Neck Circumference and Incidence of Diabetes Mellitus over 10 Years in the Korean Genome and Epidemiology Study (KoGES)

Correlation between neck circumference and hepatic steatosis determined by controlled attenuation parameter

Neck circumference is an attractive method for determining metabolic profiles and has many advantages over waist circumference. However, the correlation between neck circumference and hepatic fibrosis has not been evaluated. The aim of this study was to evaluate the correlation between neck circumference and hepatic fibrosis and define the optimal cut-off point for neck circumference to determine hepatic fibrosis. A cross-sectional study (n = 333) was conducted among Thai healthcare workers at Phramongkutklao Hospital who received an annual health maintenance program. Neck circumference was measured at the lower margin of the laryngeal prominence. Fibroscan® with a controlled attenuation parameter was used to measure the degree of hepatic fibrosis and steatosis by an experienced, well-trained operator. In the cross-sectional analysis, it was found that the large circumference of the neck was associated with hepatic fibrosis (r = 0.19, p = .001) and hepatic steatosis (r = 0.58, p < .001). Hepatic fibrosis (r = 0.15, p = .004) and steatosis (r = 0.53, p < .001) were also associated with waist circumference. The neck circumferences of 40 and 34 cm were the best cut-offs for male and female participants, respectively.Neck circumference is closely related to hepatic fibrosis and steatosis, which should be promoted and has a better advantage than waist circumference in the screening of hepatic steatosis.

Relationships of neck circumference and abdominal obesity with insulin resistance considering relative handgrip strength in middle-aged and older individuals

PURPOSE

This cross-sectional study evaluated how neck circumference (NC) influences the association between abdominal obesity (AO) and insulin resistance (IR) while considering relative handgrip strength (RHGS) in middle-aged and older people.

METHODS

Using data from the 2019 Korea National Health and Nutrition Examination Survey for 3804 Korean adults aged 40-80 years, AO (waist circumference [WC] ≥90 cm for men, ≥85 cm for women), large NC (sex-specific highest 5th quintile), weak RHGS (sex-specific 1st quintile of HGS/body mass index), and IR (homeostasis model assessment of IR [HOMA-IR] ≥2.5) were defined. A complex sample general linear model and logistic regression analyses were performed after adjusting for confounding factors.

RESULTS

As NC increased, the relationship between WC and HOMA-IR increased (p for interaction <0.001). In the group with AO, large NC, or both, the adjusted odds ratio (AOR) for IR increased in the group with weak RHGS than in the group with normal RHGS. In the group with normal NC, the AOR for IR in those with AO (vs. those without AO) was 3.3 (95% confidence interval, 2.6-4.3) even after controlling for RHGS; however, the AOR was 5.3 (95% confidence interval, 2.7-10.4) in the group with large NC. These relationships of WC, NC, and RHGS with IR were comparable across sex and age groups.

CONCLUSIONS

Large NC increased the association between AO and IR independent of RHGS and the relationships between large NC and AO and insulin resistance varied according to RHGS.

Association between neck circumference and diabetes mellitus: a systematic review and meta-analysis

BACKGROUND

Despite that several original researchers have investigated the association between neck circumference (NC) and the risk of diabetes mellitus (DM), their results remain controversial. This review aimed to quantitatively determine the risk of DM in relation to the NC.

METHODS

We conducted a literature search of PubMed, Embase, and the Web of Science from these databases' inception through September 2022 to identify observational studies that examined the association between NC and the risk of DM. A meta-analysis of the random-effects model was applied to combine the results of the enrolled studies.

RESULTS

Sixteen observational studies involving 4,764 patients with DM and 26,159 participants were assessed. The pooled results revealed that NC was significantly associated with the risk of type 2 DM (T2DM) (OR = 2.17; 95% CI: 1.30-3.62) and gestational DM (GDM) (OR = 1.31; 95% CI: 1.17-1.48). Subgroup analysis revealed that after controlling for BMI, the relationship between the NC and T2DM remained statistically significant (OR = 1.94; 95% CI: 1.35-2.79). Moreover, the pooled OR of T2DM was found to be 1.16 (95% CI: 1.07-1.27) for an increment per each centimeter in the NC.

CONCLUSIONS

Integrated epidemiological evidence supports the hypothesis that a greater NC is associated with an increased risk of T2DM and GDM.

Relationship Between Neck Circumference and Risk Factors of Metabolic Syndrome in a Bushehr Elderly Health Study

Metabolic syndrome includes a set of metabolic disorders such as obesity, high blood pressure, hypertriglyceridemia, lipid disorders, and glucose intolerance. In this cross-sectional (descriptive-analytical) study, 2,426 people were selected from the 60 years old and above population of Bushehr for a second-phase investigation of the relationship between neck circumference (NC) and cardiometabolic risk factors in the elderly people. The data (mean and standard deviation) were analyzed using STATA MP Version 15 software. The results of the study showed that the average age of all elderly participants in the study was 69.34 ± 6.39 years. The mean and standard deviation of the NC index in men, women, and all participants were 39.31 ± 2.89, 34.86 ± 2.84, and 37.00 ± 3.62, respectively. The mean and standard deviation of most laboratory indicators (triglyceride [TG], total cholesterol [TC], low-density lipoprotein [LDL], high-density lipoprotein [HDL]) were significantly higher in women, and there was no significant difference in fasting blood glucose (FBG) between men and women. NC index in the total population was significantly associated with all risk factors of metabolic syndrome (body mass index, systolic blood pressure, diastolic blood pressure) and laboratory indicators (FBG, TG, TC, LDLC, and HDL). The present study shows that the NC index can be a good predictor for the diagnosis of metabolic syndrome and visceral adipose tissue in the elderly.

Snoring Index and Neck Circumference as Predictors of Adult Obstructive Sleep Apnea

Background. Snoring is the cardinal symptom of obstructive sleep apnea (OSA). The acoustic features of snoring sounds include intra-snore (including snoring index [SI]) and inter-snore features. However, the correlation between snoring sounds and the severity of OSA according to the apnea−hypopnea index (AHI) is still unclear. We aimed to use the snoring index (SI) and the Epworth Sleepiness Scale (ESS) to predict OSA and its severity according to the AHI among middle-aged participants referred for polysomnography (PSG). Methods. In total, 50 participants (mean age, 47.5 ± 12.6 years; BMI: 29.2 ± 5.6 kg/m2) who reported snoring and were referred for a diagnosis of OSA and who underwent a whole night of PSG were recruited. Results. The mean AHI was 30.2 ± 27.2, and the mean SI was 87.9 ± 56.3 events/hour. Overall, 11 participants had daytime sleepiness (ESS > 10). The correlation between SI and AHI (r = 0.33, p = 0.021) was significant. Univariate linear regression analysis showed that male gender, body mass index, neck circumference, ESS, and SI were associated with AHI. SI (β = 0.18, p = 0.004) and neck circumference (β = 2.40, p < 0.001) remained significantly associated with AHI by the multivariate linear regression model. Conclusion. The total number of snores per hour of sleep and neck circumference were positively associated with OSA among adults referred for PSG.

Neck Circumference for NAFLD Assessment during a 2-Year Nutritional Intervention: The FLiO Study

Neck circumference (NC) and its relationship to height (NHtR) and weight (NWtR) appear to be good candidates for the non-invasive management of non-alcoholic fatty liver disease (NAFLD). This study aimed to evaluate the ability of routine variables to assess and manage NAFLD in 98 obese subjects with NAFLD included in a 2-year nutritional intervention program. Different measurements were performed at baseline, 6, 12 and 24 months. The nutritional intervention significantly improved the anthropometric, metabolic and imaging variables. NC was significantly associated with the steatosis degree at baseline (r = 0.29), 6 m (r = 0.22), 12 m (r = 0.25), and 24 m (r = 0.39) (all p < 0.05). NC was also significantly associated with visceral adipose tissue at all the study time-points (basal r = 0.78; 6 m r = 0.65; 12 m r = 0.71; 24 m r = 0.77; all p < 0.05). NC and neck ratios combined with ALT levels and HOMA-IR showed a good prediction ability for hepatic fat content and hepatic steatosis (at all time-points) in a ROC analysis. The model improved when weight loss was included in the panel (NC-ROC: 0.982 for steatosis degree). NC and ratios combined with ALT and HOMA-IR showed a good prediction ability for hepatic fat during the intervention. Thus, their application in clinical practice could improve the prevention and management of NAFLD.

Control and complications of diabetes in urban primary care units in Thailand: a cross-sectional study

Background

Primary health care system plays a central role in caring for persons with diabetes. Thai National Health Examination Survey (NHES) reports that only 40% of patients with type 2 diabetes mellitus (T2DM) achieve optimal glycemic control. We sought to evaluate the quality of diabetic care (QOC), prevalence of microvascular complications, and associated risk factors among T2DM patients treated at primary care units in urban areas in Thailand.

Methods

A population-based, cross-sectional study of 488 T2DM patients aged over 35 years from 25 primary care units in Samutsakhon, Thailand was conducted during February 2018 to March 2019. Clinical targets of care (TOC) and processes of care (POC) were measured to evaluate QOC. Multivariate logistic regression models were applied to explore the association between risk factors and glycemic control.

Results

41.2% of women and 44.4% of men achieved hemoglobin A1C (A1C) < 53 mmol/mol, while 31.3% of women and 29.7% of men had poor glycemic control (A1C > 63 mmol/mol). 39 participants (8%) achieved all TOC and 318 participants (65.2%) achieved all POC. Significant risk factors for poor glycemic control included diabetes duration > 6 years (AOR = 1.83, 95% CI = 1.20–2.79), being overweight (AOR = 2.54, 95% CI = 1.58–4.08), obesity (AOR = 1.71, 95% CI = 1.05–2.89), triglycerides > 1.7 mmol/l (AOR = 1.81, 95% CI = 1.25–2.78), low density lipoprotein-cholesterol (LDL-C) ≥ 2.6 mmol/l (AOR = 1.55, 95% CI = 1.04–2.28). On the other hand, participants aged > 65 years (AOR = 0.25, 95% CI = 0.14–0.55) or achieved TOC indicators (AOR = 0.69, 95% CI = 0.43–0.89) were significantly associated with glycemic control. Diabetic retinopathy was significantly related to obesity (AOR = 2.21, 95% CI = 1.00–4.86), over waist circumference (AOR = 2.23, 95% CI = 0.77–2.31), and diastolic blood pressure > 90 mmHg (AOR = 1.81, 95% CI = 1.48–1.96).

Conclusion

Access to essential diabetic screening in primary care units is crucial to determine status of disease control and guide disease management. Duration of T2DM, high body mass index, triglyceride and LDL-C were independently associated with poor glycemic control. Obesity was highly associated with diabetes retinopathy. Effort should be taken seriously toward monitoring these factors and providing effective care.

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.

The Effect of Weight-Loss Interventions on Cervical and Chin Subcutaneous Fat Depots; the CENTRAL Randomized Controlled Trial

Accumulation of cervical and chin subcutaneous adipose tissues (SAT) represent known phenotypes of obesity. We aimed to evaluate the sensitivity of these fat storages to long-term weight-loss directed lifestyle-intervention and to assess their relations to bodily-adiposity, insulin-resistance, and cardiometabolic risk; We randomly assigned 278 participants with abdominal-obesity/dyslipidemia to low-fat or Mediterranean/low-carbohydrate diets +/- physical-activity. All participants underwent an 18 month whole-body magnetic resonance imaging follow-up, from which we assessed cervical and chin SAT-areas; Participants (age = 48 years; 90% men; body-mass-index = 30.9 kg/m²) had an 18-month adherence-rate of 86%. Cervical-SAT and chin-SAT decreased after 6-months (-13.1% and -5.3%, respectively, p < 0.001). After 18-months only cervical-SAT remained decreased compared to baseline (-5%, p < 0.001). Cervical and chin-SAT 18-month changes were associated with changes in weight (r = 0.70, r = 0.66 respectively; <0.001 for both) and visceral-adipose-tissue (VAT; r = 0.35, r = 0.42 respectively; <0.001 for both). After adjustment to VAT, waist-circumference, or weight-changes, chin-SAT 18-month reduction was associated with favorable changes in fasting-glucose (β = 0.10; p = 0.05), HbA1c (β = 0.12; p = 0.03), and homeostasis-model-assessment-of-insulin-resistance (β = 0.12; p = 0.03). Cervical-SAT 18-month reduction was associated with decreased triglycerides (β = 0.16; p = 0.02) and leptin (β = 0.19; p = 0.01) independent of VAT; Cervical and chin-SATs are dynamic fat depots that correspond with weight-loss and are associated with changes in cardiometabolic profile. In long-term, chin-SAT displays a larger rebound compared with cervical-SAT. Chin-SAT accumulation is associated with in insulin-resistance, independent of central obesity. (ClinicalTrials identifier NCT01530724).

A review on interplay between obesity, lipoprotein profile and nutrigenetics with selected candidate marker genes of type 2 diabetes mellitus

BACKGROUND

Type 2 diabetes mellitus, a rapidly growing epidemic, and its frequently related complications demand global attention. The two factors commonly attributed to the epidemic are genetic factors and environmental factors. Studies indicate that the genetic makeup at an individual level and the environmental aspects influence the occurrence of the disease. However, there is insufficiency in understanding the mechanisms through which the gene mutations and environmental components individually lead to T2DM. Also, discrepancies have often been noted in the association of gene variants and type 2 diabetes when the gene factor is examined as a sole attribute to the disease.

STUDY

In this review initially, we have focused on the proposed ways through which CAPN10, FABP2, GLUT2, TCF7L2, and ENPP1 variants lead to T2DM along with the inconsistencies observed in the gene-disease association. The article also emphasizes on obesity, lipoprotein profile, and nutrition as environmental factors and how they lead to T2DM. Finally, the main objective is explored, the environment-gene-disease association i.e. the influence of each environmental factor on the aforementioned specific gene-T2DM relationship to understand if the disease-causing capability of the gene variants is exacerbated by environmental influences.

CONCLUSION

We found that environmental factors may influence the gene-disease relationship. Reciprocally, the genetic factors may alter the environment-disease relationship. To precisely conclude that the two factors act synergistically to lead to T2DM, more attention has to be paid to the combined influence of the genetic variants and environmental factors on T2DM occurrence instead of studying the influence of the factors separately.

Neck Circumference and Cerebral Gray Matter Volume

BACKGROUND

While obesity is linked with brain atrophy and dementia incidence, associations with regional adiposity are uncertain. Our goal was to determine whether cerebral gray matter volume is related to neck circumference (NC), a measure of regional adiposity having unique relationships with metabolic disorders and cardiovascular disease.

METHODS

Magnetic resonance imaging and NC were cross-sectionally assessed from 2011 to 2014 in a population-based sample of 2916 men and women in the Korean Genome and Epidemiology Study.

RESULTS

For men, NC was inversely associated with total and regional gray matter in the frontal, temporal, and occipital lobes after adjusting for age and intracranial brain volume. Associations were especially strong in the presence of diabetes. With further adjustment for indices of body composition and other characteristics, total and frontal gray matter in diabetic men were lowered by 6.1 mL (95% confidence interval: 2.5-9.7, P=0.004) and 2.9 mL (95% confidence interval: 1.0-4.9, P=0.017), respectively, per SD increase in NC (2.3 cm). For men without diabetes, and in all women, associations were less apparent.

CONCLUSIONS

In men with diabetes, NC was inversely associated with cerebral gray matter volume. The link between neck anthropometry and brain aging in diabetic men warrants further consideration.

Association between neck circumference and lipid profile: a systematic review and meta-analysis of observational studies

AIMS

Previous studies suggested that neck circumference (NC) as a new, simple, and valuable tool for the measuring obesity. However, the results of studies regarding the relationship between blood lipids and neck circumference were inconsistent. Therefore, we aimed to perform a systematic review and meta-analysis to summarize the association between NC and lipid profiles in adults.

METHODS AND RESULTS

PubMed and Scopus electronic databases were searched until 30 June 2018 to find articles that reported the association between NC and blood lipids. Mean serum lipids and variables contributed to heterogeneity were extracted. Sources of inter-study heterogeneity were determined by subgroup analysis. Of 2490 publications identified, 33 studies were included in the qualitative and quantitative synthesis. We found an inverse correlation between NC and high-density lipoprotein cholesterol [HDL-C; overall Fisher's Z = -0.18; 95% confidence interval (CI): -0.21, -0.15]. Furthermore, we found positive associations between NC and total cholesterol (TC; overall Fisher's Z = 0.11; 95% CI = 0.06, 0.16), low-density lipoprotein cholesterol (LDL-C; overall Fisher's Z = 0.1; 95% CI = -0.04, 0.16), and triglyceride (TG; overall Fisher's Z = 0.21; 95% CI = 0.17, 0.25) in men. Neck circumference was directly correlated to TC (overall Fisher's Z = 0.1; 95% CI = 0.01, 0.19) and LDL-C (overall Fisher's Z = 0.16; 95% CI = 0.12, 0.20) in healthy and unhealthy women, respectively. There was no correlation between NC and serum concentration of TC (overall Fisher's Z = 0.01; 95% CI = -0.02, 0.03) and LDL-C (overall Fisher's Z = 0.09; 95% CI = 0.02, 0.16) in unhealthy and healthy women, respectively.

CONCLUSION

Higher NC in unhealthy men was strongly indirectly associated with HDL-C, and directly related to LDL-C, TG, and TC. In unhealthy women, higher NC was inversely associated with HDL and directly related to LDL-C.

Higher Leptin-to-Adiponectin Ratio Strengthens the Association Between Body Measurements and Occurrence of Type 2 Diabetes Mellitus

Aim: This case-control study aimed to investigate the interrelations of body measurements and selected biomarkers in type 2 diabetes mellitus (T2DM). Methods: We recruited 98 patients with T2DM and 98 controls from 2016 to 2018 in Taiwan. Body measurements were obtained using a three-dimensional body surface scanning system. Four biomarkers related to insulin resistance, adipokines, and inflammation were assayed. A multiple logistic regression model was used to perform multivariable analyses. Results: Four body measurements, namely waist circumference (odds ratio, OR = 1.073; 95% confidence interval, CI = 1.017-1.133), forearm circumference (OR = 1.227; 95% CI = 1.002-1.501), thigh circumference (OR = 0.841; 95% CI = 0.73-0.969), and calf circumference (OR = 1.25; 95% CI = 1.076-1.451), were significantly associated with T2DM. Leptin (OR = 1.09; 95% CI = 1.036-1.146) and adiponectin (OR = 0.982; 95% CI = 0.967-0.997) were significantly associated with T2DM. Six body measurement combinations, namely body mass index, waist-to-hip ratio, waist-to-height ratio, waist-to-thigh ratio, forearm-to-thigh ratio, and calf-to-thigh ratio (CTR), were significantly associated with T2DM. CTR had the strongest linear association with T2DM. Moderating effects of significant biomarkers, namely leptin and adiponectin, were observed. Participants with high leptin-to-adiponectin ratios and in the fourth CTR quartile were 162.2 times more prone to develop T2DM. Conclusions: We concluded that a combination of leptin and adiponectin modulated the strength of the association between body measurements and T2DM while providing clues for high-risk group identification and mechanistic conjectures of preventing T2DM.

Neck Circumference and Incidence of Type 2 Diabetes in Chinese Elderly Individuals: A Community-Based Cohort Study

INTRODUCTION

This study aimed to investigate whether neck circumference (NC) was associated with the incidence of type 2 diabetes in Chinese elderly individuals.

METHODS

A community-based cohort study was conducted on elderly inhabitants in Shanghai with a mean age of 71.0 ± 5.8 years (n = 2,646). Binary logistic regression analysis was performed to evaluate the association between NC and the prevalence of type 2 diabetes, while a Cox regression model was used to determine the association between NC and the incidence of type 2 diabetes after a follow-up of 2 years.

RESULTS

Logistic regression analysis showed that a larger NC was significantly associated with an increased risk for type 2 diabetes in men (odds ratio [OR] 1.18, 95% confidence interval [CI] 1.07-1.31; p = 0.001) and women (OR 1.25, 95% CI 1.13-1.38; p < 0.001). Cox regression analysis revealed that NC was independently associated with the incidence of type 2 diabetes in both men (hazard ratio [HR] 1.14, 95% CI 1.05-1.23; p = 0.002) and women (HR 1.18, 95% CI 1.10-1.27; p < 0.001).

CONCLUSIONS

A larger NC was associated with a higher risk of developing type 2 diabetes in Chinese elderly individuals. However, studies with larger sample sizes and longer follow-up durations are needed to definitively determine the relationship between NC and the risk of developing type 2 diabetes.

Neck circumference as reliable predictor of mechanical ventilation support in adult inpatients with COVID-19: A multicentric prospective evaluation

AIMS

COVID-19 is especially severe for elderly subjects with cardiometabolic and respiratory comorbidities. Neck circumference (NC) has been shown to be strongly related to cardiometabolic and respiratory illnesses even after adjustment for body mass index (BMI). We performed a prospective study to investigate the potential of NC to predict the need for invasive mechanical ventilation (IMV) in adult COVID-19 inpatients.

MATERIALS AND METHODS

We prospectively and consecutively enrolled COVID-19 adult patients admitted to dedicated medical wards of two Italian hospitals from 25 March to 7 April 2020. On admission, clinical, biochemical and anthropometric data, including BMI and NC were collected. As primary outcome measure, the maximum respiratory support received was evaluated. Follow-up time was 30 days from hospital admission.

RESULTS

We enrolled 132 subjects (55.0-75.8 years, 32% female). During the study period, 26 (19.7%) patients underwent IMV. In multivariable logistic regression analyses, after adjusting for age, sex, diabetes, hypertension and COPD, NC resulted independently and significantly associated with IMV risk (adjusted OR 1.260-per 1 cm increase 95% CI:1.120-1.417; P < .001), with a stronger association in the subgroup with BMI ≤30 Kg/m² (adjusted OR 1.526; 95% CI:1.243-1.874; P < .001). NC showed a good discrimination power in predicting patients requiring IMV (AUC 0.783; 95% CI:0.684-0.882; P < .001). In particular, NC > 40.5 cm (>37.5 for females and >42.5 for males) showed a higher and earlier IMV risk compared to subjects with lower NC (Log-rank test: P < .001).

CONCLUSIONS

NC is an easy to measure parameter able to predict the need for IMV in adult COVID-19 inpatients.

Neck Circumference and 10-Year Cardiovascular Risk at the Baseline of the ELSA-Brasil Study: Difference by Sex

Fundamento:

A circunferência do pescoço (CP) é uma medida indireta do tecido adiposo subcutâneo da parte superior do corpo, apontada como um preditor independente de doenças cardiometabólicas.

Objetivos:

Verificar a associação entre a CP e o risco cardiovascular em 10 anos (risco de doença cardiovascular [DCV] em 10 anos) em homens e mulheres separadamente.

Métodos:

Análise seccional com inclusão de 13.920 participantes da linha de base do Estudo Longitudinal da Saúde do Adulto (ELSA-Brasil). A associação entre a CP (utilizada como variável contínua e agregada em quartis) e o risco de DCV em 10 anos, estimado pelo Framingham Global Risk Score (FGRS), foi investigada por meio de modelos lineares generalizados após ajustes por características sociodemográficas, comportamentos em saúde, índice de massa corporal e circunferência da cintura. O nível de significância estatístico adotado foi de 5%.

Resultados:

A média da CP foi de 39,5 cm (desvio-padrão [DP] de ± 3,6) nos homens e 34,0 cm (DP de ±2,9) nas mulheres. Após ajustes, o aumento de 1 cm na CP foi associado ao incremento de 3% (IC 95%: 1,02 a 1,03) e 5% (IC 95%: 1,04 a 1,06) na média aritmética do risco de DCV em homens e mulheres, respectivamente. No último quartil da CP, homens e mulheres apresentaram um incremento de 18% (IC 95%: 1,13 a 1,24) e 35% (IC 95%: 1,28 a 1,43), respectivamente, na média aritmética do risco de DCV após ajustes.

Conclusões:

Verificamos associação positiva e independente entre a CP e o risco de DCV em 10 anos. Resultados sugerem que a CP pode contribuir para a predição de risco cardiovascular além daquele observado pelas medidas antropométricas clássicas.

Interplay between rotational work shift and high altitude-related chronic intermittent hypobaric hypoxia on cardiovascular health and sleep quality in Chilean miners

Mining activities expose workers to diverse working conditions, rotational shifts and high altitude-related hypobaric hypoxia. Separately, each condition has been reported having a negative impact on miners' health risk; however, the combination of both stressors has been poorly explored. The present study aimed to analyse the effects of exposure to rotational work shift (RWS) alone or in combination with high altitude-related chronic intermittent hypobaric hypoxia (CIHH) on cardiometabolic, physical activity and sleep quality related markers in copper miners from Los Pelambres mine in Chile. One hundred and eleven male miners working in RWS with or without CIHH were included. Anthropometrics measures, sleep quality assessment, physical activity level (PAL) and handgrip strength were evaluated. Exposure to CIHH exacerbated the detrimental effects of RWS as miners exposed to the combination of RWS and CIHH where more obese and had a wider neck circumference, reduced PAL at work and worsened sleep quality. Practitioner summary: The purpose was to assess cardiometabolic health and sleep quality markers associated with the combined effects of rotational shift work and high altitude-related intermittent hypobaric hypoxia in miners. Findings showed a wider neck circumference, lower physical activity level and higher prevalence of poor sleep quality in exposed miners. Abbreviations: ANOVA: analysis of variance; BM: body mass; BMI: body mass index; CI: confidence intervals; CIHH: chronic intermittent hypobaric hypoxia; CV: cardiovascular; CVR: cardiovascular risk; HA: high altitude; HACE: high-altitude cerebral edema; HGS: handgrip strength; IPAQ-SF: International Physical Activity Questionnaire - Short Form; LSD: Fisher's least standardized difference; MANCOVA: multivariate general lineal model; MET: metabolic equivalent; PAL: physical activity level; PSQI: Pittsburg sleep quality index; RWS: rotational work shift; WHR: waist-to-hip ratio.

Influencing factors for peripheral and posterior lesions in mild non-proliferative diabetic retinopathy-the Kailuan Eye Study

AIM

To explore the influencing factors of diabetes type 2 patients with mild non-proliferative diabetic retinopathy (NPDR) in the Kailuan area of Tangshan, Hebei Province, China.

METHODS

In this non-interventional, retrospective study, 683 patients with type 2 diabetes were included in the Kailuan Diabetic Retinopathy Study involving participants with diabetes in the community-based longitudinal Kailuan Study. Based on the undilated ultra-wide field (200°; UWF) images and partial dilated digital fundus images, the diabetic retinopathy (DR) of the surveyed population was graded. Interobserver agreement was estimated by using Cohen's Kappa statistics. The main outcome indicators included gender, age, weight, height, body mass index, blood pressure, circumferences of neck, waist and hip, current smoking, levels of fasting plasma glucose (FPG), hypersensitive C-reactive protein, creatinine, and cholesterol, etc. According to different lesions' locations of patients with mild NPDR, logistic regression models were used to estimate the odds ratios (ORs) and their 95%CIs of each risk factor.

RESULTS

The study group of 683 patients included 570 males and 113 females. The mean age of the patients was 62.18±9.41y. Compared with dilated fundus examinations, there was fair agreement with the level of DR identified on UWF images in 63.91% of eyes (k=0.369, 95%CI, 0.00-0.00). Detected by UWF images, there were 98 patients with mild NPDR having peripheral retinal lesions, 35 patients with mild NPDR having posterior lesions, 44 patients with mild NPDR whose lesions were detected both in and out the standard two fields area, and 336 patients with non obvious DR. Parameters that conferred a statistically significant increased risks for mild NPDR with having peripheral retinal lesions were neck circumstance (OR, 1.124; 95%CI, 1.044-1.211), and with posterior lesions were FPG (OR, 1.052; 95%CI, 1.007-1.099).

CONCLUSION

UWF is an effectiveness means of DR screening. Moreover, it is necessary to evaluate peripheral diabetic retinal lesions which can help to estimate the severity of DR. The phenomenon that nonuniform and inhomogeneous distribution of DR lesions has been found. And the influencing factors in mild NPDR are differing by different lesions' locations.

Association between neck circumference and cardiometabolic disease in Chinese adults: a community-based cross-sectional study

OBJECTIVES

Several studies have indicated that neck circumference (NC) was associated with cardiometabolic disease in some Western countries. However, there are limited data regarding this association among Chinese adults.

DESIGN

A community-based cross-sectional study.

SETTING

A multistage-stratified random cluster survey was conducted in Xixiang Street, Bao'an District of Shenzhen in southeast China.

PARTICIPANTS

This study included 4000 participants (1605 men and 2395 women) with a mean age of 56.0±9.8 years.

MAIN OUTCOME MEASURES

Categorical data were reported as percentage and continuous data were reported as mean±SD. Receiver operating characteristic analysis and logistic regression analysis were used to evaluate the association of NC with cardiometabolic disease.

RESULTS

The mean NC values were 35.50±4.23 cm for men and 32.32±3.59 cm for women. After adjusting for body mass index and waist circumference, NC was significantly associated with the risk of hypertension (OR: 1.42 in women), decreased high-density lipoprotein (HDL) levels (OR: 1.27 in men; OR: 1.12 in women), high triglyceride (TG) levels (OR: 1.54 in women) and diabetes (OR: 1.41 in men; OR: 1.37 in women). Among men, the optimal NC cut-off values were 38.10 cm for identifying hypertension, 32.32 cm for decreased HDL levels, 36.6 cm for high TG levels and 36.6 cm for diabetes. Among women, the optimal NC cut-off values were 32.35 cm for identifying hypertension, 33.40 cm for decreased HDL levels, 32.90 cm for high TG levels and 33.40 cm for diabetes.

CONCLUSIONS

NC was significantly associated with cardiometabolic disease in Chinese population. Although further studies are needed to confirm the optimal cut-off values, evaluating NC may be useful for predicting cardiometabolic disease risk during clinical assessments.

Prevalence of Metabolic Syndrome in Overweight and Obese Patients and Their Measurement of Neck Circumference: A Cross-sectional Study

Background The utilization of neck circumference (NC) as a valuable tool to evaluate metabolic syndrome (MetS) is still unclear. MetS has been extensively reported worldwide mainly due to the increasing trend of central obesity and the risk of developing coronary artery disease. In Pakistan, its incidence is reported to be between 18% and 49% among the urban population. Methods This cross-sectional study was conducted at the Indus Hospital, Karachi, Pakistan; in total, 392 patients (body mass index [BMI] >23 kg/m², age ≥18 years, both genders) were recruited through consecutive sampling, and informed consent was obtained. Results The majority of patients were females (n = 344, 87.8%), and the mean ± SD of age and NC of all patients was 50.5 ± 9.6 years and 38 ± 4.6 cm, respectively. The majority (n = 375, 95.7%) of patients were found to have MetS, with 90% of both males and females having NC ≥38 cm and 34 cm, respectively. Conclusion The prevalence of MetS was found to be very high in overweight and obese patients. Moreover, the majority of patients with MetS were found to have higher NC.

Evaluation of neck circumference as an easy and reliable predictor for non-alcoholic fatty liver disease

BACKGROUND/AIMS

The aim of the present study was to investigate the relationship between non-alcoholic fatty liver disease (NAFLD) and neck circumference (NC) and to compare the NC predictive value with other anthropometric indices in the prediction of NAFLD and metabolic syndrome (MetS) as well as to find the NC cut-off point for the prediction of NAFLD and MetS in an Iranian population.

MATERIALS AND METHODS

A total of 590 individuals who fulfilled our criteria were enrolled in the study. Anthropometric measurements, physical examinations, and abdominal ultrasonography were performed by trained staff. Blood samples for biochemical tests were also obtained after fasting for 12 h.

RESULTS

Neck circumference was associated with NAFLD and MetS in both genders (p<0.0001) and remained significant even after adjustment for possible confounding factors. It was also significantly associated with other anthropometric indices, such as fatty liver severity, aspartate aminotransferase, alanine aminotransferase, fasting blood sugar, triglycerides, low-density lipoprotein, systolic and diastolic blood pressure, and family history of diabetes in both sexes (p<0.05). There was a significant negative correlation between high-density lipoprotein levels and NC in both sexes (p<0.001).

CONCLUSION

Neck circumference was significantly correlated with NAFLD and MetS. In addition, it had the highest predictive value for NAFLD and MetS among other common anthropometric indices. Therefore, it can be used as a simple and feasible tool for screening NAFLD in a large population.

Neck Circumference as an Anthropometric Indicator of Central Obesity in Patients with Prediabetes: A Cross-Sectional Study

Measurement of waist circumference has substantial variability and some limitations, while neck circumference is a simple and reliable anthropometric measure. This study aimed to assess the association between neck circumference and waist circumference and to identify the best cutoff of neck circumference that could predict central obesity in prediabetic patients. This cross-sectional study included adult patients with prediabetes, defined as having fasting plasma glucose levels ranging from 100 to 125 mg/dL or HbA1c ranging from 5.7 to 6.49%, who visited the outpatient clinic of Family Medicine Department, Ramathibodi Hospital, Thailand, during October 2014 and March 2016. Neck circumference was measured from the level just below the laryngeal prominence perpendicular to the long axis of the neck. Central obesity was defined as having waist circumference measurements greater than 90 and 80 cm for males and females, respectively. The correlation between neck circumference and waist circumference was explored by applying pairwise correlation coefficient. Receiver operating characteristic (ROC) curve analysis was performed and Youden index equal to "sensitivity - (1-specificity)" was calculated. Neck circumference that yielded the maximum Youden index was determined as the optimal cutoff point for prediction of central obesity. There were 1,534 patients eligible for this study. After adjusting for covariables, neck circumference was found to be significantly associated with waist circumference in both females and males, with β-coefficients of 1.01 (95% CI: 0.83, 1.20) and 0.65 (95% CI: 0.46, 0.85), respectively. After applying the ROC analysis, neck circumferences ≥ 32 cm in females and ≥ 38 cm in males were determined as the best cutoff values to predict central obesity. Neck circumference is strongly correlated with waist circumference in prediabetics and should be considered as an alternative to the waist circumference measurement in screening for central obesity.

Discriminatory ability of anthropometric measurements of central fat distribution for prediction of post-prandial hyperglycaemia in patients with normal fasting glucose: the DICAMANO Study

Background and aims

Obesity is associated with impaired glucose tolerance which is a risk factor for cardiovascular risk. However, the oral glucose tolerance test (OGTT) is not usually performed in patients with normal fasting glycaemia, thus offering false reassurance to patients with overweight or obesity who may have post-prandial hyperglycaemia. As an alternative to resource demanding OGTTs, we aimed to examine the predictive value of anthropometric measures of total and central fat distribution for post-prandial hyperglycaemia in patients with overweight and obesity with normal fasting glycaemia enrolled in the DICAMANO study.

Methods

We studied 447 subjects with overweight/obesity with a fasting glucose value ≤ 5.5 mmol l⁻¹ (99 mg dl⁻¹) and BMI ≥ 25 kg/m² who underwent a 75-g OGTT. Post-prandial hyperglycaemia was defined as a glucose level ≥ 7.8 mmol l⁻¹ (140 mg dl⁻¹) 2-h after the OGTT. The anthropometric measurements included body mass index, body adiposity index, waist circumference, neck circumference, waist-to-hip ratio and waist-to-height ratio.

Results

The prevalence of post-prandial hyperglycaemia was 26%. Mean 1-h OGTT glucose levels, insulin resistance and beta cell dysfunction was higher in those subjects in the highest tertile for each anthropometric measurement, irrespective of fasting glucose level. Central fat depot anthropometric measurements were strongly and independently associated with an increased risk of post-prandial hyperglycaemia. After multivariable-adjustment for fasting plasma glucose level, smoking, and physical activity level, the odds ratio (95% confidence intervals) for the presence of post-prandial hyperglycaemia for neck circumference, waist circumference and waist-to-height ratio were 3.3 (1.4, 7.7), 2.4 (1.4, 4.4) and 2.5 (1.4, 4.5), respectively.

Conclusions

In this large and comprehensively phenotyped cohort, one in four subjects had post-prandial hyperglycaemia despite normal fasting glycaemia. Anthropometric indices of central fat distribution were strongly and independently associated with an increased risk of post-prandial hyperglycaemia. These results support the association between central adiposity and glucose derangements and demonstrate the clinical usefulness of anthropometric measurements as screening tools for the selection of patients who are most likely to benefit from an OGTT.

Trial registration ClinicalTrials.gov Identifier: NCT03506581. Registered 24 April 2018—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03506581

Electronic supplementary material

The online version of this article (10.1186/s12967-019-1787-5) contains supplementary material, which is available to authorized users.

Waist, neck circumferences, waist-to-hip ratio: Which is the best cardiometabolic risk marker in women with severe obesity? The SOON cohort

A centralized deposit of adiposity increases the risk of cardiometabolic diseases. Several anthropometric markers can be used to characterize fat distribution. In the case of severe obesity, several markers, such as hip and waist circumference, are prone to measurement error. Conversely, neck circumference is easy to obtain. The aim was to determine the best surrogate marker of obesity-related cardiometabolic diseases from: body mass index (BMI), waist, hip and neck circumferences and waist-to-hip ratio.

Predicting Type 2 Diabetes Mellitus Occurrence Using Three-Dimensional Anthropometric Body Surface Scanning Measurements: A Prospective Cohort Study

BACKGROUND

An accurate and comprehensive anthropometric measure for predicting type 2 diabetes mellitus (T2DM) has not yet been depicted.

METHODS

A total of 8450 nondiabetic participants were recruited during 2000-2010 in Taiwan. The cohort was followed up to the end of 2013, over an average of 8.87 years. At recruitment, participants completed a questionnaire related to basic demographics, lifestyle variables, personal disease history, and family disease history. 3D body surface scanning was used to obtain 35 anatomical measurements. A Cox proportional hazard model was used to conduct multivariable analyses.

RESULTS

A total of 2068 T2DM cases at an incidence rate of 27.59 × 10-3 (year-1) were identified during the follow-up period. Multivariable-adjusted hazard ratios (HRs) demonstrated that neck circumference (NC) (HR = 1.048; 95% CI = 1.033-1.064), waist width (WW) (HR = 1.061; 95% CI = 1.040-1.081), and left thigh circumference (TC) (HR = 0.984; 95% CI = 0.972-0.995) were significant predictors of the occurrence of T2DM. While dividing body measurement into median high/low groups, an increased risk of T2DM was observed among participants with a larger NC and smaller TC (HR = 1.375; 95% CI = 1.180-1.601) and a larger WW and smaller TC (HR = 1.278; 95% CI = 1.085-1.505) relative to other participants.

CONCLUSIONS

This study suggests that as well as using traditional waist and TC measurements, NC can be used as an indicator to provide an early prediction of developing T2DM, while providing clues for future mechanistic investigations of T2DM.

The association of neck circumference with incident congestive heart failure and coronary heart disease mortality in a community-based population with or without sleep-disordered breathing

Background

Neck circumference (NC), representing upper body subcutaneous adipose tissue, may be correlated with increased risk of overweight/obesity, obstructive sleep apnoea, and metabolic and cardiovascular disease. However, the relationship between NC and the incidence of congestive heart failure (CHF) or mortality due to coronary heart disease (CHD) in a community-based population with and without sleep-disordered breathing (SDB) has not yet been clarified.

Methods

We performed a prospective study using the Sleep Heart Health Study (SHHS) cohort. Cox proportional hazards regression models were used to estimate the association of different levels of NC with CHF incidence or CHD mortality in 2234 individuals with SDB and 2199 without SDB, respectively.

Results

After adjusting for age, sex, and body mass index (BMI), NC was significantly associated with CHF when comparing the highest NC quartile group with the lowest (hazard ratio, HR, 2.265, 95% confidence interval, CI, 1.074–4.777) in the non-SDB population. This association diminished after further adjustment for other risk factors, but remained statistically significant, with an adjusted HR of 1.082 (95% CI 1.003–1.166) per unit increase in NC. Additionally, after adjustment for age, sex, and BMI, NC was also shown to be remarkably associated with CHD mortality (HR 1.141, 95% CI 1.014–1.282) per unit increase in NC in the non-SDB population but not in the SDB population. After adjustment for all the covariates, there was a significant association between NC and CHD death in those without SDB, with an adjusted HR of 1.134 (95% CI 1.001–1.284) per unit increase in NC.

Conclusions

NC may correlate with CHF incidence and CHD mortality in population without SDB. NC measurement may help risk stratification for cardiovascular diseases.

Trial registration

NCT00005275, January 1994.

Electronic supplementary material

The online version of this article (10.1186/s12872-018-0846-9) contains supplementary material, which is available to authorized users.

Albuminuria and neck circumference are determinate factors of successful accurate estimation of glomerular filtration rate in high cardiovascular risk patients

Background

Estimated glomerular filtration rate (eGFR) is used for diagnosis of chronic kidney disease (CKD). The eGFR models based on serum creatinine or cystatin C are used more in clinical practice. Albuminuria and neck circumference are associated with CKD and may have correlations with eGFR.

Aim

We explored the correlations and modelling formulates among various indicators such as serum creatinine, cystatin C, albuminuria, and neck circumference for eGFR.

Design

Cross-sectional study.

Methods

We reviewed the records of patients with high cardiovascular risk from 2010 to 2011 in Taiwan. 24-hour urine creatinine clearance was used as the standard. We utilized a decision tree to select for variables and adopted a stepwise regression method to generate five models. Model 1 was based on only serum creatinine and was adjusted for age and gender. Model 2 added serum cystatin C, models 3 and 4 added albuminuria and neck circumference, respectively. Model 5 simultaneously added both albuminuria and neck circumference.

Results

Total 177 patients were recruited in this study. In model 1, the bias was 2.01 and its precision was 14.04. In model 2, the bias was reduced to 1.86 with a precision of 13.48. The bias of model 3 was 1.49 with a precision of 12.89, and the bias for model 4 was 1.74 with a precision of 12.97. In model 5, the bias could be lower to 1.40 with a precision of 12.53.

Conclusions

In this study, the predicting ability of eGFR was improved after the addition of serum cystatin C compared to serum creatinine alone. The bias was more significantly reduced by the calculation of albuminuria. Furthermore, the model generated by combined albuminuria and neck circumference could provide the best eGFR predictions among these five eGFR models. Neck circumference can be investigated potentially in the further studies.

Neck circumference and its association with cardiometabolic risk factors: a systematic review and meta-analysis

BACKGROUND

Recently, neck circumference (NC) has been used to predict the risk of cardiometabolic factors. This study aimed to perform a systematic review and meta-analysis to examine: (i) the sensitivity (SE) and specificity (SP) of NC to predict cardiometabolic risk factors and (ii) the association between NC and the risk of cardiometabolic parameters.

METHODS

A systematic search was conducted through PubMed/Medline, Institute of Scientific Information, and Scopus, until 2017 based on the search terms of metabolic syndrome (MetS) and cardio metabolic risk factors. Random-effect model was used to perform a meta-analysis and estimate the pooled SE, SP and correlation coefficient (CC).

RESULTS

A total of 41 full texts were selected for systematic review. The pooled SE of greater NC to predict MetS was 65% (95% CI 58, 72) and 77% (95% CI 55, 99) in adult and children, respectively. Additionally, the pooled SP was 66% (95% CI 60, 72) and 66% (95% CI 48, 84) in adult and children, respectively. According to the results of meta-analysis in adults, NC had a positive and significant correlation with fasting blood sugar (FBS) (CC: 0.16, 95% CI 0.13, 0.20), HOMA-IR (0.38, 95% CI 0.25, 0.50), total cholesterol (TC) (0.07 95% CI 0.02, 0.12), triglyceride (TG) concentrations (0.23, 95% CI 0.19, 0.28) and low density lipoprotein cholesterol (LDL-C) (0.14, 95% CI 0.07, 0.22). Among children, NC was positively associated with FBS (CC: 0.12, 95% CI 0.07, 0.16), TG (CC: 0.21, 95% CI 0.17, 0.25), and TC concentrations (CC: 0.07, 95% CI 0.02, 0.12). However, it was not significant for LDL-C.

CONCLUSION

NC has a good predictive value to identify some cardiometabolic risk factors. There was a positive association between high NC and most cardiometabolic risk factors. However due to high heterogeneity, findings should be declared with caution.

Neck circumference as a risk factor of screen-detected diabetes mellitus: community-based study

BACKGROUND

Whereas an increase of neck circumference (NC) had been recently identified as a new independent cardiovascular disease (CVD) and metabolic syndrome risk factor, similar assessments concerning screen-detected diabetes mellitus (SDDM) have not been made. Thyroid gland volume (ThV) can potentially affect NC however the significance of this influence concerning the risk of NC-related disease is unknown.

METHODS

We performed a ThV-adjusted evaluation of NC within a population-based investigation of SDDM and impaired glucose regulation (IGR) prevalence. This study contains fasting plasma glucose (FPG) and 75 g 2-h glucose tolerance test results (2-hPG) of 196 residents of Kyiv region, Ukraine, randomly selected from the rural population older than 44 y.o. who were not registered as diabetes mellitus patients. Standard anthropometric (height; weight; blood pressure; waist, hip circumferences), NC and ultrasonography ThV measurements were performed, hypotensive medication, CVD events and early life nutrition history considered. HbA1c was measured, if FPG/2-hPG reached 7.0/11.1 mmol/l respectively; HbA1c level 6.5 % was considered to be SDDM diagnostic; IGR if FPG/2-hPG reached 6.1/7.8 but less than 7.0/11.1 mmol/l respectively.

RESULTS

Neck circumference among women with normal FPG/2-hPG was 35 (33-36) cm, IGR 36 (34.5-38) cm, SDDM HbA1c < 6.5 % 42 (40-43) cm, HbA1c > 6.5 % 42.5 (40-44) cm, p < 0.001, and for men from the same groups 38.5 (36.5-41.5) cm; 39 (37-42) cm; 42 (40-43) cm; 42.5 (40-44) cm, p = 0.063; medians (QI-QIII). Gender-adjusted logistic regression OR for SDDM HbA1c > 6.5 % vs. normal FPG/2-hPG category depending of NC as a continued variable, equaled to 1.60 (95 % CI 1.27-2.02) per cm. Additional adjusting by ThV, body mass or waist/hip index, high blood pressure, acute CVD events, or starvation history did not significantly influence this risk.

CONCLUSION

Neck circumference is a new risk factor of SDDM that is independent from other indicators of adipose tissue distribution as well as from the ThV.