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Table 1 Characteristics of the included studies which assessed diagnostic value of high neck circumference to predict cardiometabolic risk factors

From: Neck circumference and its association with cardiometabolic risk factors: a systematic review and meta-analysis

Study Type of study Country Target population Sam pie size Sex ratio (M/F) Age year Outco me Diagnostic criteria Cut-off values for high NC Age-sex group SE % (95% CI) SP % (95% CI) AUC (95% CI)
Silva, et al [15] Cross-sectional Brazil Healthy 388 169/219 10–19 Insulin resistance H0MA1-IR ≥ 3.87 and HOMA1-IR ≤4.19 for females.
H0MA1-IR ≥ 3.85 and HOMA1-IR  ≥ 3.77 for males
Prepubertal females:  > 32.0 cm Prepubertal females 76.92 (46.2-94.7) 77.50 (61.5–89.1) 0.84 (0.72–0.97)
Pubertal females:  > 34.1 cm Pubertal females 56.41 (39.6–72.2) 84.75 (77.0–90.7) 0.76 (0.68–0.85)
Prepubertal males:  > 30.3 cm Prepubertal males 100.00 (78.0–100.0) 42.55 (28.3–57.8) 0.72 (0.58–0.86)
Pubertal males:  > 34.8 cm Pubertal males 92.00 (73.9–98.8) 57.33 (45.4–68.7) 0.81 (0.71–0.91)
Goncalves et al. [12] Cross sectional Brazil Healthy 260 129/131 10–14 BP High BP:  > 95th percentile Total:30.2 cm, Male: 30.5 cm. Female: 29.9 cm Total 80.0 78.4 0.807 (0.754–0.854)
Female 100.0 69.5 0.908 (0.844–0.951)
Male 85.7 71.3 0.747 (0.663–0.819)
TG Triglycerides  ≥ 100 mg/dL Male 54.6 86.4 0.70 (0.613–0.777)
HDL-C HDL-C  < 45 mg/dL Both sexes 61.9 59.3 0.616 (0.554–0.676)
Female 64.5 64.0 0.645 (0.557–0.727)
Insulin resistance Fasting insulin  ≥ 15 uU/mL Both sexes 72.7 57.3 0.703 (0.643–0.757)
Female 95.7 36.1 0.659 (0.571–0.739); p < 0.05
Male 100.0 74.0 0.902 (0.837–0.947); p < 0.001
Diabet es Fasting glucose  ≥ 100 mg/dL Total 080.0 67.5 0.682 (0.621–0.738); p < 0.001
Female 100.0 75.8 0.827 (0.751–0.887); p < 0.001
Excess body fat Body fat 15–25% for females and 10–20% for males Total 64.0 65.1 67.6 (0.615–0.733); p < 0.001
Female 67.6 66.7 0.711 (0.625–0.786); p < 0.001
Male 75.0 60.7 0.728 (0.643–0.803); p < 0.001
Torriani et al. [37] Cross-sectiona USA Subjects with treated malignancies 303 152/151 18–91 MetS NCEP Adult Treatment Panel III 43.6 cm in men and 38.6 cm in women Male 74 (60, 85) 80 (66, 90) 0.79 (0.70, 0.86)
Female 74 (60, 85) 91 (80, 97) 0.85 (0.76, 0.91)
Formisano et al. [23] Cross-sectiona Italy, Belgium, Cyprus, Estonia, Germany, Hungary, Spain and Sweden Healthy 15673 7962/7711 3–10 CMetS The components used to calculate cMetS score were the same risk factors used in the adult MetS definition. cMetS score > 90th percentile was considered unfavorable Male 26.25 Male 3–4 years 47.5 89.5 0.713 (0.622–0.804)
26.60 4–5 years 58.5 86.4 0.805 (0.740–0.871)
27.10 5–6 years 82.0 78.6 0.874 (0.820–0.928)
27.60 6–7 years 83.2 79.9 0.895 (0.856–0.934)
28.30 7–8 years 79.6 80.3 0.885 (0.848–0.922)
28.65 8–9 years 88.1 78.0 0.907 (0.872–0.942)
30.90 9–10 years 71.4 88.1 0.881 (0.772–0.991)
Female 24.95 Female 3–4 years 63.6 78.6 0.741 (0.662–0.820)
25.15 4–5 years 81.4 74.4 0.823 (0.764–0.883)
26.15 5–6 years 75.0 81.0 0.839 (0.772–0.906)
26.45 6–7 years 94.7 73.8 0.921 (0.884–0.958)
27.10 7–8 years 88.6 76.3 0.897 (0.862–0.933)
27.80 8–9 years 93.6 79.0 0.924 (0.898–0.950)
29.65 9–10 years 1.00 95.0 0.984 (0.955–1.000)
Pillai et al. [27] Prospective observational cross-sectional India Women with PCOS 121 0/121 12–41 MetS MetS by IDF 33.35 Female 60.3 70.7 0.7 (0.604–0.794)
MetS by ATP III 33.87 Female 73 69 0.722 (0.631–0.816)
Yan et al. [9] Cross-sectional China Healthy 2092 971/1121  > 65 MetS The 2004 CDS criteria 38 cm in men and Male 80 55 0.76
35 cm in women Female 75 67 0.73
Obesity BMI ≥ 25 kg/m2 38 cm in men and 35 cm in women Male 87 62 NR
Female 80 74
Kurtoglu et al. [24] Case–control Turkey Healthy 581 259/322 5–18 MetS IDF criteria 36 cm in boys and 35 cm in girls Male 61.9 85.6 0.766 (0.689–0.882)
Female 60.4 78.15 0.749 (0.683–0.808)
Cizza et al. [38] Cross-sectional USA Obese 120 28/92 18–50 MetS IDF criteria NO 38 cm Female 0.54 0.70 0.63
de LucenaFerretti et al. [20] Cross-sectional Brazil Healthy 1667 751/916 10–17 Overw eight WHO criteria  > 34.25 in boys a nd  > 31.25 ingirls Male 53.3 72.8 0.690 (0.649–0.730)
Female 61.2 83.0 0.775 (0.741–0.809)
Obesity  > 37.95 in boys and  > 32.65 ingirls Male 34.2 94.5 0.712 (0.654–0.770)
Female 63.8 90.9 0.815 (0.754–0.877)
Yang et al. [10] Cross-sectional China Type 2 diabetic patient 3182 1294/1888 20–80 MetS Chinese Diabetes Society criteria NC 39 cm for men and 35 cm for women Male 42.8 83.8 0.67 (0.63–0.70); p < 0.001
Female 60.0 66.5 0.66 (0.63–0.70); p < 0.001
Central obesity WC ≥  85 cm for men and  ≥ 80 cm for women NC 37 cm for men and 35 cm for women Male 65.1 73.6 0.77 (0.72–0.82); p < 0.001
Female 64.0 75.9 0.75 (0.72–.078); p < 0.001
Overweight BMI  ≥ 24 kg/m2 NC 38 cm for men and 35 cm for women Male
Female
62.0 68.8 74.2 65.4 0.72 (0.69–0.75); p < 0.001
0.73 (0.70–0.75); p < 0.001
Zepeda et al. [39] Cross-sectional USA Healthy 1058 561/497 6–18 High BP Systolic and/or diastolic BP
 ≥ 95th percentile for age, sex and height
NC > 90,th Male
Female
NR NR 0.75 (0.70–0.81)
0.72 (0.63–0.75)
Katz et al. [40] Cross-sectional Canada Healthy 1913 977/936 6–17 Overweight/obesity BMI > 85th percentile CDC NC > 50th percentile
Boys: 25.3–35.5 cm Girls: 24.8–30.5 cm
Total 0.970 0.500 0.884
Lou et al. [41] Cross-sectional China Healthy 2847 1475/1372 7–12 Overweight/obesity BMI ≥ 85th Boys: 27.4–31.3 cm Girls: 26.3–31.4 cm Male
Female
Total
0.803 0.847 NR
0.846 0.819 0.843 0.845
Selvan et al. [13] Cross-sectional India Healthy 451 258/193 30–80 MetS NCEPATP III  > 34.9 cm for men
 > 31.25 cm for women
Male
Female
78.6
72.3
59.3
64.4
0.753 (0.694–0.813)
0.768 (0.687–0.849
Type 2 DM NR Male
Female
NR NR 0.453 (0.382–0.5324)
0.439 (0.357–0.520)
Hypertension NR Male
Female
NR NR 0.535 (0.465–0.606)
0.501 (0.416–0.586)
High TG NR Male
Female
NR NR 0.670 (0.600–0.739)
0.546 (0.463–0.629)
Low HDL NR Male
Female
NR NR 0.611 (0.537–0.685)
0.622 (0.537–0.707)
Hatipoglu et al. [25] Case–control Turkey Overweight/obese children and healthy ones as control 967 475/492 6–18 Overweight and obesity BMI ≥ 85th percentile of the BMI reference curve according to local references Boys: pre-pubertal 29.0 and pubertal 32.5 cm
Girls: pre-pubertal 28.0 and pubertal 31.0 cm
Prepubertal male 86.36 (78.5–92.2) 82.58 (75.0–88.6) 0.889 (0.843–0.926)
Pubertal male 80.85 (71.4–88.2) 76.26 (68.3–83.1) 0.877 (0.828–0.916)
Prepubertal female 78.95 (68.1–87.5) 85.15 (76.7–91.4) 0.884 (0.828–0.927)
Pubertal female 83.33 (75.9–89.2) 81.42 (75.0–86.8) 0.896 (0.857–0.928)
Atwa et al. [42] Cross-sectional Egypt Healthy 2762 1327/1435 12–15 Overweight/obesity BMI > 85th CDC Men: 29.3–32.3 cm Women:28.6–30.8 cm Male
Female
Total
0.927
0.928
0.928
0.806
0.670
0.736
NR
Luo et al. [11] Cross-sectional China Healthy 1943 783/1160 58 ±7 MetS  ≥ 2 metabolic disorders
But without abdominal obesity
NC > 38.5 cm for men
NC > 34.5 cm for women
Male
Female
50.53 (45.93–55.12)
48.95 (44.37–53.54)
67.74 (62.23–72.92)
74.85 (71.43–78.07)
NR
Abdominal obesity Visceral fatarea of ≥ 80 cm2 Male
Female
56.1
58.1
83.5
82.5
0.781
0.777
Diabetes FPG ≥ 6.10 mmol/Land (or) a 2hPG  ≥ 7.80 mmol/L/L, and (or) previously diagnosed diabetes Male
Female
46.33 (41.33–51.38)
43.64 (39.12–48.25)
59.79 (54.73–64.71)
71.08 (67.53–74.44)
NR
High BP SBP ≥ 130 mmHg, and (or) DBP ≥ 85 mmHg, and (or) previously diagnosed hypertension serum TG > 1.70 mmol/L Male
Female
48.88 (44.58–53.20)
42.94 (39.17–46.78)
68.98 (62.78–
74.71)
76.18 (72.14–79.90)
NR
High TG Serum TG ≥ 1.70 mmol/L Male
Female
52.82 (47.01–58.58)
50.73 (45.29–56.16)
62.66 (58.17–66.99)
71.67 (68.45–74.74)
NR
Low HDL-C Serum HDL-C less than 1.04 mmol/L Male
Female
51.45 (44.95–57.92)
58.56 (48.82–67.83)
60.33 (56.07–64.48)
67.59 (64.66–70.42)
 
Khalangot et al. [14] Cross-sectional Ukraine Healthy (not registered as T2D patients) 196 46/150  > 44 DM HbAlc ≥ 6.5% NO 36.5 cm for women and  >  38.5 cm for men Female 72.2 (46.5–90.3) 62.3 (53.4–70.7) 0.690 (0.815–0.564)
Male 100 (54.1–100) 38.5 (23.4–55.4) 0.774 (0.682–0.866)
Kumar et al. [26] Cross-sectional India Patients who attended medicine clinic in a tertiary care KMC hospital 431 250/181 Males  >  35 and female s > 40 MetS ATP 111 Total: 36.5cms
Female: 34
Male: 37
Total 50.0 76.0 70
Female 82 32 NR
Male 68 32 NR
Gomez-Arbelaez et al. [16] Cross-sectional Colombia Healthy 669 351/318 8–14 MetS Modified NHANES 29 cm in boys and 28.5 cm in girls Male 100 45.37 0.74 (0.68–0.78)
Female 87.50 53.61 0.73 (0.68 –0.78)
Insulin resistance HOMA-IR22.6 30 cm in males and 29 cm in females Male 52.54 61.19 0.54 (0.49–0.59)
Female 50.00 62.35 0.57 (0.51–0.62)
  1. NC neck circumference, HOMA homeostatic model assessment, IR insulin resistance, HOMA-IR Homeostasis Model Assessment-Insulin Resistance, HDL-C high density lipoprotein-cholesterol, NCEP National Cholesterol Education Program criteria, cMetS continuous metabolic syndrome, CDS Chinese Diabetes Society, CDC Centers for Disease Control and Prevention, IDF International Diabetes Federation, MetS metabolic syndrome, BMI body mass index ,WHO World Health Organization, VFA visceral fat area, DM diabetes mellitus, FBS fasting blood glucose, HbAlc hemoglobin Ale, TG triglycerides, LDL low density lipoprotein, TC total cholesterol, WC waist circumference, BP blood pressure, NR not reported