Is Neck Circumference As Reliable As Waist Circumference for Determining Metabolic Syndrome?

Accuracy of neck circumference in the diagnosis of overweight in children

OBJECTIVE

The objective of this study was to estimate the accuracy of measuring neck circumference as a diagnostic method for overweight in 10-year-old children.

METHODS

A cross-sectional diagnostic accuracy study was performed in 2019. The population was composed of 942 school children from the municipality of Palhoça, SC, Brazil. For each measurement of the neck circumference, sensitivity, specificity, positive and negative predictive values, likelihood ratio for a positive test, and accuracy were estimated using the receiver operator characteristic curve, with body mass index as a reference.

RESULTS

The estimated overall accuracy was 88.9%. For males, the accuracy was 90.1%, and for females, 88.5%. A 30.0 cm neck circumference had a sensitivity of 22.8%, a specificity of 95.4%, a positive predictive value of 76.6%, a negative predictive value of 65.3%, a likelihood ratio for a positive test of 5.0, and an accuracy of 66.7% for all students.

CONCLUSION

Neck circumference showed a global accuracy of 88.9% as a method for diagnosing overweight in 10-year-old children. Predictive values showed high values, mainly starting with a neck circumference of 30 cm.

Neck Circumference Cut-Off Points for Identifying Adiposity: Association with Chronic Metabolic Diseases in Older People

BACKGROUND

The leading cause of death in older people is cardiovascular diseases. Several studies have found that neck circumference (NC) is a simple anthropometric marker associated with adiposity. The aim of this study is to estimate and validate NC cut-off points as adiposity markers and analyze their association with cardiovascular and chronic metabolic diseases in older people.

METHODS

A cross-sectional study in 358 non-disabled, community-dwelling older people (71.7 ± 3.9 years) living in Santiago de Chile and participating in the HTSMayor study was conducted. Measurements of body composition and cardiovascular risks were evaluated. Receiver operating characteristic (ROC) curves and multiple logistic regression models were used to evaluate the association of NC with cardiovascular and chronic metabolic diseases. NC cut-off points were obtained to predict obesity, abdominal obesity, and adiposity.

RESULTS

The best performance values of neck circumference relative to obesity and adiposity were obtained with respect to abdominal obesity (40.6 cm in men and 34.2 cm in women). Higher NC values were associated with a higher area under the curve (AUC) for men and women (men: AUC = 0.84; women: AUC = 0.86). NC was significantly associated with a higher risk for diabetes mellitus (OR = 1.95), hypertension (OR = 2.42), acute myocardial infarction (OR = 4.36), and comorbidities (OR = 2.01), and a lower risk for sarcopenia (OR = 0.35).

CONCLUSIONS

This study shows that NC is a useful tool for detecting abdominal obesity, obesity, and adiposity in older people and that a higher NC increases the risk of chronic diseases.

Combined association of abdominal obesity and depressive symptoms with risk of type 2 diabetes: A cohort study

OBJECTIVE

To explore the combined effect of abdominal obesity and depressive symptoms on the risk to type 2 diabetes, while also assessing the potential influence of various glycemic states and gender on this combined relationship.

METHODS

Data is acquired from the China Health and Retirement Longitudinal Study, and 5949 participants were included for analysis. Participants were divided into four groups: neither have abdominal obesity nor depressive symptoms (AO-/DS-), only have depressive symptoms (AO-/DS+), only have abdominal obesity (AO+/DS-), and have both abdominal obesity and depressive symptoms (AO+/DS+). Stratified analyses differentiating the glycemic statuses and sex of the participants were also carried out.

RESULTS

After adjusting for the confounders, the AO-/DS+, AO+/DS- and AO+/DS+ phenotypes were all discovered to be risk factors for type 2 diabetes (OR = 1.38, 95%CI: 1.06-1.79; OR = 2.07, 95%CI: 1.63-2.63; OR = 2.38, 95%CI: 1.83-3.11, respectively) compared with the AO-/DS- phenotype in the overall population. In further stratified analyses, we arrived at the same conclusion for normoglycemic individuals, especially in females. For prediabetes and males, the AO+/DS- and AO+/DS+ phenotypes are risk factors for type 2 diabetes compared with the AO-/DS- phenotype, but not with AO-/DS+.

CONCLUSION

Regardless of glycemic status and sex, the coexistence of abdominal obesity and depressive symptoms were associated with an increased risk of type 2 diabetes. Depressive symptoms were independent risk factors for type 2 diabetes only in normoglycemic individuals and females.

Correlation Between Neck Circumference and Gestational Diabetes

Purpose

The objective of this study was to explore whether neck circumference can serve as an early predictor of the risk of Gestational Diabetes (GDM).

Patients and Methods

A total of 318 singleton pregnant women who underwent routine prenatal examinations at Qinhuangdao Maternal and Child Health Hospital from September 2017 to September 2020 were selected and categorized into the GDM group and the normal glucose tolerance group (NGT) based on the results of the oral glucose tolerance test (OGTT) conducted during the second trimester. The general information and laboratory test results were compared and analyzed. Inter-group comparison was conducted using the t-test, and multivariate logistic regression analysis was employed to analyze the independent risk factors of GDM. The predictive threshold of various indicators for GDM occurrence during pregnancy was determined using the subject's work curve.

Results

The GDM group exhibited significantly higher levels of pre-pregnancy weight, pre-pregnancy BMI, neck circumference, waist circumference, hip circumference, triglycerides (TG), uric acid (UA), TG/HDL-C ratio, and waist-hip ratio compared to the NGT group. Additionally, HDL cholesterol (HDL-C) levels were significantly lower in the GDM group, and blood glucose levels at each point of the OGTT were markedly higher compared to the NGT group (P<0.05). Multivariate logistic regression analysis revealed that neck circumference (OR=1.239, P<0.001) and early pregnancy TG (OR=1.842, P<0.001) were independent risk factors for GDM. The receiver operating characteristic analysis demonstrated that the optimal critical value of neck circumference for predicting GDM was 32.6 cm, with a sensitivity of 50% and specificity of 74.3%.

Conclusion

The neck circumference during early pregnancy was found to be related to GDM, and the predictive cutoff point of 32.6 cm for neck circumference could be employed as a simple index to predict GDM in early pregnancy.

Prevalence of the metabolic syndrome and associated factors among inpatients with severe mental illness in Botswana: a cross-sectional study

INTRODUCTION

The metabolic syndrome, a cluster of inter-related risk factors for cardiovascular diseases is highly prevalent among individuals with obesity and sedentary lifestyle. Chronic psychiatric disorders such as severe mental illness are associated with increased risk for cardiovascular diseases. We aimed to assess the prevalence and correlates of metabolic syndrome among inpatients with severe mental illness in a resource limited setting with high HIV prevalence.

METHODS

This was a cross-sectional study among adult inpatients at a referral psychiatric hospital in Botswana. We used convenience sampling to enrol participants available at the time of the study. The National Cholesterol Education Program Adult Treatment Panel-III (NCEP-ATP III) criteria was used to define the metabolic syndrome. Data were analysed using descriptive statistics as well as multiple logistic regression modelling.

RESULTS

A total of 137 participants were enrolled. Of these, 119 (87%) had complete data for the main analysis. The overall prevalence of metabolic syndrome was 22.6% (95% CI 15.9, 30.6) and did not differ significantly by gender or HIV status. Age was significantly associated with the risk of having the metabolic syndrome while gender, body mass index, HIV status, and days of moderate physical activity were not.

CONCLUSION

There was a moderately high prevalence of metabolic syndrome. Thus, the management of individuals with severe mental illness in resource limited settings should include assessment of cardiovascular risk and target modifiable risk factors in this population. Consideration for the patient's age should be made when rationalizing the limited resources available for assessing metabolic syndrome among patients with severe mental illness.

[Correlation of neck circumference with body mass index in preschool children]

OBJECTIVES

To study the correlation between neck circumference and body mass index and the value of neck circumference in identifying overweight and obesity in preschool children.

METHODS

The stratified cluster sampling method was used to recruit 3 719 children under 7 years from 10 kindergartens in Urumqi, China. General data were collected, and physical measurements were performed. A Pearson correlation analysis was used to evaluate the correlation between neck circumference and body mass index. The receiver operating characteristic (ROC) curve was used to assess the accuracy of neck circumference in identifying overweight/obesity. The Kappa consistency test was used to assess the consistency of neck circumference and body mass index in identifying overweight/obesity.

RESULTS

There was a positive correlation between neck circumference and body mass index in boys and girls of all ages (r≥0.50, P<0.001). According to body mass index as the criteria for overweight/obesity, the children were divided into an overweight/obesity group and a non-overweight/obesity group, and the analysis showed that the overweight/obesity group had a significantly larger neck circumference than the non-overweight/obesity group (P<0.001). The ROC curve analysis showed that neck circumference had an area under the ROC curve of >0.7 in identifying overweight/obesity for boys and girls. The Kappa consistency test showed that the neck circumference and body mass index had a Kappa value of >0.40 in identifying overweight/obesity in boys and girls of all ages.

CONCLUSIONS

Neck circumference is positively correlated to body mass index, and neck circumference can be used to identify overweight/obesity in preschool children.

Neck circumference may predict sarcopenia in Japanese older adults requiring long-term care

Several studies have established the advantage of using anthropometric measurements as indicators of sarcopenia. Nevertheless, no study has explored the association between sarcopenia and neck circumference. In this cross-sectional study, we examined the data of 90 older adults requiring long-term care to evaluate this association and establish cut-off points for individuals at risk of sarcopenia as defined by the Asian Working Group for Sarcopenia (AWGS) 2019. A significant association was found between sarcopenia and neck circumference using binomial logistic regression and receiver operating characteristic analyses. The optimal cut-off value for neck circumference associated with increased risk for sarcopenia among older adults was 32.8 cm for females and 38.0 cm for males. Given the potential of declining neck circumference as an anthropometric marker of sarcopenia, it has clinical applications in screening for sarcopenia in older adults requiring long-term care.

Neck circumference is independently associated with metabolic syndrome in women with polycystic ovary syndrome

Recent compelling evidence has shown that neck circumference (NC), as a reliable and convenient anthropometric index, has better predictive values of hyperuricemia and insulin resistance in women with polycystic ovary syndrome (PCOS) compared with traditional anthropometric measurements. Since both PCOS and metabolic syndrome (MetS) share similar characteristics and affect long-term health of women, we conducted this cross-sectional study to explore the correlation of NC with MetS and metabolic risk factors. Anthropometric parameters, blood pressure, glycemic and lipid profile of 633 PCOS and 2,172 non-PCOS women from January 2018 to June 2021 were analyzed. The results showed that the prevalence of MetS was 28.0% and 9.4% in PCOS and non-PCOS women, respectively. The prevalence of MetS, hypertention, obesity, central obesity, hyperglycemia and dyslipidaemia was also significantly higher in both PCOS and non-PCOS women with larger NC. Additionally, logistic regression analysis showed that PCOS women in the highest quartile of NC had the highest prevalence of MetS (RR = 9.94, 95%CI: 2.41-40.99) after adjusting for confounding factors, while the association between NC and MetS was much attenuated after adjusting for confounding factors in non-PCOS women. Furthermore, we also identified that the optimal NC cutoff value was 33 cm in PCOS women for the prediction of MetS. The potential mechanism could be attributed to the increased release of adipokines and excessive free fatty acids release from subcutaneous adipose tissue, which consequently precipitate the development of MetS. In conclusion, NC was found to be positively and independently correlated with the prevalence of MetS.

Garlic: A systematic review of the effects on cardiovascular diseases

Allium sativum (garlic) certainly is one of the oldest horticultural crops in the world and presents bioactive compounds that are related to the garlic's effects on human health. Several authors have shown beneficial effects on diabetes, hypertension, dyslipidemia, obesity, and cardiovascular diseases (CVD), which are among the most relevant causes of mortality in the world. The aim of this systematic review was to evaluate the effects of garlic in the risk factors of CVD and evaluate its economic importance. MEDLINE-PubMed, COCHRANE, EMBASE, and Google Scholar databases were searched. The included studies showed that the use of garlic can reduce blood pressure, waist circumference, body mass index, LDL-c, non-HDL-c, total cholesterol, triglycerides, and inflammatory markers. It also can increase the levels of HDL-c and can improve cardiovascular parameters such as coronary artery calcium, microcirculation, epicardial and periaortic adipose tissue, post occlusive reactive hyperemia, low attenuation plaque, carotid intima-media thickness; and carotid intima-media thickness. Due to these reasons, garlic can be considered in the prevention and treatment of CVD risk factors.

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.

Newly proposed insulin resistance indexes called TyG-NC and TyG-NHtR show efficacy in diagnosing the metabolic syndrome

PURPOSE

Obesity and insulin resistance are considered cardinal to the pathophysiology of metabolic syndrome. Several simple indexes of insulin resistance calculated from biochemical or anthropometric variables have been proposed. The study aimed to assess the diagnostic accuracy of indirect insulin resistance indicators in detecting metabolic syndrome in non-diabetic patients, including TG/HDLc, METS-IR, TyG, TyG-BMI, TyG-WC, TyG-WHtR, and new indicators TyG-NC (TyG-neck circumference) and TyG-NHtR (Tyg-neck circumference to height ratio).

METHODS

The diagnostic accuracy of eight insulin resistance indexes was assessed using the receiver operating characteristic curves (ROC curves) in 665 adult non-diabetic patients. Then, the analysis was performed after the division into groups with proper body mass index, overweight and obese.

RESULTS

All indexes achieved significant diagnostic accuracy, with the highest AUC (area under the curve) for TyG (0.888) and Tg/HDLc (0.874). The highest diagnostic performance in group with the proper body mass index was shown for TyG (0.909) and TyG-BMI (0.879). The highest accuracy in the group of overweight individuals was presented by TyG (0.884) and TG/HDLc (0.855). TG/HDLc and TyG showed the highest AUC (0.880 and 0.877, respectively) in the group with obesity. Both TyG-NC and TyG-NHtR reached significant areas under the curve, which makes them useful diagnostic tests in metabolic syndrome.

CONCLUSIONS

Indirect indices of insulin resistance, including proposed TyG-NC and TyG-NHtR, show an essential diagnostic value in diagnosing metabolic syndrome. TyG and TG/HDLc seem to be the most useful in the Caucasian population.