Evaluation of neck circumference as a predictor of elevated cardiometabolic risk outcomes in 5–8-year-old Brazilian children

Meghan K Shirley,Joilane Alves Pereira-Freire,Karoline De Macêdo Gonçalves Frota,Jesuana Oliveira Lemos,Jonathan C.K Wells,Lays Arnaud Rosal Lopes Rodrigues,Larisse Monteles Nascimento,Valdenir Queiroz Ribeiro,Patrícia Helen De Carvalho Rondó

doi:10.1080/2574254x.2020.1738837

Abstract

ABSTRACT Background: Childhood overweight and obesity is a global health problem that continues to worsen in many low- and middle-income countries. Low-cost measurements for monitoring overweight and relative metabolic risk, such as neck circumference (NC), should be evaluated in different populations and age groups. Aim: To test associations of NC and BMI with cardiometabolic parameters in 5-8-year-old Brazilian children. Methods: This cross-sectional study carried out from 2004–2006 measured height, weight and NC by anthropometry, and estimated fat and fat-free mass by bioelectrical impedance. Cardiometabolic risk factors assessed were systolic and diastolic blood pressure, high- and low-density lipoprotein cholesterol, triglycerides, and homeostatic model assessment of insulin resistance (HOMA). Associations of NC and BMI with cardiometabolic risk factors were tested using multiple regression and precision-recall plot analysis. Results: Analyses included 371 children (52% female). NC associated positively with BMI, fat mass, and fat-free mass, and with systolic blood pressure and HOMA following adjustment for age in sex-stratified multiple regression models. However, the latter relationships largely disappeared following adjustment for BMI. Area under the curve for NC or BMI in association with systolic blood pressure or HOMA >90th percentile was low in the pooled sample, indicating poor classifier performance. Conclusions: NC and BMI demonstrated similar associations with cardiometabolic risk factors, although NC mostly did not correlate with risk factors independently of BMI. In contrast to previous studies, NC was a poor classifier of cardiometabolic risk factors in children. The association of NC with both fat and fat-free mass may aid in explaining its poor performance.

Highlights

The prevalence of overweight and obesity in children and adolescents, as assessed by body mass index (BMI, kg/m2), has plateaued at high levels in highincome countries, while continuing to increase in many low- and middleincome countries (Abarca-Gómez et al 2017)
neck circumference (NC) and BMI demonstrated similar associations with cardiometabolic risk factors, NC mostly did not correlate with risk factors independently of BMI
In contrast to previous studies, NC was a poor classifier of cardiometabolic risk factors in children

Summary

Introduction

The prevalence of overweight and obesity in children and adolescents, as assessed by body mass index (BMI, kg/m2), has plateaued at high levels in highincome countries, while continuing to increase in many low- and middleincome countries (Abarca-Gómez et al 2017). Cardiometabolic risk factors assessed were systolic and diastolic blood pressure, high- and low-density lipoprotein cholesterol, triglycerides, and homeostatic model assessment of insulin resistance (HOMA). NC associated positively with BMI, fat mass, and fat-free mass, and with systolic blood pressure and HOMA following adjustment for age in sex-stratified multiple regression models. The latter relationships largely disappeared following adjustment for BMI. Area under the curve for NC or BMI in association with systolic blood pressure or HOMA >90th percentile was low in the pooled sample, indicating poor classifier performance

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Discussion

Conclusion