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Neck Circumference May Be a Better Alternative to Standard Anthropometric Measures

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Neck Circumference May Be a Better Alternative to Standard Anthropometric Measures Neck Circumference May Be a Better Alternative to Standard Anthropometric Measures The Harvard community has made this article openly available. Please share how this access benefits you. Your story matters Citation Joshipura, Kaumudi, Francisco Muñoz-Torres, José Vergara, Cristina Palacios, and Cynthia M. Pérez. 2016. “Neck Circumference May Be a Better Alternative to Standard Anthropometric Measures.” Journal of Diabetes Research 2016 (1): 6058916. doi:10.1155/2016/6058916. http://dx.doi.org/10.1155/2016/6058916. Published Version doi:10.1155/2016/6058916 Citable link http://nrs.harvard.edu/urn-3:HUL.InstRepos:26318719 Terms of Use This article was downloaded from Harvard University’s DASH repository, and is made available under the terms and conditions applicable to Other Posted Material, as set forth at http:// nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of- use#LAA Hindawi Publishing Corporation Journal of Diabetes Research Volume 2016, Article ID 6058916, 8 pages http://dx.doi.org/10.1155/2016/6058916 Research Article Neck Circumference May Be a Better Alternative to Standard Anthropometric Measures Kaumudi Joshipura,1,2 Francisco Muñoz-Torres,1 José Vergara,1,3 Cristina Palacios,3 and Cynthia M. Pérez3 1 Center for Clinical Research and Health Promotion, University of Puerto Rico, Medical Sciences Campus, San Juan, PR 00936-5067, USA 2Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA 3Graduate School of Public Health, University of Puerto Rico, Medical Sciences Campus, San Juan, PR 00936-5067, USA Correspondence should be addressed to Kaumudi Joshipura; [email protected] Received 4 November 2015; Revised 3 January 2016; Accepted 6 January 2016 Academic Editor: Konstantinos Kantartzis Copyright © 2016 Kaumudi Joshipura et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This paper evaluates neck circumference as a metabolic risk marker. Overweight/obese, nondiabetic Hispanics, 40–65 years old, who are free of major cardiovascular diseases, were recruited for the San Juan Overweight Adults Longitudinal Study (SOALS). Baseline exams were completed by 1,206 participants. Partial correlation coefficients () and logistic models adjusted for age, gender, smoking status, and physical activity were computed. Neck circumference was significantly correlated with waist circumference ( = 0.64), BMI ( = 0.66), and body fat % ( = 0.45). Neck circumference, highest (compared to lowest) tertile, had higher association with prediabetes: multivariable OR = 2.30 (95% CI: 1.71–3.06) compared to waist circumference OR = 1.97 (95% CI: 1.48–2.66) and other anthropometric measures. Neck circumference showed higher associations with HOMA, low HDL-C, and triglycerides, multivariable OR = 8.42 (95% CI: 5.43–13.06), 2.41 (95% CI: 1.80–3.21), and 1.52 (95% CI: 1.14–2.03), but weaker associations with hs-CRP and hypertension, OR = 3.61 (95% CI: 2.66–4.90) and OR = 2.58 (95% CI: 1.90–3.49), compared to waist circumference. AIC for model fit was generally similar for neck or waist circumference. Neck circumference showed similar or better associations with metabolic factors and is more practicable than waist circumference. Hence, neck circumference may be a better alternative to waist circumference. 1. Introduction body distribution of fat, especially with increased visceral adipose tissue, is considered predictive of cardiometabolic Obesity is rising to pandemic proportions [1] and is an conditions [7–9]. Several anthropometric measures are used important risk factor for cardiometabolic diseases, including to assess overall obesity and also to assess specific aspects such diabetes, hypertension, dyslipidemia, and coronary heart as central or abdominal obesity, visceral fat, or subcutaneous disease (CHD) [2–4]. Neck circumference may likely be a fat. Computed tomography and MRI are the gold standard very convenient and valid alternative measure of obesity and methods for measuring visceral fat, and dual-energy X-ray may even be a better marker of metabolic risk compared to absorptiometry is considered a very reliable alternative [10]. standard measures such as body mass index (BMI) and waist However, these are expensive and not feasible for large epi- circumference (WC). Overweight and obesity are defined by demiological studies [11]. Anthropometric measures such as BMI, depicting weight higher than what is generally consid- weight and height for calculating BMI and waist circumfer- ered healthy for a given height [5], although the location of ence are relatively low-burden standard and valid surrogate fat may modify the health implications of BMI, and central measures for abdominal adiposity. obesity is generally considered to be a stronger risk factor Overweight and obesity may be associated with fat depo- for cardiometabolic risk than overall obesity [6]. An upper sition in the neck [12], resulting in higher neck circumference. 2 Journal of Diabetes Research Neck circumference is a simple, convenient but less used potentially increase the risk of systemic complications that anthropometric measure, which is correlated with waist cir- could develop during a periodontal examination. Participants cumference and BMI, and has been associated with com- were further excluded if they had fasting plasma glucose ≥ ponents of metabolic syndrome in cross-sectional [12–17] 126 mg/dL, two-hour oral glucose tolerance test (OGTT) ≥ and cohort studies in different populations [14, 18]. The 200 mg/dL, or glycosylated hemoglobin (HbA1c) ≥ 6.5% at association between neck fat and metabolic syndrome and thebaselineexam[25].The1,206eligibleparticipantswho its components may be attributed to an excess release of completed the baseline exam were included in the analyses. free fatty acids into plasma from the upper body subcu- taneous fat [9]. High levels of plasma free fatty acids, in 2.2. Anthropometric Measures. Anthropometric measure- turn, have been associated with markers of oxidative stress ments were taken in duplicate according to the NHANES III and insulin resistance [19], which in turn impact glycemia. procedures. In cases where the first two measures differed It has been suggested that fat in the neck may be more by 0.5 cm, a third measure was recorded, and the average similar to visceral fat, which is more strongly related with of all measures recorded was computed. Both body weight cardiometabolic risks compared to subcutaneous fat [9]. An increase in neck circumference has even been found to be an (0.2 kg weight graduation) and body fat percent (0.1% body independent predictor of nonalcoholic fatty liver disease [20– fat graduation) were measured by a bioelectrical impedance 22]. Although studies have shown associations between neck analysis (BIA) technology using Tanita scale (Tanita Body circumference and components of metabolic syndrome, more Composition Analyzer-TBF-310A), and height was measured studies directly comparing neck circumference with other in meters using a portable stadiometer (Seca Corporation, anthropometric measures are needed, as neck circumference Hanover, MD) to calculate BMI. Circumferences were mea- is not included in standard guidelines and practices and is not sured with a Gulick tape. Waist circumference was measured generally included in research studies or clinical assessments attheumbilicusandrecordedtothenearest0.1cm.Neckcir- [23, 24], even in situations when waist circumference may cumference was measured below the laryngeal prominence notbefeasibleormeaningful.Neckcircumferenceisrarely and perpendicular to the long axis of the neck, and the evaluated in clinical practice or research, although it is a more minimal circumference was recorded to the nearest 0.1 cm practical and likely better measure, which may be especially [26]. The average Pearson correlation coefficient between useful in special populations such as morbidly obese people, repeats for all measures was greater than 0.99 showing patients in bed rest, and pregnant women. Hence more excellent reproducibility. studies are needed in different populations to elucidate the utility of this measurement for assessing obesity and 2.3. Metabolic Measures. We used standard cutoffs from predicting cardiometabolic risk factors when the traditional the literature as described below for classifying metabolic anthropometric measurements are not practicable or valid. syndrome and its components [27]. Participants were clas- Therefore, the aim of this paper is to compare the relative util- sified as having elevated blood pressure if they had systolic ity of neck circumference as a metabolic risk marker among blood pressure ≥ 130 mm Hg or diastolic blood pressure a high risk group of overweight/obese Hispanic adults by ≥ 85 mm Hg or reported antihypertensive drug treatment. comparing associations of neck circumference and metabolic Elevated triglycerides were defined as levels ≥ 150 mg/dL or factors including metabolic syndrome components, against a history of drug treatment for elevated triglycerides. Low similar comparisons using waist circumference and other HDL-C was defined as levels < 40 mg/dL in men and levels < standard measures. 50 mg/dL in women or history of drug treatment for reduced HDL-C. Elevated fasting glucose was defined as levels ≥ 2. Methods and Procedures 100 mg/dL or a history of drug treatment for elevated glucose. 2.1. Study
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