Skip to main content
Top
Published in: Diabetology & Metabolic Syndrome 1/2018

Open Access 01-12-2018 | Research

Neck circumference is associated with non-traditional cardiovascular risk factors in individuals at low-to-moderate cardiovascular risk: cross-sectional analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Authors: B. Almeida-Pititto, I. T. Silva, A. C. Goulart, M. I. H. Fonseca, M. S. Bittencourt, R. D. Santos, M. Blaha, S. Jones, P. P. Toth, K. Kulakarni, P. A. Lotufo, I. M. Bensenor, S. R. G. Ferreira, the ELSA Research Group

Published in: Diabetology & Metabolic Syndrome | Issue 1/2018

Login to get access

Abstract

Background

Neck circumference (NC) is associated with traditional cardiovascular risk factors (CVRF), but its usefulness to identify earlier atherogenic risk has been scarcely examined. Associations of NC with non-traditional CVRF were investigated in participants at low-to-moderate risk from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

Methods

807 individuals (35–54 years) without obesity, diabetes or cardiovascular disease was stratified into quartiles of NC (cut-off for men: 36.5; 37.9 and 39.5 cm; women: 31.4; 32.5 and 34 cm) and traditional and non-traditional risk factors (lipoprotein subfractions by Vertical Auto Profile, adiponectin, leptin, E-selectin) were compared across groups. In linear regression models, associations of NC with non-traditional risk factors were tested for the entire sample and for low-risk group (≤ 2 CVRF).

Results

In both sexes, BMI, waist circumference, systolic and diastolic blood pressure, fasting and 2-h plasma glucose, HOMA-IR, triglycerides, leptin, E-selectin, small dense LDL-cholesterol, IDL-cholesterol, VLDL3-cholesterol and TG/HDL ratio increased significantly, while HDL2-cholesterol and HDL3-cholesterol decreased across NC quartiles. In linear regression models, a direct association [β(95% CI)] of NC with leptin [(0.155 (0.068–0.242); 0.147 (0.075–0.220)], E-selectin [(0.105 (0.032–0.177); 0.073 (0.006 to 0.140)] and small-dense LDL [(1.866 (0.641–3.091); 2.372 (1.391–3.353)] and an inverse association with HDL2-cholesterol [(− 0.519 (− 0.773 to − 0.266); − 0.815 (− 1.115 to 0.515)] adjusted for age were detected for men and women, respectively.

Conclusion

Our findings indicate that measurement of NC may be useful for an earlier identification of unfavorable atherogenic metabolic profile in middle-aged individuals at lower cardiovascular risk level.
Literature
2.
go back to reference Preis SR, Massaro JM, Hoffmann U, D’Agostino RB, Levy D, Robins SJ, Meigs JB, Vasan RS, O’Donnell CJ, Fox CS, et al. Neck circumference as a novel measure of cardiometabolic risk: the Framingham Heart study. J Clin Endocrinol Metab. 2010;95:3701–10.CrossRef Preis SR, Massaro JM, Hoffmann U, D’Agostino RB, Levy D, Robins SJ, Meigs JB, Vasan RS, O’Donnell CJ, Fox CS, et al. Neck circumference as a novel measure of cardiometabolic risk: the Framingham Heart study. J Clin Endocrinol Metab. 2010;95:3701–10.CrossRef
3.
go back to reference Ben-Noun L, Laor A. Relationship of neck circumference to cardiovascular risk factors. Obes Res. 2003;11:226–31.CrossRef Ben-Noun L, Laor A. Relationship of neck circumference to cardiovascular risk factors. Obes Res. 2003;11:226–31.CrossRef
4.
go back to reference Baena CP, Lotufo PA, Santos IS, Goulart AC, Bittencourt MS, Duncan BB, Liu S, Benseñor IM. Neck circumference is associated with carotid intimal-media thickness but not with coronary artery calcium: results from the ELSA-Brasil. Nutr Metab Cardiovasc Dis. 2016;26:216–22.CrossRef Baena CP, Lotufo PA, Santos IS, Goulart AC, Bittencourt MS, Duncan BB, Liu S, Benseñor IM. Neck circumference is associated with carotid intimal-media thickness but not with coronary artery calcium: results from the ELSA-Brasil. Nutr Metab Cardiovasc Dis. 2016;26:216–22.CrossRef
6.
go back to reference Calder PC, Ahluwaia N, Albers R, Bosco N, Sicard-Bourdet R, Haller D, Holgate ST, Jonsson LS, Latulippe ME, Marcos A, Moreines J, M’Rini C, Muller M, Pawelec G, van Neerven RJJ, Watzl B, Zhao J. A consideration of biomarkers to be used for evaluation of inflammation in human nutritional studies. Brit J Nutr. 2013;109(S1):S1–34.CrossRef Calder PC, Ahluwaia N, Albers R, Bosco N, Sicard-Bourdet R, Haller D, Holgate ST, Jonsson LS, Latulippe ME, Marcos A, Moreines J, M’Rini C, Muller M, Pawelec G, van Neerven RJJ, Watzl B, Zhao J. A consideration of biomarkers to be used for evaluation of inflammation in human nutritional studies. Brit J Nutr. 2013;109(S1):S1–34.CrossRef
7.
go back to reference Ridker PM, Hennekens CH, Buring JE, Rifai N. C-Reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med. 2000;342:836–43.CrossRef Ridker PM, Hennekens CH, Buring JE, Rifai N. C-Reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med. 2000;342:836–43.CrossRef
10.
go back to reference Lindberg S, Jensen JS, Bjerre M, Oedersen SH, Frystyk J, Flyvbjerg A, Galatius S, Jeppesen J, Mogelvang R. Adiponectin, type 2 diabetes and cardiovascular risk. Eur J Prev Cardiol. 2015;22(3):276–83.CrossRef Lindberg S, Jensen JS, Bjerre M, Oedersen SH, Frystyk J, Flyvbjerg A, Galatius S, Jeppesen J, Mogelvang R. Adiponectin, type 2 diabetes and cardiovascular risk. Eur J Prev Cardiol. 2015;22(3):276–83.CrossRef
11.
go back to reference Martin SS, Qasim A, Reilly MP. Leptin resistance: a possible interface of inflammation and metabolism in obesity-related cardiovascular disease. J Am Coll Cardiol. 2008;52(15):1201–10.CrossRef Martin SS, Qasim A, Reilly MP. Leptin resistance: a possible interface of inflammation and metabolism in obesity-related cardiovascular disease. J Am Coll Cardiol. 2008;52(15):1201–10.CrossRef
12.
go back to reference Mora S. Advanced lipoprotein testing and subfractionation are not (yet) ready for routine clinical use. Circulation. 2009;119:2396–404.CrossRef Mora S. Advanced lipoprotein testing and subfractionation are not (yet) ready for routine clinical use. Circulation. 2009;119:2396–404.CrossRef
13.
go back to reference Zhang Y, Zhu CG, Xu RX, Li S, Li XL, Guo YL, Wu NQ, Gao Y, Qing P, Cui CJ, Sun J, Li JJ. HDL subfractions and very early CAD: novel findings from untreated patients in a Chinese cohort. Sci Rep. 2016;6:30741.CrossRef Zhang Y, Zhu CG, Xu RX, Li S, Li XL, Guo YL, Wu NQ, Gao Y, Qing P, Cui CJ, Sun J, Li JJ. HDL subfractions and very early CAD: novel findings from untreated patients in a Chinese cohort. Sci Rep. 2016;6:30741.CrossRef
14.
go back to reference Aquino EML, Barreto SM, Bensenor IM, Carvalho MS, Chor D, Duncan B, Lotufo PA, Mill JG, Molina MDC, Mota ELA, Passos VMA, Schmidt MI, Szklo M. Brazilian longitudinal study of adult health (ELSA-Brasil): objectives and design. Am J Epidemiol. 2012;175(4):315–24.CrossRef Aquino EML, Barreto SM, Bensenor IM, Carvalho MS, Chor D, Duncan B, Lotufo PA, Mill JG, Molina MDC, Mota ELA, Passos VMA, Schmidt MI, Szklo M. Brazilian longitudinal study of adult health (ELSA-Brasil): objectives and design. Am J Epidemiol. 2012;175(4):315–24.CrossRef
15.
go back to reference Mill JG, Karina Pinto K, Griep RH, Goulart A, Foppa M, Lotufo PA, Maestri MK, Ribeiro AL, Andreão RV, Dantas EM, Oliveir I, Fuchs SC, Cunha RS, Bensenor IM. Medical assessments and measurements in ELSA-Brazil. Rev Saúde Pública. 2013;47(Supl 2):54–62.CrossRef Mill JG, Karina Pinto K, Griep RH, Goulart A, Foppa M, Lotufo PA, Maestri MK, Ribeiro AL, Andreão RV, Dantas EM, Oliveir I, Fuchs SC, Cunha RS, Bensenor IM. Medical assessments and measurements in ELSA-Brazil. Rev Saúde Pública. 2013;47(Supl 2):54–62.CrossRef
16.
go back to reference Lohman TG, Roche AF, Martorell R, editors. Anthropometric standardization reference manual. Champaign: Human Kinetics Publications; 1988. Lohman TG, Roche AF, Martorell R, editors. Anthropometric standardization reference manual. Champaign: Human Kinetics Publications; 1988.
17.
go back to reference Fedeli LG, Vidigal PG, Leite CM, Castilhos CD, Pimentel RA, Maniero VC, Mill JG, Lotufo PA, Pereira AC, Bensenor IM. Logistics of collection and transportation of biological samples and the organization of the central laboratory in the ELSA-Brasil. Rev Saude Publica. 2013;47(Suppl 2):63–71 (Portuguese).CrossRef Fedeli LG, Vidigal PG, Leite CM, Castilhos CD, Pimentel RA, Maniero VC, Mill JG, Lotufo PA, Pereira AC, Bensenor IM. Logistics of collection and transportation of biological samples and the organization of the central laboratory in the ELSA-Brasil. Rev Saude Publica. 2013;47(Suppl 2):63–71 (Portuguese).CrossRef
18.
go back to reference Kidney Disease Improving Global Outcomes. Clinical practice guideline for the evaluation and management of chronic kidney disease. Off J Int Soc Nephrol. 2013;3(1):7–10. Kidney Disease Improving Global Outcomes. Clinical practice guideline for the evaluation and management of chronic kidney disease. Off J Int Soc Nephrol. 2013;3(1):7–10.
19.
go back to reference Kulkarni KR. Cholesterol profile measurement by vertical auto profile method. Clin Lab Med. 2006;26:787–802.CrossRef Kulkarni KR. Cholesterol profile measurement by vertical auto profile method. Clin Lab Med. 2006;26:787–802.CrossRef
20.
go back to reference Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). JAMA. 2001;285(19):2486–97. https://doi.org/10.1001/jama.285.19.2486.CrossRef Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). JAMA. 2001;285(19):2486–97. https://​doi.​org/​10.​1001/​jama.​285.​19.​2486.CrossRef
21.
go back to reference Stabe C, Vasques ACJ, Lima MMO, et al. Neck circumference as a simple tool for identifying the metabolic syndrome and insulin resistance: results from the Brazilian Metabolic Syndrome Study. Clin Endocrinol (Oxf). 2013;78:874–81.CrossRef Stabe C, Vasques ACJ, Lima MMO, et al. Neck circumference as a simple tool for identifying the metabolic syndrome and insulin resistance: results from the Brazilian Metabolic Syndrome Study. Clin Endocrinol (Oxf). 2013;78:874–81.CrossRef
26.
go back to reference Almeida-Pititto B, Ribeiro-Fiçho FF, Santos IS, Bensenor IM, Lotufo PA, Ferreira SRG. Association between carotid intima-media thickness and adiponectin in participants without diabetes or cardiovascular disease of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Eur J Prev Cardiol. 2016. https://doi.org/10.1177/2047487316665490.CrossRefPubMed Almeida-Pititto B, Ribeiro-Fiçho FF, Santos IS, Bensenor IM, Lotufo PA, Ferreira SRG. Association between carotid intima-media thickness and adiponectin in participants without diabetes or cardiovascular disease of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Eur J Prev Cardiol. 2016. https://​doi.​org/​10.​1177/​2047487316665490​.CrossRefPubMed
28.
go back to reference Hwang S-J, Ballantyne CM, Sharrett AR, Smith LC, Davis CE, Gotto AM, Boerwinkle E. Circulating adhesion molecules VCAM-1, ICAM-1, and E-selectin in carotid atherosclerosis and incident coronary heart disease cases. The atherosclerosis risk in communities (ARIC) study. Circulation. 1997;96:4219–25.CrossRef Hwang S-J, Ballantyne CM, Sharrett AR, Smith LC, Davis CE, Gotto AM, Boerwinkle E. Circulating adhesion molecules VCAM-1, ICAM-1, and E-selectin in carotid atherosclerosis and incident coronary heart disease cases. The atherosclerosis risk in communities (ARIC) study. Circulation. 1997;96:4219–25.CrossRef
30.
go back to reference Sánchez-Quesada JL, Vinagre I, De Juan-Franco E, et al. Impact of the LDL subfraction phenotype on Lp-PLA2 distribution, LDL modification and HDL composition in type 2 diabetes. Cardiovasc Diabetol. 2013;12:112.CrossRef Sánchez-Quesada JL, Vinagre I, De Juan-Franco E, et al. Impact of the LDL subfraction phenotype on Lp-PLA2 distribution, LDL modification and HDL composition in type 2 diabetes. Cardiovasc Diabetol. 2013;12:112.CrossRef
31.
go back to reference Hoogeveen RC, Gaubatz JW, Sun W, Dodge RC, Crosby JR, Jiang J, et al. Small dense low-density lipoprotein-cholesterol concentrations predict risk for coronary heart disease: the Atherosclerosis Risk In Communities (ARIC) study. Arterioscler Thromb Vasc Biol. 2014;34(5):1069–77.CrossRef Hoogeveen RC, Gaubatz JW, Sun W, Dodge RC, Crosby JR, Jiang J, et al. Small dense low-density lipoprotein-cholesterol concentrations predict risk for coronary heart disease: the Atherosclerosis Risk In Communities (ARIC) study. Arterioscler Thromb Vasc Biol. 2014;34(5):1069–77.CrossRef
Metadata
Title
Neck circumference is associated with non-traditional cardiovascular risk factors in individuals at low-to-moderate cardiovascular risk: cross-sectional analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)
Authors
B. Almeida-Pititto
I. T. Silva
A. C. Goulart
M. I. H. Fonseca
M. S. Bittencourt
R. D. Santos
M. Blaha
S. Jones
P. P. Toth
K. Kulakarni
P. A. Lotufo
I. M. Bensenor
S. R. G. Ferreira
the ELSA Research Group
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Diabetology & Metabolic Syndrome / Issue 1/2018
Electronic ISSN: 1758-5996
DOI
https://doi.org/10.1186/s13098-018-0388-4

Other articles of this Issue 1/2018

Diabetology & Metabolic Syndrome 1/2018 Go to the issue
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.