Changes In Neck Circumference Research Articles

Effects of Tongue Strength Training on Patients with Mild to Moderate Sleep-disordered Breathing: A Randomized Controlled Trial.

: Several studies have reported that oropharyngeal myofunctional therapy (OMT) reduces the severity of obstructive sleep apnea (OSA). However, because OMT protocols are often complicated, they take time and effort to implement. The aim of this study was to determine the therapeutic effect of 8 weeks of simple tongue strength training with a training device. : Twenty patients with mild to moderate sleep-disordered breathing were randomized to the control group (n=10) or intervention group (n=10). The patients in the intervention group completed 8 weeks of daily tongue strength training using a training device. After 8 weeks, we evaluated each patient for sleep-disordered breathing by portable monitoring. We also evaluated each patient's body mass index (BMI), neck circumference, Epworth Sleepiness Scale (ESS) score, and tongue pressure. No significant difference was found in the change in apnea hypopnea index (AHI) from baseline to 8 weeks between the control and intervention groups (P=0.44). However, the changes in neck circumference (P=0.02) and maximum tongue pressure (P=0.03) from baseline to 8 weeks were significantly different between the two groups. No significant difference was found for changes in BMI and ESS scores from baseline to 8 weeks between the two groups. : Tongue strength training in patients with sleep-disordered breathing did not significantly improve AHI as measured by portable monitoring, although significant changes were observed for increased tongue pressure and reduced neck circumference.

Change in Mallampati Score during Pregnancy, Labour and Post Labour: An Observational Study

Background Mallampati (MP) score is used to predict the ease of endotracheal intubation. Pregnancy is often associated with failed intubation during anaesthesia for caesarean delivery and contributes majorly to maternal complications that are related to anaesthesia. This study aimed to determine the change in MP grade over the course of pregnancy (first trimester, during labour and post-delivery). Methods The study was conducted on 389 pregnant women in the first trimester. Demographic data, airway characteristics and MP score of the patients were recorded at different stages of pregnancy. Change in MP grade was assessed for those patients, who have delivered vaginally. Results The mean age of the study subjects was 25.77±3.64 years. There was a significant association of MP score with weight gain (P<0.0001) and change in neck circumference (P<0.0001). There was a significant change in the number of patients with MP grade 3 and 4 was noted from first trimester (n=14; 2.26%) to 48 hours post-delivery (n=78; 24.6%) (P<0.01), showing a strong association between change in MP score and pregnancy. Conclusion There was a significant increase in the MP score over the course of pregnancy that may be attributed to gestational weight gain along with variations in the neck circumference in pregnant women. Hence, assessment of MP score is important for proper management of difficult intubation, especially in parturient.

The relationship between extracellular fluid and obstructive sleep apnea in non-obese patients

ABSTRACT Objective To evaluate the relationship between obstructive sleep apnea syndrome (OSAS) and the fluid change in composition throughout the night. Methods The study included 92 non-obese patients who underwent polysomnography because of suspected OSAS. Weight and body composition analyses were applied using a Tanita DC-360 multi-frequency body composition analysis device. Results In the correlation analyses between apnea/hypopnea index (AHI) values and independent variables, a positive relationship was determined with extracellular fluid shift (r: 0.381, p = 0.009) and change in neck circumference (r: 0.226, p = 0.031), and there was a negative relationship between disease severity and an increase in the number of daily steps taken (r: 0.208, p = 0.047). Conclusion The results of the study clearly showed that movement to the neck area of fluid accumulated in the lower extremities and an increase in extracellular fluid were related to AHI values independent of body mass index (BMI).

Effect of compression stockings on overnight rostral fluid shift and obstructive sleep apnea: A meta-analysis

ObjectiveThe overnight rostral fluid shift from the lower limbs is one of the causes of obstructive sleep apnea (OSA). Compression stockings (CS) prevent lower limb fluid retention and have been reported to decrease nighttime fluid shift. The aim of this study is to evaluate the effect of CS on fluid shift and the severity of OSA. MethodsA systematic literature search was performed in the PubMed, EMBASE and Cochrane Library databases. The data were analyzed using Comprehensive Meta-Analysis software (Version 3; Biostat, Englewood, NJ). Studies evaluating the effect of CS on the overnight fluid shift and OSA severity were included in the analysis. ResultsA total of 4 studies were included in this meta-analysis. The pooled analysis showed that the apnea-hypopnea index (AHI) of the overall study group was significantly lower after using CS (SMD, -1.08; 95% CI, -1.49 to -0.67). Decreases in the AHI were also observed in the normal fluid status (SMD, -1.05; 95% CI, -1.73 to -0.37) and fluid overload status (SMD, -1.17; 95% CI, -1.76 to -0.58) populations. The overall study group had significant decreases in overnight changes in neck circumference (SMD, -1.05; 95% CI, -2.06 to -0.03) and leg fluid volume (SMD, -1.14; 95% CI, -1.88 to -0.41) after using CS. However, no significant differences in overnight changes in neck circumference and leg fluid volume were observed in normal fluid status patients. ConclusionCS may help decrease overnight fluid shift and could be a treatment option for OSA.

Taste loss with obesity in mice and men

Our sense of taste is critical in defining our food choices and habits. Located primarily in our tongue, taste buds are small assemblies of constantly renewing sensory cells, tasked with evaluating oral stimuli before the food we eat is consumed. Using both mice and a free-living human population, we tracked taste papilla abundancy with weight gain, to test for deficiencies in the taste system of obese mice and humans with increased adiposity. Mice fed a high-fat diet for 8 weeks expressed markers for all subtypes of taste cells at a lower level than chow-fed counterparts. This came alongside the loss of markers for taste cell proliferation (Ki-67) and development (β-catenin), as well as lower fungiform papillae density, consistent with earlier results showing lower circumvallate taste bud abundance in obese mice. Likewise, in a population of college students tracked through 4 years of college attendance, the change in density of fungiform papillae, which house taste buds in the anterior tongue, was negatively correlated with change in neck circumference, a marker of adiposity. These results highlight changes in taste during weight gain as a potentially important consideration in the study of obesity.

Serum Uric Acid Reduction Is Associated with Gender Differences and Body Fat Distribution after Laparoscopic Sleeve Gastrectomy

Background: Uric acid is believed be an important modulator in glucose and lipid metabolism. This study is aimed to estimate the efficacy of laparoscopic sleeve gastrectomy (LSG) on obese patients and find out the relationship of serum uric acid (SUA) to body fat distribution in both male and female of Chinese patients. Methods: A total of 65 obese patients (32 females and 33 males) who underwent LSG were enrolled for this study. Their body composition was measured by dual-energy X-ray absorptiometry (DEXA). The data of anthropometric measurements, glucolipid metabolism and SUA was collected before and 6 months after LSG separately. Results: More significant reduction of SUA was observed in the female group than the male group after LSG (female (17.98±12.72)% vs. male(3.22±15.66)%, p<0.001). Furthermore, changes in SUA showed significantly positive correlation with visceral adipose tissue (VAT) in female patients (r=0.542,p=0.011). And it was also positively correlated with changes of the area under the curve(AUC) for glucose during 75g oral glucose tolerance test(r=0.567,p=0.002), fasting insulin(r=0.505,p=0.006) and natural logarithm of HOMA-IR (r=0.427,p=0.023). Post-surgery high-density lipoprotein (HDL) levels significantly increased from 0.89±0.19 to 1.18±0.23 mmol/L (p<0.001) in males. The reduction of SUA in male patients were positively associated with changes in neck circumference(r=0.617,p=0.000)and hip circumference(r=0.381,p=0.042), and negatively correlated with changes in HDL levels (r = -0.422, P = 0.018). It was also positively correlated with changes of fat content in upper arm, legs and gynoid area (r=0.450, r=0.650, r=0.432, respectively; all p<0.05), while unrelated to visceral fat in the male group. Conclusions: The efficacy of LSG on glycolipid metabolism may be associated with gender-related differences in body fat distribution. Uric acid may be a gendered modulator of glucose and lipid metabolism. Disclosure X. Zhang: None. F. Mei: None. J. Gao: None. X. Cheng: None. L. Bu: None. C. Zhu: None. S. Qu: None.

Association of Changes in Neck Circumference with Cardiometabolic Risk in Postmenopausal Healthy Women.

Although neck circumference (NC) is thought to predict obesity-related metabolic abnormality, its causal role in cardiometabolic risk is unclear. The aim of this study was to clarify the impact of changes in NC on cardiometabolic risk in healthy postmenopausal women through a community-based longitudinal study. From a local community in Japan, 63 generally healthy postmenopausal women were recruited. All participants received an assessment of obesity-related anthropometric markers, biochemical parameters, and hemodynamic measures and were followed on average for 3 years. At baseline analysis, larger NC was positively associated with atherosclerosis-related markers, brachial-ankle pulse wave velocity (baPWV) and blood pressure, as well as some lipid parameters. After the follow-up period, change in NC was associated with changes in body mass index (BMI), body fat percentage, and waist circumference (WC). Interestingly, significant correlations of change in NC with changes in baPWV and blood pressure were observed, whereas changes in WC and BMI were only associated with changes in low-density lipoprotein cholesterol and/or total cholesterol. In multivariate linear regression analysis, change in NC was significantly associated with changes in baPWV and systolic blood pressure, independent of changes in BMI, WC, and biochemical parameters. In addition, an increase in NC was associated with a 2.69-fold increased odds ratio of accelerated baPWV. Change in NC was independently associated with changes in atherosclerosis-related markers. These observations suggest that NC is an important predictor of the risk of developing obesity-related atherosclerosis in healthy postmenopausal women.

Change in neck circumference after shoulder arthroscopy: An observational study.

Background and Aims:Shoulder arthroscopy requires fluid irrigation, which causes soft-tissue oedema around chest, neck, and arm intraoperatively, leading to postoperative airway complications. We decided to study the incidence of increase in the neck circumference in shoulder arthroscopy and its effects on the airway.Methods:We studied 32 cases of shoulder arthroscopies over a period of 1-year, performed under general anaesthesia with interscalene block. The neck circumference of patients before and after the procedure was measured along with other parameters. The endotracheal tube cuff was deflated at the end of surgery to determine air leak around the tube. The negative leak test suggested airway oedema.Results:Thirty out of 32 patients showed positive air leak test. The average change in neck circumference was 1.17 ± 1.16 cm and all could be extubated uneventfully. Two showed negative leak test with an increase in neck circumference by 4.5 and 6.4 cm and were not extubated. Multiple regression analysis for risk factors showed intraoperative hypertension as a single predictor for an increase in neck circumference.Conclusion:Change in the neck circumference beyond 4 cm may suggest airway compromise and below 4 cm, airway compromise is unlikely even in the presence of extensive soft-tissue oedema around the shoulder, upper arm and chest.

Shoulder arthroscopy and complications: Can we afford to relax?

Shoulder arthroscopy and complications: Can we afford to relax?

Effect of intensified diuretic therapy on overnight rostral fluid shift and obstructive sleep apnoea in patients with uncontrolled hypertension

Fluid displacement from the lower extremities to the upper body during sleep is strongly associated with obstructive sleep apnoea in hypertensive patients. The present pathophysiological study tests the hypothesis that intensified diuretic therapy will reduce the apnoea-hypopnoea index and blood pressure of uncontrolled hypertensive patients with obstructive sleep apnoea in proportion to the reduction in overnight change in leg fluid volume. Uncontrolled treated hypertensive patients underwent overnight polysomnography and measurement of overnight changes in leg fluid volume and neck circumference. Those with an apnoea-hypopnoea index at least 20 events per hour (n=16) received metolazone 2.5 mg and spironolactone 25 mg daily for 7 days after which the daily dose was doubled for 7 additional days. Baseline testing was again repeated. Intensified diuretic therapy reduced the apnoea-hypopnoea index from 57.7 ± 33.0 to 48.5 ± 28.2 events per hour (P=0.005), overnight change in leg fluid volume from -418.1 ± 177.5 to -307.5 ± 161.9 ml (P<0.001) and overnight change in neck circumference from 1.2 ± 0.6 to 0.7 ± 0.4 cm (P<0.001). There was an inverse correlation between the reduction in overnight change in leg fluid volume and decrease in apnoea-hypopnoea index (r=-0.734, P=0.001). The reduction in overnight change in leg fluid volume was also significantly correlated with the change in morning blood pressure (r=0.708, P=0.002 for SBP; r=0.512, P=0.043 for DBP). The findings provide further evidence that fluid redistribution from the legs to the neck during sleep contributes to the severity of obstructive sleep apnoea in hypertension and may be an important link between these two conditions.

Anthropometry and Body Composition Status during Ramadan among Higher Institution Learning Centre Staffs with Different Body Weight Status

This study was done to observe the anthropometry and body composition changes before, during, and after the holy month of Ramadan. This study was carried out on 46 staff from one of the local universities, which comprised of 14 males and 32 females ranging in age from 25 to 40 years old. There were four sessions done to complete this study, namely, a week before Ramadan (T1), 1st week of Ramadan (T2), 3rd week of Ramadan (T3), and a month after Ramadan (T4). All subjects were assessed according to weight, body circumference, and body composition status. It was found that subjects with different weight status showed a significant reduction in weight (P < 0.01) but no significant reduction in body fat percentage (P < 0.05). The findings suggest that weight reduction does not promise a reduction in body fat. Changes in neck circumference were only found in normal subjects. Hence, it can be said that overweight and obese subjects showed no changes in anthropometry status during Ramadan. No changes in body composition were reported in all three weight groups except for trunk body fat. In conclusion, normal subjects showed significant changes in various anthropometry parameters, but overweight and obese subjects showed no obvious difference.

Immediate and overnight recumbence-dependent changes of neck circumference: Relationship with OSA severity in obese and nonobese subjects

Overnight increases in neck circumference - attributed to rostral fluid displacement - correlate with the severity of obstructive sleep apnea (OSA). No studies were found investigating the relationship between OSA severity and recumbence-related immediate changes in neck circumference. We evaluated the relationship of OSA severity with immediate recumbence-related and overnight changes in neck circumference in obese and nonobese subjects. Male patients undergoing full-night in-laboratory polysomnography had their neck and ankle circumferences determined before and after sleep, both while standing and supine. Circumference changes were calculated by the difference between standing and recumbent positions (Immediate Change) and between before and after sleep (Overnight Change). Immediate Change in neck circumference showed a linear significant correlation with apnea-hypopnea index (AHI; r=0.37373; p=0.012) and with lowest O2 saturation (r=-0.35355; p=0.017). In a multivariate model to predict AHI, adjusting for age and obesity, Immediate Change in neck circumference is the only significant regressor (beta=0.34; p=0.03). The Overnight Change in neck circumference correlated neither with the AHI nor with the lowest SaO2. Correlation of AHI with the immediate increase in neck circumference on assuming recumbence indicates that fast components of tissue displacement, besides overnight fluid displacement, may have implications in the pathogenesis of OSA.

Rostral overnight fluid shift in end-stage renal disease: relationship with obstructive sleep apnea

In both healthy male subjects and men with heart failure, the severity of obstructive sleep apnea (OSA) is related to the amount of fluid displaced from their legs into the neck overnight. Whether overnight rostral fluid shift contributes to the pathogenesis of OSA in patients with end-stage renal disease (ESRD) is unknown. We hypothesized that the change in neck circumference (NC) and severity of OSA are related to the extent of overnight change in leg fluid volume (LFV) in patients with ESRD. We studied 26 patients with ESRD (14 men) on conventional hemodialysis. All subjects underwent polysomnography. LFV was measured by bioelectric impedance at bedtime and repeated in the next morning on awakening. Our cohort's overall apnea-hypopnea index was 22.8±26.8 episodes/h of sleep. Their overnight change in LFV was -243±278 mL. The change in LFV correlated with apnea-hypopnea time (AHT) (P=0.001) and NC (P=0.0016). Other independent factors associated with AHT included age (P=0.005), baseline neck (P=0.0002), sitting time (P=0.008) and male gender. Stepwise multiple regression analysis revealed that age, change in LFV and male gender remained independent related to AHT. Nocturnal rostral fluid shift is associated with the severity of OSA in ESRD. Prospective evaluation of the effect of reducing fluid overload and severity of OSA in ESRD patients warrants further examination.

Association of Incident Cardiovascular Disease With Progression of Sleep-Disordered Breathing

Prospective data suggest that sleep-disordered breathing enhances risk for incident and recurrent cardiovascular disease (CVD). However, a reverse causal pathway whereby incident CVD causes or worsens sleep-disordered breathing has not been studied. A total of 2721 Sleep Heart Health Study participants (mean age 62, standard deviation=10 years; 57% women; 23% minority) without CVD at baseline underwent 2 polysomnograms 5 years apart. Incident CVD events, including myocardial infarction, congestive heart failure, and stroke, were ascertained and adjudicated. The relation of incident CVD to change in apnea-hypopnea index between the 2 polysomnograms was tested with general linear models, with adjustment for age, sex, race, study center, history of diabetes mellitus, change in body mass index, change in neck circumference, percent sleep time spent in supine sleep, and time between the 2 polysomnograms. Incident CVD occurred in 95 participants between the first and second polysomnograms. Compared with participants without incident CVD, those with incident CVD experienced larger increases in apnea-hypopnea index between polysomnograms. The difference in adjusted mean apnea-hypopnea index change between subjects with and without incident CVD was 2.75 events per hour (95% confidence interval, 0.26 to 5.24; P=0.032). This association persisted after subjects with central sleep apnea were excluded. Compared with participants without incident CVD, participants with incident CVD had greater increases in both mean obstructive and central apnea indices, by 1.75 events per hour (95% confidence interval, 0.10 to 1.75; P=0.04) and by 1.07 events per hour (95% confidence interval, 0.40 to 1.74; P=0.001), respectively. In a diverse, community-based sample of middle-aged and older adults, incident CVD was associated with worsening sleep-disordered breathing over 5 years.

Nocturnal Rostral Fluid Shift

Obstructive sleep apnea (OSA) and central sleep apnea are common in patients with heart failure. We hypothesized that in such patients, severity of OSA is related to overnight rostral leg fluid displacement and increase in neck circumference, severity of central sleep apnea is related to overnight rostral fluid displacement and to sleep Pco(2), and continuous positive airway pressure alleviates OSA in association with prevention of fluid accumulation in the neck. In 57 patients with heart failure (ejection fraction <or=45%), we measured change in leg fluid volume and neck circumference before and after polysomnography, and we measured transcutaneous Pco(2) during polysomnography. Patients were divided into an obstructive-dominant group (>or=50% of apneas and hypopneas obstructive) and a central-dominant group (>50% of events central). Patients with OSA received continuous positive airway pressure. In obstructive-dominant patients, there were inverse relationships between overnight change in leg fluid volume and both the overnight change in neck circumference (r=-0.780, P<0.001) and the apnea-hypopnea index (r=-0.881, P<0.001) but not transcutaneous Pco(2). In central-dominant patients, the overnight reduction in leg fluid volume correlated inversely with the apnea-hypopnea index (r=-0.919, P<0.001) and the overnight change in neck circumference (r=-0.568, P=0.013) and directly with transcutaneous Pco(2) (r=0.569, P=0.009). Continuous positive airway pressure alleviated OSA in association with prevention of the overnight increase in neck circumference (P<0.001). Our findings suggest that nocturnal rostral fluid shift is a unifying concept contributing to the pathogenesis of both OSA and central sleep apnea in patients with heart failure.

Effects of Oropharyngeal Exercises on Patients with Moderate Obstructive Sleep Apnea Syndrome

Upper airway muscle function plays a major role in maintenance of the upper airway patency and contributes to the genesis of obstructive sleep apnea syndrome (OSAS). Preliminary results suggested that oropharyngeal exercises derived from speech therapy may be an effective treatment option for patients with moderate OSAS. To determine the impact of oropharyngeal exercises in patients with moderate OSAS. Thirty-one patients with moderate OSAS were randomized to 3 months of daily ( approximately 30 min) sham therapy (n = 15, control) or a set of oropharyngeal exercises (n = 16), consisting of exercises involving the tongue, soft palate, and lateral pharyngeal wall. Anthropometric measurements, snoring frequency (range 0-4), intensity (1-3), Epworth daytime sleepiness (0-24) and Pittsburgh sleep quality (0-21) questionnaires, and full polysomnography were performed at baseline and at study conclusion. Body mass index and abdominal circumference of the entire group were 30.3 +/- 3.4 kg/m(2) and 101.4 +/- 9.0 cm, respectively, and did not change significantly over the study period. No significant change occurred in the control group in all variables. In contrast, patients randomized to oropharyngeal exercises had a significant decrease (P < 0.05) in neck circumference (39.6 +/- 3.6 vs. 38.5 +/- 4.0 cm), snoring frequency (4 [4-4] vs. 3 [1.5-3.5]), snoring intensity (3 [3-4] vs. 1 [1-2]), daytime sleepiness (14 +/- 5 vs. 8 +/- 6), sleep quality score (10.2 +/- 3.7 vs. 6.9 +/- 2.5), and OSAS severity (apnea-hypopnea index, 22.4 +/- 4.8 vs. 13.7 +/- 8.5 events/h). Changes in neck circumference correlated inversely with changes in apnea-hypopnea index (r = 0.59; P < 0.001). Oropharyngeal exercises significantly reduce OSAS severity and symptoms and represent a promising treatment for moderate OSAS. Clinical trial registered with www.clinicaltrials.gov (NCT 00660777).

Relationship between Overnight Rostral Fluid Shift and Obstructive Sleep Apnea in Nonobese Men

The cause of increased pharyngeal collapsibility in patients with obstructive sleep apnea is incompletely understood. In awake healthy subjects, we showed that fluid displacement from the legs into the neck induced by lower body positive pressure reduces upper airway size and increases its collapsibility. Prolonged sitting leads to dependent fluid accumulation in the legs. To test the hypotheses that the apnea-hypopnea index (AHI) during sleep will be related to the amount of fluid spontaneously displaced from the legs overnight, and that this will, in turn, be related to the time spent sitting the previous day. In 23 nonobese healthy men referred for sleep studies for suspected obstructive sleep apnea, we assessed the changes in leg fluid volume and in neck circumference from the beginning to the end of the night, and the time spent sitting during the previous day. The overnight change in leg fluid volume correlated strongly with the AHI (r = -0.773, P < 0.001), the change in neck circumference (r = -0.792, P < 0.001), and the time spent sitting (r = -0.588, P = 0.003). Multivariate analysis showed that the only significant independent correlates of the AHI were the overnight changes in leg fluid volume and neck circumference, which together explained 68% of the variability in the AHI among subjects. These novel findings suggest that overnight rostral fluid displacement from the legs, related to prolonged sitting, may play a previously unrecognized role in the pathogenesis of obstructive sleep apnea in nonobese men that is independent of body weight.

Differentiating Effortful and Noneffortful Swallowing with a Neck Force Transducer: Implications for the Development of a Clinical Feedback System

This study sought to determine whether effortful saliva swallows could be differentiated from habitual, noneffortful saliva swallows on the basis of swallow-related changes in neck circumference in humans. Gender differences in swallow-related neck circumference were examined as a secondary question. Twenty-seven healthy adults (14 females; mean age = 26.6 years, SD = 3.9 years) participated in two experimental runs (run duration = 10 min) during which they produced single trials of three visually cued tasks in random order: effortful saliva swallowing, saliva swallowing, and a control task involving repetitive apposition of the dominant thumb and index finger. Neck and ribcage circumference were simultaneously collected from the output of force transducers positioned around the neck and ribcage, respectively. The primary outcome variables were the positive and negative voltage peak amplitudes associated with changes in neck circumference during single-swallow trials. Effects of the swallowing task on positive and negative voltage peaks were examined with separate two-way analysis of variance procedures. Results indicated that both positive (F = 6.49, p < 0.05) and negative (F = 12.05, p <or= .05) voltage peaks were significantly greater for effortful swallows compared with those for noneffortful swallows. The gender main effect and the swallow type by gender interaction were not significant. Effortful and noneffortful swallows of saliva can be differentiated from the output of a noninvasive force transducer worn around the neck. This type of physiologic recording may have potential as a biofeedback technique in training dysphagic patients on the effortful swallow maneuver.

Relationship between changes in neck circumference and changes in blood pressure

Objective Neck circumference (NC), as an upper body obesity index, is a simple screening measure for identifying overweight and obese patients. This study examines a relationship between changes in systolic blood pressure (BP), and diastolic BP and changes in NC, and other components of the metabolic syndrome. Methods In a longitudinal cohort study the study group was comprised of 364 subjects (155 men and 209 women) with no known major medical conditions who were not receiving any medication therapy. Main indicators studied included systolic BP, diastolic BP, NC, waist circumference (WC), waist-to-hip ratio (WHR), lipoprotein, glucose, and uric acid levels. Results Pearson's correlation coefficients indicated a significant association between changes in systolic BP and changes in NC (men, r = 0.54; women, r = 0.56; each, P < .0001), WC men, r = 0.51; women, r = 0.56; each, P < .0001), triglycerides (men, r = 0.41; women, r = 0.44; each, P < .0001), and glucose (men, r = 0.43, P < .001; women, r = 0.48, P < .0001); between changes in diastolic BP and changes in NC (men, r = 0.56; women, r = 0.68; each, P < .0001), WC (men, r = 0.62; women, r = 0.50; each, P < .0001), triglycerides (men, women; each, r = 0.39, P < .0001), and glucose (men, r = 0.45; women, r = 0.49; each, P < .0001). Conclusions Changes in systolic BP and diastolic BP correlated positively with changes in NC and other components of the metabolic syndrome.