Neck circumference in assessment of cardiovascular disease and dyslipidemia risk in Chinese type 2 diabetes: Beijing Community Diabetes Study (BCDS-15)
Authors: Guangran Yang, Shenyuan Yuan, Hanjing Fu, Gang Wan, Liangxiang Zhu, Mingxia Yuan, Sufang Pan, Xianglei Bu, Jiandong Zhang, Xueping Du, Yuling Li, Yu Ji, Xiaoning Gu, Yue Li, Xueli Cui, Wei Bai, Yujie Chen, Ziming Wang, Shuyan Cheng, Ying Gao, Deyuan Liu, Yipin Wang
Journal: BMJ (2016)

Objective
To evaluate the detecting power of neck circumference (NC) for cardiovascular disease and dyslipidemia in type 2 diabetes among the Chinese population.


Methods
Total 3 176 subjects aged 20-80 years with type 2 diabetes, including 1 291 (40.7%) males and 1 885 (59.3%) females, were recruited from 15 community health centers in Beijing using a multi-stage random sampling approach. The duration of diabetes was (9±7) years. Among all subjects there were 2 103 (66.2%) with hypertension, 2 903 (91.4%) with dyslipidemia, 616 (19.4%) with coronary heart disease and 398 (12.5%) with stroke. An anthropometric study, including neck and waist circumference (NC and WC) measurements, was conducted. ROC analyses were used to compare the association between different anthropometric indicators with cardiovascular risk factors. 1 291 (40.7%) were male and 1 885 (59.3%) were female. The duration of diabetes was (9±7) years. There were 2103 people (66.2%) with hypertension, 2 903 people (91.4%) with dyslipidemia, 616 people (19.4%) had coronary heart disease and 398 people (12.5%) with stroke.


Results
The mean NC was (36.6±3.7) cm, WC was (89.4±9.4) cm, waist-to-hip ratio (WHR) was 0.89±0.06. NC, WC and WHR in males were higher than those in females [NC(38.4±3.6) vs. (35.4±3.3)cm, WC (91.6±8.7) vs. (87.9±9.6)cm, WHR (0.91±0.06) vs. (0.88±0.06), t=24.251, 11.148, 14.249, all P<0.001]. HbA1c value in males was higher than that in females [(7.3±1.7%) vs. (7.2±1.5)%, t=2.089, P=0.037]. There were statistically significant differences in TC, LDL-C and HDL-C between the sex groups [TC (5.0±1.3)mmol/L vs. (5.3±1.2) mmol/L, LDL-C(2.9±0.9) vs. (3.0±0.9) mmol/L, HDL-C(1.3±0.5) vs. (1.4±0.5) mmol/L, t=-5.837, -3.562, -6.788, all P<0.001]. The area under curve (AUC) of NC, WC and WHR in detection of hypertension in males were 0.599, 0.557, and 0.563 (NC vs. WC, Z=2.486, P=0.013, NC vs. WHR, Z=0.273, P=0.785). The AUC of NC, WC and WHR in detection of hypertension in females were 0.578, 0.576, and 0.540 (WC vs. WHR, Z=3.021, P=0.003, WC vs. NC, Z=0.181, P=0.857, NC vs. WHR, Z=1.983, P=0.057). There was no statistically significant in the AUC of NC, WC and WHR in detection of dyslipidemia, stroke, and coronary heart disease. The AUC of NC, WC and WHR in detection of two or more diseases (hypertension, coronary heart disease, stroke and dyslipidemia) were not statistically significant.


Conclusion
Compared to WC and WHR, NC, an operable anthropometric index, might be used to identify hypertension, dyslipidemia, stroke, coronary heart disease with medium efficiency in the Chinese diabetic population.


Key words: 
Diabetes mellitus, type 2; Waist circumference; Neck circumference; Waist-hip ratio; Cardiovascular disease