Neck circumference and future cardiovascular events in a high-risk population--A prospective cohort study

Correlation of neck circumference, coronary calcification severity and cardiovascular events in Chinese elderly patients with acute coronary syndromes

BACKGROUND AND AIMS

We aimed to investigate whether neck circumference (NC) can predict metabolic syndrome (MetS), coronary calcification and lesion, and major adverse cardiovascular events (MACEs).

METHODS

A total of 867 patients with acute coronary syndrome (ACS) over 60 years old from the Second Hospital of Shandong University, who had undergone coronary computed tomography, were randomly selected for a retrospective analysis. The subjects were divided into male and female groups, NC quartile 1-4 groups (Q1-Q4 groups), non-multivessel coronary disease (non-MVCD) and multi-vessel coronary disease (MVCD) groups.

RESULTS

After adjusting for potential confounders, NC was associated with risk factors promoting coronary artery disease (CAD) and coronary artery calcification score (CACS). The severity of CAD increased by 0.202 times and 0.372 times for each unit of NC in male and female groups, respectively. Compared with the lower CACS group, the risk of coronary calcification increased by 0.139 times, and MVCD increased 0.268 times, with each unit increase of NC. Except for all-cause death, there were significant differences between the Q1-Q4 groups in the prevalence of all primary endpoints, cardiogenic death, unexpected re-hospitalization of heart failure, ACS recurrence or unplanned revascularization, and non-fatal stroke (p log-rank <0.01). In view of the overall trend, with the increase of NC quartiles, the prevalence of MACEs gradually increased (all p < 0.01).

CONCLUSIONS

NC is closely associated with MetS and its components, coronary calcification and lesion degree, and MACEs. NC could be used as surrogate of CACS to predict the coronary condition and prognosis of elderly patients with ACS.

Cashew nut (Anacardium occidentale L.) and cashew nut oil reduce cardiovascular risk factors in adults on weight-loss treatment: a randomized controlled three-arm trial (Brazilian Nuts Study)

Introduction

Cashew nut contains bioactive compounds that modulate satiety and food intake, but its effects on body fat during energy restriction remains unknown. This study aimed to assess the effects of cashew nut and cashew nut oil on body fat (primary outcome) as well as adiposity, cardiometabolic and liver function markers (secondary outcomes).

Materials and methods

An eight-week (8-wk) randomized controlled-feeding study involved 68 adults with overweight/obesity (40 women, BMI: 33 ± 4 kg/m2). Participants were randomly assigned to one of the energy-restricted (-500 kcal/d) groups: control (CT, free-nuts), cashew nut (CN, 30 g/d), or cashew nut oil (OL, 30 mL/d). Body weight, body composition, and blood collection were assessed at the baseline and endpoint of the study.

Results

After 8-wk, all groups reduced significantly body fat (CT: -3.1 ± 2.8 kg; CN: -3.3 ± 2.7 kg; OL: -1.8 ± 2.6 kg), body weight (CT: -4.2 ± 3.8 kg; CN: -3.9 ± 3.1 kg; OL: -3.4 ± 2.4 kg), waist (CT: -5.1 ± 4.6 cm; CN: -3.9 ± 3.9 cm; OL: -3.7 ± 5.3 cm) and hip circumferences (CT: -2.9 ± 3.0 cm; CN: -2.7 ± 3.1 cm; OL: -2.9 ± 2.3 cm). CN-group reduced liver enzymes (AST: -3.1 ± 5.3 U/L; ALT: -6.0 ± 9.9 U/L), while the OL-group reduced LDL-c (-11.5 ± 21.8 mg/dL) and atherogenic index (-0.2 ± 0.5). Both intervention groups decreased neck circumference (CN: -1.0 ± 1.2 cm; OL: -0.5 ± 1.2 cm) and apo B (CN: -6.6 ± 10.7 mg/dL; OL: -7.0 ± 15.3 mg/dL).

Conclusion

After an 8-wk energy-restricted intervention, all groups reduced body fat (kg), weight, and some others adiposity indicators, with no different effect of cashew nut or cashew nut oil. However, participants in the intervention groups experienced additional reductions in atherogenic marker, liver function biomarkers, and cardiovascular risk factors (neck circumference and apo B levels), with these effects observed across the OL group, CN group, and both intervention groups, respectively.Clinical trial registration:https://ensaiosclinicos.gov.br/rg/RBR-8xzkyp2, identifier 8xzkyp2.

The association between physical activity and neck circumference with cardiovascular disease risk in older wheelchair users

OBJECTIVE

To examine the association between physical activity, neck circumference, and cardiovascular disease risk in older wheelchair users.

DESIGN

A cross-sectional study.

SUBJECTS/PATIENTS

Sixty-one Korean wheelchair users aged 50 years and older.

METHODS

Physical activity was assessed using a self-administered questionnaire. Neck circumference was measured with a tape ruler. Cardiovascular disease risk was evaluated by calculating the Framingham risk score (FRS) for estimating 10-year cardiovascular disease risk, which was classified as low-moderate (19% or less) or high risk (20% or more).

RESULTS

The FRS for 10-year cardiovascular disease risk was inversely related to physical activity (beta [SE] = -0.213 (0.103), p = 0.043) and positively related to neck circumference (beta [SE] = 1.331 ± 0.419, p = 0.003). Binary logistic regression showed that those with low physical activity (odds ratio [95% confidence interval] = 4.256 (1.188~15.243), p = 0.026) or a large neck circumference (odds ratio [95% confidence interval] = 3.645 (1.172~11.338), p = 0.025) had a higher risk for high cardiovascular disease risk compared with those with high physical activity or normal neck circumference.

CONCLUSION

The current study findings suggest that an intervention targeting physical inactivity and upper-body obesity should be implemented to reduce cardiovascular disease risk in older wheelchair users.

Neck circumference as an additional predictor of cardiovascular disease mortality: A multi-center prospective population-based study in northeastern China

BACKGROUND AND AIMS

This study aimed to assess the potential of neck circumference (NC) and neck-to-height ratio (NHR) as predictors of future cardiovascular disease (CVD) mortality in a general population from Northeastern China.

METHODS

A multi-center prospective study was conducted in Northeastern China, involving 18, 796 participants. The associations between NC or NHR and the incidence of overall CVD mortality, stroke mortality, and coronary heart disease (CHD) mortality were examined using multivariate Cox regression models. Hazard ratios (HRs) and the corresponding 95% confidence intervals (CIs) were calculated. Reclassification analyses were conducted to determine the incremental predictive value of NC or NHR.

RESULTS

NC was significantly associated with the risk of CVD mortality, independent of other anthropometric measurements for obesity. Individuals in the highest quartile of NC had a 1.83-fold (95% CI 1.29 to 2.61) and a 2.40-fold (95% CI 1.45 to 4.00) higher risk of overall CVD mortality and CHD mortality, respectively. Larger NC was significantly related to a heightened risk of ischemic stroke mortality, although no such association was observed with hemorrhagic stroke mortality. Furthermore, the risk of overall CVD mortality, stroke mortality, and CHD mortality increased by approximately 1.21 to 1.25 times per 1-SD change in NC. Similar findings were observed for NHR. The percentages of correct classification of overall CVD mortality improved by 12.1% and 16.3% after the addition of NC or NHR into established models, respectively.

CONCLUSIONS

NC and NHR might be promising predictors of CVD mortality, with higher values indicating greater risk.

Vitamin D Concentration Changes after Bariatric Surgery

Introduction

Bariatric surgery causes physiological and anatomical changes in the gastrointestinal tract that interfere with intestinal absorption and, consequently, with the nutritional status, especially about vitamin D. The aim of the study was to evaluate the vitamin D levels and body composition of these patients in the Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) types of surgery.

Methods

The retrospective cohort study included a population of 120 patients aged between 18 and 65 years, with class II or III obesity, undergoing bariatric surgery procedures (VSG or RYGB-type). Data were collected on the degree of obesity, age, average time since surgery, and gender. The individuals underwent a complete physical examination, measuring blood pressure, weight, height, waist, and neck circumference. In addition to calculating the percentage of loss of body weight and assessing body fat, the food frequency and physical activity of these patients were evaluated. Blood was collected, and the insulin variables, hydroxyvitamin D (25OHD), were analyzed.

Results

There was a significant difference between groups only for PTH, total BMD, and insulin variables. A significant intragroup difference was found in the variables' body mass index (BMI) and vitamin D for the vertical sleeve gastrectomy group and BMI for the RYGB group.

Conclusion

The analysis between the groups of procedures, similarity in body composition and postsurgical vitamin D levels, with significant differences only for PTH, BMD, and insulin variables, demonstrates that both procedures are effective in reducing fat mass.

Increased Neck Circumference and Increased Waist-Hip Ratio: Predictive Factors of Acute Myocardial Infarction

Background We hypothesize that neck circumference (NC) is a better predictor of acute myocardial infarction (AMI) compared to the waist-hip ratio (WHR) in patients presenting with acute coronary syndrome (ACS). The objective of this study is to investigate the association between NC and WHR with AMI and determine whether NC is a superior predictor of AMI in ACS patients compared to WHR. Methods This cross-sectional observational study was conducted in the Department of Cardiology at the Medical Teaching Institute, Lady Reading Hospital, Peshawar. The study lasted from February 20, 2018, to September 12, 2018. Patients having ACS who presented to the emergency department were enrolled via non-probability convenient sampling. Demographic data and baseline variables, including NC and WHR, were documented using a pre-designed pro forma. SPSS V.20 (IBM Corp, Armonk, NY) was used for data analysis. Continuous variables were expressed as mean ± standard deviation, while categorical variables were presented as frequencies and percentages. Chi-square tests were performed to determine the association between variables, and logistic regression models were used to measure odds ratios (ORs). Results In this study, 180 patients were included, with a mean age of 54.48±8.48 years and a male predominance of 51.5%. The results indicated a significant association between increased NC and WHR with AMI. The chi-square values for NC and WHR were 78.26 (p≤0.001) and 43.38 (p≤0.001), respectively. As NC increased from <37 cm to >38.5 cm, the OR for AMI increased from 0.46 to 4.51. Furthermore, the prevalence odds ratio (POR) of AMI increased by 2.185 times with an increase in WHR from 0.90. Conclusion Increased NC and increased WHR are statistically significantly associated and strong predictors of AMI in ACS patients. However, NC being more reliable, effective, and user-friendly should be the preferred measure.

Neck circumference for predicting the occurrence of future cardiovascular events: A 7.6-year longitudinal study

BACKGROUND & AIMS

This study aimed to investigate whether neck circumference (NC) could be used to predict future cardiovascular (CV) events in a community-based Chinese cohort.

METHODS AND RESULTS

We enrolled 1435 participants aged 50-80 years (men, 43.62%) from communities in Shanghai. High NC was defined as NC ≥ 38.5 cm in men and NC ≥ 34.5 cm in women. Kaplan-Meier analysis and Cox proportional hazards regression were performed to explore the association between NC and CV events. During a mean follow-up period of 7.6 years, 148 CV events (10.31%) occurred. The incidence of CV events was higher in men than in women (83 (13.26%) vs. 65 (8.03%), P = 0.002). Multivariable-adjusted Cox regression analysis showed that for every 1-SD increase in NC in the whole population, the hazard ratio (HR) of CV events was 1.45 (95% confidence interval [CI], 1.15-1.83). The dose-response association between NC and CV events was significant in men (HR, 1.37, 95% CI, 1.10-1.71) but not in women (HR, 1.19, 95% CI, 0.94-1.52). In comparison with participants showing low baseline NC, those with high baseline NC showed a significantly higher risk of CV events (HR, 1.59, 95% CI, 1.14-2.22). Further stratified by sex, the positive association remained significant in men (HR, 1.90, 95% CI, 1.21-2.98) but not in women (HR, 1.25, 95% CI, 0.75-2.07).

CONCLUSION

NC was significantly associated with the risk of future CV events in middle-aged and elderly populations in the community and was a better predictor in men.

Neck Circumference Predicts the Occurrence and Remission of Metabolic Associated Fatty Liver Disease: A Longitudinal Study of Community-Dwelling Population

AIM

Neck circumference (NC), a proxy for upper-body subcutaneous fat, is closely related to metabolic dysfunction, independent of other obesity indices. The purpose of this study was to explore the relationship between NC and the incidence and remission of metabolic associated fatty liver disease (MAFLD), a novel concept proposed by an international consensus panel in 2020 through a community-based longitudinal cohort.

METHODS

This study included 1,549 community participants and was conducted from 2013 to 2016. MAFLD was diagnosed using the International Expert Consensus (2020) criteria. All participants underwent NC measurement and biochemical measurements. Elevated NC was defined as NC ≥38.5 cm in men and NC ≥34.5 cm in women.

RESULTS

A total of 1,549 subjects (638 men and 911 women), with an average age of 59.6 ± 7.3 years, were included. During a mean follow-up of 2.1 years, MAFLD occurred in 146 of the 870 participants without baseline MAFLD and was resolved in 225 of the 679 participants with baseline MAFLD. After adjusting for confounding factors such as age, sex, body mass index, waist circumference, fasting plasma glucose, and liver enzyme levels, multivariable logistic regression showed that higher NC at baseline was positively correlated with MAFLD occurrence (OR 1.96, 95% confidence interval: 1.21-3.31; p = 0.003) and negatively correlated with MAFLD remission (OR 0.57, 95% confidence interval: 0.40-0.80; p < 0.001).

CONCLUSION

A higher NC is associated with an increased risk of MAFLD occurrence and a reduced probability of MAFLD remission, making NC measurement a potential predictor in MAFLD management.

Neck circumference predicts development of carotid intima-media thickness and carotid plaque: A community-based longitudinal study

BACKGROUND AND AIMS

Carotid intima-media thickness (C-IMT) is an important index for evaluating subclinical atherosclerosis. Neck circumference (NC), a new anthropometric index of the upper body fat, is closely related to cardiovascular disease (CVD) and CVD risk factors. This study investigated the relationship between NC, C-IMT, and carotid plaque in a community-based cohort.

METHODS AND RESULTS

Participants recruited from Shanghai communities were followed up for 1.1-2.9 years. All participants underwent anthropometric and biochemical measurements. Elevated NC was defined as NC ≥ 38.5 cm and NC ≥ 34.5 cm in men and women, respectively. Elevated C-IMT, determined by ultrasound, was defined as a level higher than the 75th percentile in the study population (>0.75 mm). In total, 1189 participants without carotid plaque at baseline were included, with an average age of 59.6 ± 7.3 years. After a mean follow-up of 2.1 ± 0.2 years, 203 participants developed carotid plaques. After adjusting for various atherosclerosis risk factors, the logistic regression showed that the higher NC group had a significantly greater risk of developing carotid plaque than the lower NC group (odds ratio [OR], 1.55; 95% confidence interval [CI], 1.12-2.14; P = 0.008). Of those without carotid plaque at follow-up, 495 participants developed elevated C-IMT. Compared to the lower NC group, the higher NC group had a significantly increased risk of elevated C-IMT (OR, 1.49; 95% CI, 1.14-1.95; P = 0.003).

CONCLUSION

Higher NC was significantly positively correlated with the risk of carotid plaque and elevated C-IMT.

Relationship between Cardiovascular Disease Risk and Neck Circumference Shown in the Systematic Coronary Risk Estimation (SCORE) Risk Model

INTRODUCTION

The most important way to reduce CVD-related mortality is to apply appropriate treatment according to the risk status of the patients. For this purpose, the SCORE risk model is used in Europe. In addition to these risk models, some anthropometric measurements are known to be associated with CVD risk and risk factors.

OBJECTIVES

This study aimed to investigate the association of these anthropometric measurements, especially neck circumference (NC), with the SCORE risk chart.

METHODS

This was planned as a cross-sectional study. The study population were classified according to their SCORE risk values. The relationship of NC and other anthropometric measurements with the total cardiovascular risk indicated by the SCORE risk was investigated.

RESULTS

A total of 232 patients were included in the study. The patients participating in the study were analysed in four groups according to the SCORE ten-year total cardiovascular mortality risk. As a result, the NC was statistically significantly lower among the SCORE low and moderate risk group than all other SCORE risk groups (low-high and very high 36(3)-38(4) (IQR) p: 0.026, 36(3)-39(4) (IQR) p < 0.001, 36(3)-40(4) (IQR) p < 0.001), (moderate-high and very high 38(4) vs. 39(4) (IQR) p: 0.02, 38(4) vs. 40(4) (IQR) p < 0.001, 39(4) vs. 40(4) (IQR) p > 0.05). NC was found to have the strongest correlation with SCORE than the other anthropometric measurements.

CONCLUSIONS

Neck circumference correlates strongly with the SCORE risk model which shows the ten-year cardiovascular mortality risk and can be used in clinical practice to predict CVD risk.

The Association of Metabolic Syndrome Components with Anthropometric Measurements

Aim: This study aims to research the association of metabolic syndrome components with anthropometric measurements like arm circumference, neck circumference, hip circumference, waist-hip ratio, and waist-to-height ratio, which are applied rarely. Methods: This cross-sectional study was conducted with 292 patients in November-December 2019. The arm circumference, neck circumference, waist circumference, hip circumference, waist-hip ratio, waist-to-height ratio, and body mass index measurements of the patients were made. Glucose, high-density lipoprotein, low-density lipoprotein, systolic, and diastolic blood pressure measurements were also recorded. The association between metabolic syndrome components and anthropometric measurements was analyzed. Results: Metabolic syndrome is diagnosed in 32.8% of the participants. According to body mass index, 18.6% of the patients were normal, 34.2% were overweight, and 47.2% were obese. There was a significant difference between the patients with and without metabolic syndrome in terms of laboratory parameters, blood pressure values, and anthropometric measurements. In the diagnosis of metabolic syndrome, optimal cut-off values for arm circumference, neck circumference, hip circumference, waist-hip ratio, and waist-to-height ratio were determined as 31.75 (AUC=0.703), 34.85 (AUC=0.763), 113.75 (AUC=0.757), 0.90 (AUC=0.701), 0.61 (AUC=0.769) for females while they were 35.75 (AUC=0.573), 39.75 (AUC=0.795), 111.5 (AUC=0.607), 0.96 (AUC=0.888), 0.61 (AUC=0.888) for males respectively. Conclusion: A significant correlation was detected between arm circumference, neck circumference, hip circumference, waist-hip ratio, and waist-to-height ratio, and metabolic syndrome components. However, low-density lipoprotein was not correlated with neck circumference and high-density lipoprotein with waist-to-height ratio. Keywords: metabolic syndrome, anthropometric measurement, body mass index, obesity, lipid profile

Neck circumference and metabolic syndrome: A cross-sectional population-based study

OBJECTIVES

This study aimed to investigate the possible association of neck circumference with cardiometabolic risk factors, and to find out the possible cutoff points of neck circumference for the diagnosis of metabolic syndrome among the Iranian population.

METHOD

This is a cross-sectional study in 1619 participants who were selected through clustered random sampling, as a part of a health cohort in Amol, Iran. Diagnosis of metabolic syndrome (MetS) was based on the modified criteria of the National Cholesterol Educational Program Adult Treatment Panel (NCEP ATP III). Associations of neck circumference with Mets and its components were studied using logistic regression. The optimal cutoff point of neck circumference for MetS diagnosis was calculated based on the Youden index.

RESULTS

Metabolic syndrome was diagnosed in 433 (26.7%) of patients. Neck circumference was shown to be significantly associated with central obesity, hypertension, hypertriglyceridemia, impaired fasting glucose, and low serum high-density lipoprotein (HDL) level, as well as MetS. The optimal cutoff points of neck circumference in the diagnosis of MetS are 36 cm and 42 cm for women and men, respectively. Sensitivity of the optimal cut-off point of NC for diagnosing patients with MetS was higher in women compared to men (70.6% compared to 55.9%).

CONCLUSION

A significant association was observed between neck circumference and the presence of MetS among the Iranian population and neck circumference can be offered as a new index in screening and diagnosis for MetS and assessing cardiometabolic risk factors.

Eating in the Amazon: Nutritional Status of the Riverine Populations and Possible Nudge Interventions

The Amazon is the largest tropical forest in the world and a source of healthy food, such as fruits and fish. Surprisingly, the Amazonian riverine population present an increased prevalence (as high as 58%) of non-communicable diseases, such as hypertension and insulin resistance, even higher than that described for the urban population of the Amazon. Therefore, this work aimed to analyze the nutritional status and associated risk of the riverine population. Body mass index, waist circumference (WC), waist-to-hip ratio, and neck circumference (NC) were evaluated, and risk analysis was assayed. Furthermore, data about occupation and the prevalence of consumers of the different groups of food were analyzed. All anthropometric parameters revealed high proportions of individuals at risk, WC and NC being the factors that had more high-risk women and men, respectively. Our data confirmed the characteristic profile of the riverine communities with a high number of fish consumers, but also observed different patterns probably associated to a phenomenon of nutrition transition. Based on our data, some nudge interventions that take into account the principles of behavior analysis are discussed and proposed for these populations, aiming to improve the nutritional status and avoid the long-term consequences of the results showed by this work.

Neck circumference and waist circumference associated with cardiovascular events in type 2 diabetes (Beijing Community Diabetes Study 23)

Obesity increases the risk of developing cardiovascular disease and other metabolic diseases. We intended to compare three different anthropometric indicators of obesity, in predicting the incidence of cardiovascular events in Chinese type 2 diabetes. Beijing Community Diabetes Study was a prospective multi-center study conducted in Beijing community health centers. Type 2 diabetes patients from fourteen community health centers were enrolled at baseline. The primary endpoint was cardiovascular events. The upper quartile of neck circumference (NC) was set as greater NC. A total of 3299 diabetes patients were enrolled. In which, 941 (28.52%) had cardiovascular disease at baseline. Logistic analysis showed that central obesity (waist circumference (WC) above 90 cm in men and 85 cm in women) and greater NC were all related to baseline cardiovascular disease (adjusted OR = 1.49, and 1.55). After 10-year follow-up, 340 (10.31%) had cardiovascular events. Compared with patients without cardiovascular events, those having cardiovascular events had higher BMI, larger WC and NC. Cox regression analysis showed that greater WC and NC were all associated with the occurrence of cardiovascular events (adjusted HR = 1.41, and 1.38). A higher NC and WC might increase the risk of cardiovascular events by about 40% in type 2 diabetes patients in Beijing communities.

Inflammatory Gene Expression in Neck Perivascular and Subcutaneous Adipose Tissue in Men With Carotid Stenosis

The inflammatory phenotype of neck adipose tissue (NAT) might reflect its involvement in the pathogenesis of carotid atherosclerosis. We investigated inflammatory gene expression in the subcutaneous and the perivascular (pericarotid) adipose tissue from patients with carotid stenosis (CS) undergoing endarterectomy and a control group of patients without significant carotid atherosclerosis undergoing thyroid surgery. Only male patients were included (n = 13 in each study group). Clinical and biochemical data along with serum leptin, adiponectin, and monocyte chemoattractant protein 1 (MCP-1) were collected. Adipose tissue samples were obtained from both the subcutaneous and pericarotid compartments. Real-time polymerase chain reaction was used to measure gene expression of macrophage markers and adipokines. The CS group had higher subcutaneous and pericarotid visfatin gene expression and higher pericarotid expression of MCP-1 and CD68 genes. The ratio between pericarotid CD206 and CD68 gene expression was similar between study groups. Adiponectin gene expression in both NAT compartments did not differ between groups, but it was negatively associated with body weight. These observations suggest that NAT, and especially the pericarotid compartment, express enhanced inflammatory properties in patients with CS, but the proportion of anti-inflammatory macrophages in advanced atherosclerosis seems to be maintained.

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

Background: Metabolic syndrome (MS) comprises a cluster of risk factors for the development of cardiovascular diseases, which are among the leading causes of morbidity and mortality worldwide. Many studies have shown that neck circumference (NC) has validity in the measure of MS since it correlates positively with the traditional components. For these reasons, this study aimed at comparing waist circumference (WC) and NC for identifying MS parameters in patients treated at a cardiology unit. Methods: This study included 309 patients assisted in a Cardiology Unit. Biochemical and anthropometric parameters were evaluated. Correlations between neck and WC with anthropometric, biochemical, and atherogenic indices were evaluated. The diagnostic ability of neck and WC was assessed by using the receiver operating characteristics curve. Results: The patients had a mean age of 57.2 years, and 56% were men. The diagnosis of MS was present in 48% of men and 39% of women. Neck and WC showed a positive correlation with each other, and both showed positive correlations with the criteria for MS. Moreover, NC showed a positive correlation with body mass index (BMI), insulin, homeostatic model assessment (HOMA)-β, and C-reactive protein. WC showed a positive correlation with BMI, HOMA of insulin resistance (HOMA-IR), and Castelli Index I. Both neck and WC showed the ability to identify the presence of the MS. Conclusion: Both neck and WC showed a significant correlation with several of the metabolic parameters, including some used as criteria for the diagnosis of MS. In addition, both measures demonstrated a good ability to predict MS, making these measures promising for screening patients with this syndrome.

Subcutaneous adipose tissue distribution and telomere length

Background Overweight and obese individuals have a reduced life expectancy due to cardiovascular disease (CVD), type 2 diabetes, stroke and cancer. Systemic inflammation and premature telomere shortening have been discussed as potential mechanisms linking these conditions. We investigated the relation of subcutaneous adipose tissue (SAT) distribution to leukocyte relative telomere length (RTL). Methods We measured RTL in 375 participants of the observational STYJOBS/EDECTA cohort (ClinicalTrials.gov Identifier NCT00482924) using a qPCR based method. SAT distribution was determined by lipometry yielding a percent body fat value and SAT thicknesses at 15 standardized locations across the entire body. A correlation analysis between RTL, age, sex, lipometry data and conventional body measures (body mass index [BMI], waist-, hip circumference, waist-to-hip ratio, waist-to-height ratio) was calculated. The strongest determinants of RTL were determined by a stepwise multiple regression analysis. Results RTL was not associated with age or sex. RTL was significantly negatively correlated with BMI, percent body fat, waist-, hip circumference and waist-to-height ratio. Furthermore, RTL correlated with SAT at the following locations: neck, triceps, biceps, upper back, front chest, lateral chest, upper abdomen, lower abdomen, lower back, hip, front thigh, lateral thigh, rear thigh and calf. Stepwise regression analysis revealed nuchal and hip SAT as the strongest predictors of RTL. No significant association was seen between RTL and waist-to-hip ratio. Conclusions RTL is negatively associated with parameters describing body fat composure. Nuchal and hip SAT thicknesses are the strongest predictors of RTL. Central obesity appears to correlate with premature genomic aging.

Associations between abdominal obesity indices and diabetic complications: Chinese visceral adiposity index and neck circumference

Background and aims

Obesity, especially abdominal obesity, has been considered a risk factor for diabetic complications. Many abdominal obesity indices have been established, including neck circumference (NC), waist-to-hip ratio (WHR), lipid accumulation product (LAP), visceral adiposity index (VAI) and the Chinese visceral adiposity index (CVAI). However, studies investigating the associations between these indices and diabetic complications are limited. The objective of this study was to investigate the associations of the abdominal obesity indices with cardiovascular and cerebrovascular disease (CVD), diabetic kidney disease (DKD) and diabetic retinopathy (DR).

Methods

A total of 4658 diabetic participants were enrolled from seven communities in Shanghai, China, in 2018. Participants completed questionnaires and underwent blood pressure, glucose, lipid profile, and urine albumin/creatinine ratio measurements; fundus photographs; and anthropometric parameters, including height, weight, waist circumference (WC), NC and hip circumference (HC).

Results

In men, a one standard deviation (SD) increase in CVAI level was significantly associated with a greater prevalence of CVD (OR 1.35; 95% CI 1.13, 1.62) and DKD (OR 1.38; 95% CI 1.12, 1.70) (both P < 0.05). In women, a one SD increase in CVAI level was significantly associated with a greater prevalence of CVD (OR 1.32; 95% CI 1.04, 1.69) and DKD (OR 2.50; 95% CI 1.81, 3.47) (both P < 0.05). A one SD increase in NC was significantly associated with a greater prevalence of CCA plaque in both men (OR 1.26; 95% CI 1.10, 1.44) and women (OR 1.20; 95% CI 1.07, 1.35). These associations were all adjusted for potential confounding factors.

Conclusions

CVAI was most strongly associated with the prevalence of CVD and DKD among the abdominal obesity indices, and NC was unique associated with the prevalence of CCA plaque in Chinese adults with diabetes.

Trial registration ChiCTR1800017573, www.chictr.org.cn. Registered 04 August 2018.

Neck circumference is an independent risk factor for hyperuricemia within 3 years in women: a longitudinal study

INTRODUCTION

Our previous cross-sectional study revealed the association between neck circumference (NC) and hyperuricemia. This study aimed to further investigate the longitudinal association between NC and hyperuricemia and to compare the strengths of longitudinal association of NC and waist circumference (WC) with hyperuricemia.

METHODS

A total of 4383 subjects without hyperuricemia at baseline were included. Multivariable linear regression was used to assess the association between baseline anthropometric indices and uric acid level at follow-up. Cox regression was used to assess the relationship between baseline anthropometric indices and the risk of future hyperuricemia. A receiver-operating characteristic curve was used to compare the predictive ability of baseline anthropometric indices for future hyperuricemia.

RESULTS

Among women, only baseline NC was positively, linearly associated with uric acid level at follow-up (β = 1.75) and risk of future hyperuricemia (p_trend < 0.05); risk of hyperuricemia in the third and fourth quartile groups of baseline NC significantly increased, compared with the first quartile group of baseline NC (HR = 1.48 and 1.81, respectively). Among men, neither NC nor WC was associated with hyperuricemia after adjusting for confounder factors. The area under the curve of baseline NC and WC for hyperuricemia was comparable in both genders (0.606 for NC and 0.599 for WC in women, 0.578 for NC and 0.602 for WC in men).

CONCLUSIONS

For women, only baseline NC is an independent risk factor of hyperuricemia within 3 years. NC and WC have a similar 3-year predictive ability for hyperuricemia in both genders. Key Points • This is the first study to assess the longitudinal association between neck circumference and hyperuricemia. • According to the results of this study, we propose for the first time that neck circumference is an independent risk factor for hyperuricemia in women in the future, rather than waist circumference. • We found for the first time that neck circumference and waist circumference have similar predictive ability for future hyperuricemia in both genders.

Breakfast skipping, nutritional status, and physical activity in a middle-aged Latin American population: a population-based study from Ecuador

Introduction

Introduction: the failure to eat breakfast has been associated with weight gain, a lower level of physical activity, and poor diet quality. Objective: to examine the frequency of skipping breakfast in an Ecuadorian population and its association with nutritional status and level of physical activity. Methods: a cross-sectional study of individuals who reported breakfast omission in a national survey. Nutritional status and physical activity were evaluated through anthropometric measures and the International Physical Activity Questionnaire, respectively. Results: the mean age of the study sample was 34.2 ± 14 years, 40% were aged 20 to 34 years, one half were women, 55% were living in the coastal region, and one half were classified as low socioeconomic status. Overall, 6.6% of participants did not mention breakfast in both recalls. Individuals who skipped breakfast were more likely to be aged 20 to 34 years (42.6% vs. 37.4%) and from the coastal region (61.1% vs. 51.8%) than those who ate breakfast. We did not find an association between skipping breakfast and being overweight or obese (35.2% vs. 36.1%), nor achieving a low level of physical activity (28.6% vs. 29.8%). In addition, breakfast consumers (vs. non-consumers) had higher intake of total energy, macronutrients (protein, carbohydrate, fat, and sugar), and micronutrients (fiber and calcium). Conclusions: in Ecuador, ~ 7% of the population skips breakfast. The nutritional status and level of physical activity did not differ between those who ate breakfast and those who did not. However, the long-term health consequences should be avoided by changing this eating habit.

Telomere shortening associates with elevated insulin and nuchal fat accumulation

Obesity and relative leucocyte telomere length (RTL) are both linked to accelerated aging and premature mortality. We examined if nuchal subcutaneous adipose tissue (SAT) thickness, a surrogate marker of central trunk-weighted obesity, is an independent predictor of RTL that provides information beyond BMI, metabolic and inflammatory markers. RTL and nuchal SAT thickness were determined in 362 participants of the STYJOBS/EDECTA study (STYrian Juvenile Obesity Study, Early DEteCTion of atherosclerosis), which included overweight individuals and matched eutrophic controls. Fasting plasma samples were used for the measurement of leptin, resistin, adiponectin, glucose, insulin, high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), liver enzymes, creatinine, cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, oxidized LDL, triglycerides, homocysteine and uric acid. Furthermore, all participants underwent carotid artery ultrasound. Obese individuals had markedly higher body mass index (BMI), nuchal SAT thickness, hip and waist circumferences and carotid intima media thickness (IMT) than eutrophic controls. In addition, they showed typical biochemical abnormalities related to energy metabolism, systemic inflammation and liver function. RTL was inversely correlated with nuchal SAT thickness, IMT, hs-CRP, alkaline phosphatase, insulin, resistin, and leptin. Positive correlations were seen with homocysteine and creatinine. Stepwise linear regression analyses identified nuchal SAT thickness and insulin as the only significant predictors of RTL. In conclusion, nuchal SAT thickness is a robust predictor of RTL that provides information beyond traditional obesity-related metabolic and inflammatory biomarkers. This suggests an important role of fat depots at the neck for accelerated telomere shortening.

Association between Neck Circumference and the Occurrence of Cardiovascular Events in Type 2 Diabetes: Beijing Community Diabetes Study 20 (BCDS-20)

Background

Neck circumference (NC) was found to be related to the risk factors of cardiovascular disease. However, the effects of NC on cardiovascular disease are still controversial. A prospective study of Chinese patients with type 2 diabetes was performed to evaluate the relationship between NC and cardiovascular disease.

Methods

A multicenter prospective study with eight-year follow-up was conducted in Beijing communities. Cardiovascular events were defined as myocardial infarction, unstable angina pectoris, hospitalization for heart failure, coronary revascularization, cardiac death, stroke, transient ischemic attack, and cerebral hemorrhage.

Results

A total of 3,009 diabetic patients were recruited. Following an eight-year follow-up, 211 patients with cardiovascular events (105 in men and 106 in women) were identified. All patients were categorized into two groups according to the upper quartile of NC (43 cm in men and 39 cm in women). The prevalence of cardiovascular events in men with an NC >43 cm (16.48%) was higher than that in the group with an NC <43 cm (8.16%, p=0.007). The prevalence of cardiovascular events in women with the NC >39 cm (10.67%) was higher compared to the group with NC <39 cm (5.31%, p=0.004). The longitudinal prevalence of cardiovascular events in groups with different NC increased with the increasing duration of follow-up (p < 0.001). Cox regression analysis showed that higher NC was associated with the occurrence of cardiovascular events after adjusting for confounding variables (adjusted HR = 2.305 (1.535–3.460)).

Conclusions

NC was associated with the occurrence of cardiovascular events in type 2 diabetes in Chinese communities, and greater NC may increase the risk of cardiovascular events by about 2.3-fold.

Association of moderate-to-vigorous physical activity with neck circumference in eight Latin American countries

BACKGROUND

Physical activity is a cornerstone in the prevention and treatment of obesity. There are relatively few studies that explore the effect of accelerometer-determined moderate-to-vigorous physical activity (MVPA) on neck circumference (NC), most of them confined to single high-income countries. The present study investigated the association of accelerometer-determined MVPA with NC in adolescents and adults from eight Latin American countries, which are mostly upper-middle income countries.

METHODS

The sample consisted of 2370 participants (47.8% male) from the Latin American Study of Nutrition and Health, a multicenter cross-sectional nutrition and health surveillance study of a nationally representative sample from eight Latin American countries (Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru, and Venezuela). Times (min/day) in MVPA (defined as time accumulated at ≥1952 activity counts/min) was assessed by ActiGraph GT3X+ accelerometer over 7 days. NC for adolescent was categorized as abnormal if circumference was > 34.5 cm for boys and > 31.25 for girls, whereas for adults the cut-off points for abnormal were > 39 cm for men and > 35 cm women. Multilevel logistic models, including country and region as random effects and adjusted for sex, age, socioeconomic level, and educational level, were used to study the association between MVPA and NC.

RESULTS

The average time of MVPA was 34.88 min/day, ranging from 31.16 in Venezuela to 40.27 in Chile. Concerning NC, 37.0% of the sample was classified as having elevated NC. Chile was the country with the highest percentage of people with elevated NC (56.9%), and Colombia had the lowest percentage (24.8%). Overall, the MVPA (min/day) was associated with elevated NC (OR = 0.994, CI95% = 0.990-0.998). In Costa Rica and Peru, there were significant associations between MVPA and NC when analyzed by country.

CONCLUSIONS

The present study provided evidence of significant associations between MVPA and NC in adolescents and adults from Latin America, independent of sex, age, socioeconomic level, and educational level. This analysis of accelerometry data and NC represents the first examination of these associations in eight Latin America countries. Further research is required to understand the differences between countries in the observed associations.

TRIAL REGISTRATION

ClinicalTrials.Gov NCT02226627 . Retrospectively registered on August 27, 2014.

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.

Neck circumference and cardiovascular outcomes: Insights from the Jackson Heart Study

BACKGROUND

Emerging data suggest that neck circumference (NC) is associated with cardiometabolic risk factors. Limited research is available regarding the association between NC and cardiovascular outcomes in African Americans.

METHODS

Using data from the Jackson Heart Study, we included participants with recorded NC measurements at baseline (2000-2004). Baseline characteristics for the included population were summarized by tertiles of NC. We then calculated age- and sex-adjusted cumulative incidence of clinical cardiovascular outcomes and performed Cox proportional-hazards with stepwise models.

RESULTS

Overall, 5,290 participants were categorized into tertiles of baseline NC defined as ≤37 cm (n = 2179), 38-40 cm (n = 1552), and >40 cm (n = 1559). After adjusting for age and sex, increasing NC was associated with increased risk of heart failure (HF) hospitalization (cumulative incidence = 13.4% [99% CI, 10.7-16.7] in the largest NC tertile vs 6.5% [99% CI, 4.7-8.8] in the smallest NC tertile), but not mortality, stroke, myocardial infarction, or coronary heart disease (all P ≥ .1). Following full risk adjustment, there was a nominal increase in the risk of HF hospitalization with increasing NC, but this was not statistically significant (hazard ratio per 1-cm increase, 1.04 [99% CI, 0.99-1.10], P = .06).

CONCLUSIONS

In this large cohort of African American individuals, a larger NC was associated with increased risk for HF hospitalization following adjustment for age and sex, but this risk was not statistically significant after adjusting for other clinical variables. Although NC is not independently associated with increased risk for cardiovascular events, it may offer prognostic information particularly related to HF hospitalization.

The association between neck adiposity and long-term outcome

Anthropometric indices of obesity (e.g. body mass index, waist circumference and neck circumference) are associated with poor long-term cardiovascular outcome. Prior studies have associated neck circumference and central body adiposity. We explored the association between neck fat volume (NFV) and long-term cardiovascular outcome. The study provides a retrospective analysis of all patients undergoing computerized tomography angiography for suspected cerebrovascular accident between January and December 2013. NFV was assessed by three dimensional reconstructions and was adjusted to height to account for differences in body sizes, thus yielding the NFV/height ratio (NHR). Univariate and multivariate analysis were utilized to explore the association between various indices including NHR and all-cause mortality. The analysis included 302 patients. The average age was 61.9±14.3 years, 60.6% of male gender. Diabetes mellitus, hypertension and cardiovascular disease were frequent in 31.5%, 69.9%, and 72.2% of patients, respectively. The median NHR was 492.53cm² [IQR 393.93–607.82]. Median follow up time was 41.2 months, during which 40 patients (13.2%) died. Multivariate analysis adjusting for age, sex, and diabetes mellitus indicated an independent association between the upper quartile of NHR and all-cause mortality (hazard ratio = 2.279; 95% CI = 1.209–4.299; p = .011). NHR is a readily available anthropometric index which significantly correlated with poor long-term outcome. Following validation in larger scale studies, this index may serve a risk stratifying tool for cardiovascular disease and future outcome.

Association Between Neck Circumference and Coronary Heart Disease: A Meta-analysis

Aims: Neck circumference (NC) was found to be related to the risk factors for coronary heart disease (CHD). However, the effects of NC on CHD are still controversial. To evaluate the relationship between NC and CHD, a meta-analysis of observational studies was performed.

Method: Eligible studies on the association between NC and CHD were searched in Medline, Embase, Ovid, and Web of Science databases published in English from January 1980 to December 2016. Moreover, studies published in Chinese in Wanfang and China Hospital Knowledge databases were also searched. Random effects models in the metafor package in statistical analysis software R 3.3.3 were used for the meta-analysis. Heterogeneity was analyzed with Q statistics.

Results: Eight studies were selected for the meta-analysis. A larger NC was associated with a higher prevalence of CHD (OR = 1.18, 95% CI 1.04–1.34, p = 0.0108). The eight studies were further divided into three subgroups according to the criteria for diagnosing CHD. In the subgroup of coronary angiography, NC was also found to be associated with the prevalence of CHD with low heterogeneity (OR = 1.17, 95% CI 1.07–1.28, p = 0.0007, I² = 17.02%). However, in the subgroup of computed tomography or past history, no association between NC and CHD was found. In addition, subgroup analyses were also conducted according to the regions of the study. No association between NC and CHD was identified in either Chinese studies or Brazil studies (OR = 1.20, 95% CI 0.96–1.49; OR = 1.31, 95% CI 0.82–2.09, respectively).

Conclusion: Larger NC is associated with increased risk of CHD, especially when coronary angiography was taken to diagnose CHD.

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.

Neck circumference as an independent indicator of visceral obesity in a Chinese population

Background

Neck circumference (NC) was reported to be associated with visceral obesity in some specific subjects. However, no studies have reported whether NC could identify visceral obesity in the general population. Here, we mainly aimed to explore whether NC is suitable to identify visceral obesity in the general population.

Methods

Our data were from a cross-sectional survey on the prevalence of metabolic diseases and risk factors in East China from 2014 to 2015. A total of 9366 participants aged 18–93 were identified for analysis. Anthropometric indices, biochemical parameters and clinical characteristics were measured. The NC values were quartered according to sex. Spearman’s correlation coefficient was employed to test the correlations between different variables. Linear regression and logistic regression were conducted to explore the relationship of NC with visceral adiposity indices and visceral obesity.

Results

Among the 9366 participants, 3938 (42.05%) were male and 5428 (57.95%) were female. NC had a positive correlation with the visceral adiposity indices, regardless of sex. In all quartiles of NC, in both men and women, as NC values increased, the values of all the fatness indices showed a tendency to increase (all P < 0.001). After full adjustment for demographic variables and metabolic factors, linear regression showed that NC was still associated with the fatness indices for visceral obesity (all P < 0.001). In addition, logistic analysis showed that a larger NC was associated with a higher risk of visceral obesity in both males (OR 32.34, 95% CI 24.02–43.53; P < 0.001) and females (OR 21.43, 95% CI 17.30–26.55; P < 0.001) after adjusting for potential confounding factors.

Conclusion

NC can be a supplemental indicator for identifying visceral obesity in the general Chinese population.

Neck adipose tissue - tying ties in metabolic disorders

Upper body adipose tissue accumulation has been associated with clustering of metabolic disorders and increased cardiovascular risk. Neck circumference (NC) indicated that subcutaneous adipose tissue (SAT) in that region is an independent pathogenic depot that might account for the additional risk missed by visceral adipose tissue (VAT). Neck adipose tissue (NAT) is not only one more ectopic depot but has several particular features that might modulate its metabolic role. Besides a controversial impact on obstructive apnea syndrome, neck fat encompasses carotid arteries as an important perivascular adipose tissue (PVAT) depot. With dysfunctional changes in obesity, physiologic vascular regulation is lost and inflammatory signals accelerate atherogenesis. Unexpected was the discovery of brown and beige adipocytes in the neck of human adults. When stimulated, brown adipose tissue (BAT) dissipates energy through thermogenesis and it is associated with other favorable metabolic effects. Moreover, the neck is the region where the browning mechanism was disclosed. With this unique plastic nature, NAT revealed multiple ties, challenging dynamics and potential new therapeutic targets that might have significant implications on metabolic outcomes and vascular risk.

Utility of Neck Circumference for Identifying Metabolic Syndrome by Different Definitions in Chinese Subjects over 50 Years Old: A Community-Based Study

AIMS

Whether neck circumference (NC) could be used as a valuable tool for identifying metabolic syndrome (MS) by different criteria in Chinese is still unclear.

METHODS

We conducted a cross-sectional survey from October 2010 to January 2011 in Shipai community, Guangzhou, Guangdong Province, China. A total of 1473 subjects aged over 50 years were investigated. We measured height, weight, NC, waist circumference, blood pressure, blood glucose, and lipids in all subjects. MS was identified by criteria of the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III), Chinese Diabetes Society (CDS), and International Diabetes Federation (IDF).

RESULTS

Mean NC was 38.0 ± 2.7 cm in men and 34.2 ± 2.5 cm in women. By using receiver operating characteristic curves, the area under the curve (AUC) of NC for identifying MS (IDF) was 0.823 in men and 0.777 in women, while for identifying MS (CDS), it was 0.788 in men and 0.762 in women. The AUC of NC for diagnosing MS (ATP III) was 0.776 in men and 0.752 in women. The optimal cut points of NC for MS were 38.5 cm by three definitions in men, while those were 34.2 cm, 33.4 cm, and 34.0 cm in women by IDF, ATP III, and CDS definitions, respectively. No significant difference was observed between the AUC of NC and BMI for diagnosing MS by using different criteria (all p > 0.05).

CONCLUSIONS

NC is associated with MS by different definitions in Chinese subjects over 50 years old. It may be a useful tool to identify MS in a community population.

Neck circumference is associated with non-traditional cardiovascular risk factors in individuals at low-to-moderate cardiovascular risk: cross-sectional analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

BACKGROUND

Neck circumference (NC) is associated with traditional cardiovascular risk factors (CVRF), but its usefulness to identify earlier atherogenic risk has been scarcely examined. Associations of NC with non-traditional CVRF were investigated in participants at low-to-moderate risk from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

METHODS

807 individuals (35-54 years) without obesity, diabetes or cardiovascular disease was stratified into quartiles of NC (cut-off for men: 36.5; 37.9 and 39.5 cm; women: 31.4; 32.5 and 34 cm) and traditional and non-traditional risk factors (lipoprotein subfractions by Vertical Auto Profile, adiponectin, leptin, E-selectin) were compared across groups. In linear regression models, associations of NC with non-traditional risk factors were tested for the entire sample and for low-risk group (≤ 2 CVRF).

RESULTS

In both sexes, BMI, waist circumference, systolic and diastolic blood pressure, fasting and 2-h plasma glucose, HOMA-IR, triglycerides, leptin, E-selectin, small dense LDL-cholesterol, IDL-cholesterol, VLDL₃-cholesterol and TG/HDL ratio increased significantly, while HDL₂-cholesterol and HDL₃-cholesterol decreased across NC quartiles. In linear regression models, a direct association [β(95% CI)] of NC with leptin [(0.155 (0.068-0.242); 0.147 (0.075-0.220)], E-selectin [(0.105 (0.032-0.177); 0.073 (0.006 to 0.140)] and small-dense LDL [(1.866 (0.641-3.091); 2.372 (1.391-3.353)] and an inverse association with HDL₂-cholesterol [(- 0.519 (- 0.773 to - 0.266); - 0.815 (- 1.115 to 0.515)] adjusted for age were detected for men and women, respectively.

CONCLUSION

Our findings indicate that measurement of NC may be useful for an earlier identification of unfavorable atherogenic metabolic profile in middle-aged individuals at lower cardiovascular risk level.

A Study of Correlation of Neck Circumference with Framingham Risk Score as a Predictor of Coronary Artery Disease

Introduction

It has been observed that metabolic syndrome is risk factor for Coronary Artery Disease (CAD) and exerts its effects through fat deposition and vascular aging. CAD has been acknowledged as a leading cause of death. In earlier studies, the metabolic risk has been estimated by Framingham risk score. Recent studies have shown that Neck Circumference (NC) has a good correlation with other traditional anthropometric measurements and can be used as marker of obesity. It also correlates with Framingham risk score, which is slightly more sophisticated measure of CAD risk.

Aim

To assess the risk of CAD in a subject based on NC and to correlate the NC to Framingham risk score.

Materials and Methods

The present cross-sectional study, done at Karnataka Institute of Medical Sciences, Hubli, Karnataka, India, includes 100 subjects. The study duration was of one year from 1^st January 2015 to 31^st December 2015. Anthropometric indices Body Mass Index (BMI) and NC were correlated with 10 year CAD risk as calculated by Framingham risk score. The correlation between BMI, NC, vascular age and Framingham risk score was calculated using Karl Pearson's correlation method.

Results

NC has a strong correlation with 10 year CAD risk (p≤0.001). NC was significantly greater in males as compared to females (p≤0.001). Males had greater risk of cardiovascular disease as reflected by higher 10 year Framingham risk score (p≤0.0035).

Conclusion

NC gives simple and easy prediction of CAD risk and is more reliable than traditional risk markers like BMI. NC correlates positively with 10 year Framingham risk score.

Can neck circumference predict insulin resistance in older people? A cross-sectional study at primary care in Brazil

This study focused on the correlation between neck circumference and other anthropometric measurements and cardiovascular risk factors and insulin resistance in the elderly in Niterói, Rio de Janeiro State, Brazil. This was a cross-sectional study in 411 patients seen in primary care. Anthropometric measurements including neck circumference, body mass index (BMI), waist circumference (WC), and waist-hip ratio (WHR) were recorded. Bioelectrical impedance analysis (BIA) estimated the percentage of total body fat (%TBF). Insulin resistance was estimated by HOMA-IR (homeostasis model assessment IR index). The data were analyzed by the Mann-Whitney test and the correlation between numerical variables by Spearman's test. Receiver operating characteristic (ROC) was used to assess the anthropometric measurements' predictive capacity to diagnosis insulin resistance. Neck circumference was positively correlated with WC, BMI, WHR, %TBF, and HOMA-IR in both sexes. In women, neck circumference showed higher AUC (area under the curve) for insulin resistance. In men, WC showed higher AUC, followed by BMI and neck circumference. The current study in Southeast Brazil suggests that neck circumference can predict insulin resistance, an important marker of cardiovascular risk in the elderly population treated in primary care.

Neck Circumference Is Associated with Muscle Sympathetic Nerve Activity in Overweight and Obese Men but Not Women

Background: Neck circumference (NC) is a predictor of cardiometabolic risk. The objective of this study was to explore the relationship of NC to muscle sympathetic nerve activity (MSNA) within an overweight and obese population.

Methods: The study design was a retrospective cross-sectional analysis. Un-medicated persons (72 men, 53 postmenopausal women) aged 56 ± 1 years (mean ± SEM) with body mass index (BMI) 32.8 ± 0.4 kg/m², were studied. NC was measured together with traditional anthropometric measures, supine blood pressure, fasting blood lipids, insulin, and glucose. Insulin sensitivity was assessed by homeostasis model (HOMA-IR) and Matsuda Insulin Sensitivity Index (ISI) derived from 75-g oral glucose tolerance test. Resting multiunit MSNA was recorded by microneurography in the peroneal nerve and expressed as burst frequency and burst incidence.

Results: Men within the highest tertile of NC had significantly higher fasting and post-glucose plasma insulin levels (insulin AUC₀₋₁₂₀), HOMA-IR, non-esterified fatty acids, MSNA (45 ± 2 vs. 36 ± 2 bursts per min; 69 ± 3 vs. 58 ± 3 bursts per 100 hb) and heart rate, and lower Matsuda ISI compared to men in the lowest tertile (P all <0.05). In stepwise regression analyses, NC alone explained 12%, and together with insulin AUC₀₋₁₂₀ it accounted for 22%, of the variance in MSNA in men. In women, NC was associated with anthropometric measures but not with MSNA or metabolic indices.

Conclusions: Among overweight and obese men, NC was independently associated with elevated MSNA and hyperinsulinemia, and thus may be relevant to cardiometabolic risk prediction. The biological basis of gender differences merits further elucidation.

Neck circumference as an effective measure for identifying cardio-metabolic syndrome: a comparison with waist circumference

Neck circumference is a new anthropometric index for estimating obesity. We aimed to determine the relationship between neck circumference and body fat content and distribution as well as the efficacy of neck circumference for identifying visceral adiposity and metabolic disorders. A total of 1943 subjects (783 men, 1160 women) with a mean age of 58 ± 7 years were enrolled in this cross-sectional study. Metabolic syndrome was defined according to the standard in the 2013 China Guideline. Analyses were conducted to determine optimal neck circumference cutoff points for visceral adiposity quantified by magnetic resonance imaging, and to compare the performance of neck circumference with that of waist circumference in identifying abdominal obesity and metabolic disorders. Visceral fat content was independently correlated with neck circumference. Receiver operating characteristic curves showed that the area under the curve for the ability of neck circumference to determine visceral adiposity was 0.781 for men and 0.777 for women. Moreover, in men a neck circumference value of 38.5 cm had a sensitivity of 56.1 % and specificity of 83.5 %, and in women, a neck circumference value of 34.5 cm had a sensitivity of 58.1 % and specificity of 82.5 %. These values were the optimal cutoffs for identifying visceral obesity. There were no statistically significant differences between the proportions of metabolic syndrome and its components identified by an increased neck circumference and waist circumference. Neck circumference has the same power as waist circumference for identifying metabolic disorders in a Chinese population.