Waist, neck circumferences, waist-to-hip ratio: Which is the best cardiometabolic risk marker in women with severe obesity? The SOON cohort.

Anne-Laure Borel,Catherine Arvieux,Stéphane Ruckly,Fabian Reche,Nelly Wion,Renaud Tamisier,Sandrine Coumes,Jean-Louis Pépin,Ying-Mei Feng

doi:10.1371/journal.pone.0206617

Anne-Laure Borel, Catherine Arvieux + Show 7 more

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https://doi.org/10.1371/journal.pone.0206617

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Abstract

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.MethodsData from women (n = 305, aged 43 [34; 53] years-old, BMI 44.2 [40.8; 48.2] kg/m2) included in the Severe Obesity Outcome Network (SOON) cohort were analyzed (i) to evaluate collinearity between the different anthropometric markers, (ii) to compare the association of markers with hypertension, type 2 diabetes, obstructive sleep apnea syndrome (OSAS) and other cardiometabolic risks.ResultsHip, waist and neck circumferences correlated with BMI with respectively less collinearity (r = 0.70, r = 0.59 and r = 0.37, respectively, p<0.001) whereas waist-to-hip ratio was not correlated (r = 0.11, p = 0.072). Waist and neck circumferences were significantly associated with hypertension, type 2 diabetes and OSAS in univariate logistic regressions, waist-to-hip ratio with hypertension and type 2 diabetes. Hip circumference was inversely correlated with type 2 diabetes (OR 0.970 (95CI: 0.948; 0.991) p = 0.006). BMI was only linked to OSAS (OR 1.092 (95CI: 1.043; 1.143) p<0.001). Neck circumference was the only marker significantly associated with all cardiometabolic risk markers (HOMA-IR, apnea-hypopnea index, Log Triglycerides/HDL-c, alanin-aminotransferase, aspartate-aminotransferase, gammaglutamyl transpeptidase).ConclusionsNeck circumference appears the most appropriate anthropometric marker to identify the fat distribution associated with high cardiometabolic risk in women with severe obesity.

Highlights

Obesity affects physical, psychological and social well-being
Waist and neck circumferences correlated with body mass index (BMI) with respectively less collinearity (r = 0.70, r = 0.59 and r = 0.37, respectively, p
Waist and neck circumferences were significantly associated with hypertension, type 2 diabetes and obstructive sleep apnea syndrome (OSAS) in univariate logistic regressions, waist-to-hip ratio with hypertension and type 2 diabetes

Summary

Introduction

There is a relationship between obesity and cardiometabolic diseases, the risk of developing such diseases is variable. In the 1950’s studies showed that obesity-related cardiovascular and metabolic comorbidities were associated with a centralized deposit of adiposity [1]. Excess visceral fat is associated with a loss of the capacity to stock excessive calories within subcutaneous adipose tissue, inducing an ectopic fat deposition in the liver, muscles, heart etc. Patients with a central obesity distribution have a higher risk of hypertension, type 2 diabetes, obstructive sleep apnea syndrome (OSAS) and non-alcoholic fatty liver diseases (NAFLD). Obese patients with peripheral or subcutaneous adiposity are usually “metabolically healthy”, and even protected against metabolic diseases because subcutaneous adiposity is both a marker of, and a contributor to, a high level of insulin sensitivity [4, 5]

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