Neck circumference might predict gestational diabetes mellitus in Han Chinese women: A nested case-control study

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Association of body composition in early pregnancy with gestational diabetes mellitus: A meta-analysis

INTRODUCTION

Body composition as dynamic indices constantly changes in pregnancy. The use of body composition indices in the early stages of pregnancy has recently been considered. Therefore, the current meta-analysis study was conducted to investigate the relationship between body composition in the early stages of pregnancy and gestational diabetes.

METHOD

Valid databases searched for papers published from 2010 to December 2021 were based on PRISMA guideline. Newcastle Ottawa was used to assess the quality of the studies. For all analyses, STATA 14.0 was used. Mean difference (MD) of anthropometric indices was calculated between the GDM and Non-GDM groups. Pooled MD was estimated by "Metan" command, and heterogeneity was defined using Cochran's Q test of heterogeneity, and I 2 index was used to quantify heterogeneity.

RESULTS

Finally, 29 studies with a sample size of 56438 met the criteria for entering the meta-analysis. Pooled MD of neck circumference, hip circumference, waist hip ratio, and visceral adipose tissue depth were, respectively, 1.00 cm (95% CI: 0.79 to 1.20) [N = 5; I^2: 0%; p: 0.709], 7.79 cm (95% CI: 2.27 to 13.31) [N = 5; I2: 84.3%; P<0.001], 0.03 (95% CI: 0.02 to 0.04) [N = 9; I2: 89.2%; P<0.001], and 7.74 cm (95% CI: 0.11 to 1.36) [N = 4; I^2: 95.8%; P<0.001].

CONCLUSION

Increased neck circumference, waist circumference, hip circumference, arm circumference, waist to hip ratio, visceral fat depth, subcutaneous fat depth, and short stature increased the possibility of developing gestational diabetes. These indices can accurately, cost-effectively, and affordably assess the occurrence of gestational diabetes, thus preventing many consequences with early detection of gestational diabetes.

Appropriate neck/waist circumference cut-off points for gestational diabetes prediction in Iranian pregnant women: The baseline analysis of the Qazvin maternal and neonatal metabolic study (QMNMS), Iran

BACKGROUND

Gestational diabetes is the most common complication during pregnancy and it is essential to identify the high-risk groups for gestational diabetes mellitus (GDM) in the first trimester. A large neck circumference (NC) in the first trimester is a measure of obesity.

OBJECTIVE

The present study investigated whether pregnant women's first-trimester NC and waist circumference (WC) measurements present a predictive index for GDM diagnosis.

MATERIALS AND METHODS

This longitudinal cohort study was conducted on 676 pregnant women aged ≥20 years. Pregnant women at 12-14th (baseline) gestational weeks underwent measurement of neck and other anthropometric indices. GDM was diagnosed with 75-g oral glucose tolerance test at 24-28th gestational week.

RESULTS

GDM was developed in 110 (16.3%) pregnant women. The logistic regression analysis showed that baseline NC > 33.5 cm (OR: 2.037, 95% CI: 1.313-3.161; P = 0.002) and WC > 90.5 (OR: 2.299, 95% CI: 1.510-3.501; p < 0.001) were independent predictors of GDM. The area under the receiver operating characteristic (ROC) curve analysis of baseline NC and WC for GDM prediction respectively yielded 0.614 (95% CI: 0.558-0.670, p < 0.001) and 0.641 (CI: 0.583-0.698, p < 0.001). The optimal cut-off level of maternal baseline NC was >33.5 cm, with 68.5% sensitivity and 48.3% specificity, and for baseline WC it was >90.5.50 cm, with 57% sensitivity and 63.4% specificity.

CONCLUSION

Pregnant women with an NC > 33.5 cm and a WC > 90.5 cm at baseline (12-14th gestational weeks) had a higher chance of developing GDM. first-trimester NC and waist circumference (WC) measurements present a predictive index for GDM diagnosis.

Association between maternal adiposity measures and adverse maternal outcomes of pregnancy: Systematic review and meta-analysis

Maternal obesity increases pregnancy-related risks. Women with a body mass index (BMI) ≥ 30 kg/m² are considered to be at risk and should receive additional care, although approximately half will have uncomplicated pregnancies. This systematic review aimed to identify early pregnancy measures of adiposity associated with adverse maternal health outcomes. Searches included six databases, reference lists, citations, and contacting authors. Screening and quality assessment were carried out by two authors independently. Random effects meta-analysis and narrative synthesis were conducted. Seventy studies were included with a pooled sample of 89,588 women. Meta-analysis showed significantly increased odds of gestational diabetes mellitus (GDM) with higher waist circumference (WC) categories (1.40, 95% confidence interval [CI] 1.04, 1.88) and per unit increase in WC (1.31, 95% CI 1.03, 1.67). Women with GDM had higher WC than controls (mean difference [MD] 6.18 cm, 95% CI 3.92, 8.44). WC was significantly associated with hypertensive disorders, delivery-related outcomes, metabolic syndrome, and composite pregnancy outcomes. Waist to hip ratio was significantly associated with GDM, hypertensive disorders, and delivery-related outcomes. Fat mass, neck circumference, skinfolds, and visceral fat were significantly associated with adverse outcomes, although limited data were available. Our findings identify the need to explore how useful adiposity measures are at predicting risk in pregnancy, compared with BMI, to direct care to women with the greatest need.

Neck circumference as a predictor of gestational diabetes and risk of adverse outcomes in pregnancy of Brazilian woman with overweight and obesity

Objective

To evaluate the association of neck circumference (NC) with gestational diabetes (GDM) and adverse outcomes in women with overweight and obesity.

Subjects and methods

This prospective study included 132 (BMI > 25 kg/m2) pregnant women without and with GDM. Standardized questionnaire and biochemical/physical evaluation were performed during the 1st to 3rd trimester. Fifth-five women were evaluated regarding hypertension in pregnancy, type of delivery and neonatal complications (death, intensive care unit admission and hypoglycemia).

Results

Women with (n = 61) and without (n = 71) GDM had similar mean (SD) pre-gestational BMI [30.3 (4.0) vs. 29.4 (3.5) kg/m2, p = 0.16]. Women with GDM were older [32 (6) vs. 28 (6) yrs, p < 0.001] and had greater NC [36.0 (2.7) vs. 34.5 (1.8) cm, p < 0.001]. NC was similar in women with GDM diagnosed in first or third trimester [p = 0.4] and was correlated with FPG [r 0.29, p = 0.01] and systolic [r 0.28, p = 0.001] and diastolic [r 0.25, p = 0.004] blood pressure. NC was associated with GDM [OR 1.25, 95%CI 1.03-1.52] adjusted for age, physical activity, education and familiar history of diabetes. In ROC analysis, the area under the curve was 0.655 and the cut-off value of 34.5 cm had 0.70 of sensitivity and 0.51 of specificity for GDM. Women who had NC ≥ 34.5 vs. < 34.5 cm had higher frequencies of hypertension [32.3 vs. 4.2%, p = 0.01].

Conclusion

In a group of pregnant women with overweight or obesity, NC can be a useful tool for identifying risk of GDM and obstetric adverse outcomes.

The relationship between neck circumference and gestational diabetes mellitus in Iranian women

Background

The aim of the present study was to assess the relationship between neck circumference and gestational diabetes.

Methods

This prospective study was conducted on 372 Iranian pregnant women. The criteria set by the American Diabetes Association through 2 h was used to classify subjects with regard to their gestational diabetes. At the 14–16th weeks of pregnancy, the neck circumference was measured. The maternal and fetal outcomes were measured as well.

Results

The adjusted logistic regression revealed that neck circumference was a predictor for gestational diabetes mellitus (OR = 1.20; 95% CI = 1.06, 1.34; P = 0.002). The ROC analysis depicted that the cut-off for neck circumference in indicating gestational diabetes was 34.3 cm, with the sensitivity of 53% and the specificity of 66%.

Conclusion

The findings of the present study revealed that the neck circumference of ≥34.3 cm can be deemed as a predictor of gestational diabetes in the case of Iranian pregnant women.

Correlation of Maternal Neck/Waist Circumferences and Fetal Macrosomia in Low-Risk Turkish Pregnant Women, a Preliminary Study

Goals: Our aim in this study was to determine if the maternal neck and waist circumference measured in the first three months of pregnancy were effective in prediction of fetal macrosomia.Material and methods In this retrospective cohort study; body mass index, neck circumference (NC) and waist circumference (WC) was measured in low risk pregnant women at 11-13+^6th weeks of pregnancy.Results Among the 361 women, 8% of newborns were over 4000 grams. The rate of fetal macrosomia increased with the increased NC and WC. In ROC analysis, optimum cutoff value of NC was >36.5 cm to predict fetal macrosomia with 68.97% sensitivity and 66.97% specifity and for WC it was >88 cm with 62.07% sensitivity and 61.26% specifity.Conclusion Risk of fetal macrosomia increased with the increased maternal NC and WC.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Optimal maternal neck and waist circumference cutoff values for prediction of gestational diabetes mellitus at the first trimester in Turkish population; a prospective cohort study

Aims: To investigate if the maternal neck (NC) and waist (WC) circumferences measured in the first trimester of pregnancy have a predictive value in diagnosing gestational diabetes mellitus (GDM).Materials and methods: In this prospective study NC and WC of pregnant women were measured at 11-14th weeks. GDM was evaluated with a two-step oral glucose tolerance test at 24-28th weeks.Result: A total of 525 women were recruited; 49(9%) developed GDM. NC was positively correlated with WC (r: 0.583, p < .001), BMI (r: 0.533, p < .001), age (r: 0.123, p = .002), parity (r: 0.170, p < .001), and 50 g OGTT levels (r: 0.206, p < .001). Regarding the area under receiver operating characteristic (ROC) curve (AUC) analysis of NC and WC for predicting GDM were 0.585 (95% confidence interval (CI): 0.50-0.66, p = .043), and 0.693 (95%CI: 0.61-0.76, p < .001). The optimal cut off level of maternal NC was >38.5 cm, with 69% sensitivity and 45% specificity, and WC was >84.50 cm with a sensitivity of 78% and a specificity of 54%. Increased WC >84.50 cm (OR: 3.58, 95% CI:1.77-7.27; p < .001) and age >25 (OR: 3.05, 95% CI:1.38-6.72; p = .006) were independent predictors for the development of GDM adjusted for age, gravidity, parity, BMI, and NC.Conclusion: Maternal NC and WC were significantly higher in women with GDM; however, only maternal WC was a significant predictive marker for GDM in low-risk pregnant women.

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

OBJECTIVES

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

DESIGN

A community-based cross-sectional study.

SETTING

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

PARTICIPANTS

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

MAIN OUTCOME MEASURES

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

RESULTS

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

CONCLUSIONS

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

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Risk factors for hyperglycemia in pregnancy in the DALI study differ by period of pregnancy and OGTT time point

OBJECTIVE

Risk factors are widely used to identify women at risk for gestational diabetes mellitus (GDM) without clear distinction by pregnancy period or oral glucose tolerance test (OGTT) time points. We aimed to assess the clinical risk factors for Hyperglycemia in pregnancy (HiP) differentiating by these two aspects.

DESIGN AND METHODS

Nine hundred seventy-one overweight/obese pregnant women, enrolled in the DALI study for preventing GDM. OGTTs were performed at ≤19 + 6, 24-28 and 35-37 weeks (IADPSG/WHO2013 criteria). Women with GDM or overt diabetes at one time point did not proceed to further OGTTs. Potential independent variables included baseline maternal and current pregnancy characteristics.

STATISTICAL ANALYSIS

Multivariate logistic regression.

RESULTS

Clinical characteristics independently associated with GDM/overt diabetes were at ≤19 + 6 weeks, previous abnormal glucose tolerance (odds ratio (OR): 3.11; 95% CI: 1.41-6.85), previous GDM (OR: 2.22; 95% CI: 1.20-4.11), neck circumference (NC) (OR: 1.58; 95% CI: 1.06-2.36 for the upper tertile), resting heart rate (RHR, OR: 1.99; 95% CI: 1.31-3.00 for the upper tertile) and recruitment site; at 24-28 weeks, previous stillbirth (OR: 2.92; 95% CI: 1.18-7.22), RHR (OR: 3.32; 95% CI: 1.70-6.49 for the upper tertile) and recruitment site; at 35-37 weeks, maternal height (OR: 0.41; 95% CI: 0.20-0.87 for upper tertile). Clinical characteristics independently associated with GDM/overt diabetes differed by OGTT time point (e.g. at ≤19 + 6 weeks, NC was associated with abnormal fasting but not postchallenge glucose).

CONCLUSION

In this population, most clinical characteristics associated with GDM/overt diabetes were non-modifiable and differed by pregnancy period and OGTT time point. The identified risk factors can help define the target population for future intervention trials.

Correlation Between Neck Circumference and Gestational Diabetes Mellitus and Associated Risk Factors During Pregnancy

Introduction

Due to normal physiological changes in various anthropometric indices during pregnancy, the routine measurements of body weight, height, waist circumference, and waist-to-hip ratio are deemed inappropriate in predicting obesity and risk of gestational diabetes mellitus in pregnancy. Neck circumference is a novel marker to determine the risk of gestational diabetes in pregnancy. We conducted this study to determine the correlation between neck circumference and gestational diabetes mellitus and its associated risk factors.

Methods

This was an observational, cross-sectional study conducted at Jinnah Allama Iqbal Institute of Diabetes and Endocrinology (JAIDE), Allama Iqbal Medical College/ Jinnah Hospital, Lahore from July 2017 to March 2018. Pregnant females at 16 weeks of gestation underwent measurement of weight, height, body mass index, neck, and waist circumference. At the 24^th gestational week, an oral glucose test was conducted and fasting lipid profile, serum albumin, and uric acid were measured. Pearson’s correlation was used to see any correlation between neck circumference and gestational diabetes and its associated risk factors.

Results

There were 90 subjects in the study with a mean age 30.8 ± 3.2 (range: 26 – 34) years. The waist and neck circumference at 16 weeks of gestation measured 104.2 ± 9.0 cm and 36.1 ± 2.8 cm, respectively. Age, weight, waist circumference, and body mass index were positively and significantly correlated with neck circumference (p-value < 0.05). After adjusting for age, the correlation between neck circumference and weight, waist circumference, and body mass index (BMI) was statistically significant with a p-value < 0.05. Analysis of the receiver operating curve revealed that the cut-off value of neck circumference for predicting gestational diabetes was 35.70 cm with a sensitivity of 51.4% and specificity of 81.2%.

Conclusion

Neck circumference at the 16^th gestational week is a reliable and valid tool to predict gestational diabetes mellitus at 24 weeks of gestation.

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 circumference might predict gestational diabetes mellitus in Han Chinese women: A nested case-control study

AIMS/INTRODUCTION

A large neck circumference might be an indicator of metabolic syndrome and its components, and for certain patients is more practical as an index than waist circumference. The demarcation value for neck circumference that suggests metabolic syndrome appears to vary by ethnic group. Gestational diabetes mellitus is considered a component of metabolic syndrome in pregnant women. We investigated whether neck circumference in Han Chinese women is associated with gestational diabetes mellitus in early pregnancy, and determined a predictive demarcation value.

MATERIALS AND METHODS

A nested case-control study was carried out with 255 women aged 18-35 years. Gestational diabetes mellitus was diagnosed according to the criteria of the American Diabetes Association through a 2-h, 75-g oral glucose tolerance test.

RESULTS

Of the total population, 41 (16%) women developed gestational diabetes mellitus by 24-28 weeks of gestation. Neck circumference at gestational week 16 positively correlated with pre-pregnancy waist circumference, bodyweight and body mass index, and maternal age (P = 0.029) and hemoglobin A1c at gestational week 24 (P ≤ 0.001). By binary logistic regression, neck circumference was an independent predictor of gestational diabetes mellitus (odds ratio 1.840, 95% confidence interval 1.040-3.254; P = 0.036). According to the receiver operating characteristic curve, for predicting gestational diabetes mellitus the optimal demarcation for neck circumference at gestational week 16 was 35.15 cm.

CONCLUSIONS

Neck circumference is a viable tool to screen for gestational diabetes mellitus. In this population of pregnant Han Chinese women, a neck circumference of ≥35.15 cm was a predictor of gestational diabetes mellitus.