumference cut-off points established for adults may not be suitable for elderly populations. We suggest testing the cut-off points obtained by this study on other groups of active elderly.