Table 1 Characteristics of the included studies which assessed diagnostic value of high neck circumference to predict cardiometabolic risk factors
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 |
35Â 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) |