Li, Hongyan

Li, Yanping

Liang, Jun

Liu, Xuekui

Qi, Lu

Teng, Fei

Wang, Yu

Zou, Caiyan

Diabetes Care

Harvard University - DASH 

 Neck Circumference and Insulin Resistance in Chinese Adults:The Cardiometabolic Risk in Chinese (CRC) Study  (Article begins on next page)The Harvard community has made this article openly available.Please share how this access benefits you. Your story matters.Citation Liang, Jun, Fei Teng, Yanping Li, Xuekui Liu, Caiyan Zou, YuWang, Hongyan Li, and Lu Qi. 2013. “Neck Circumference andInsulin Resistance in Chinese Adults: The Cardiometabolic Riskin Chinese (CRC) Study.” Diabetes Care 36 (9): e145-e146.doi:10.2337/dc13-1114. http://dx.doi.org/10.2337/dc13-1114.Published Version doi:10.2337/dc13-1114Accessed February 16, 2015 10:08:16 PM ESTCitable Link http://nrs.harvard.edu/urn-3:HUL.InstRepos:12987237Terms of Use This article was downloaded from Harvard University's DASHrepository, and is made available under the terms and conditionsapplicable to Other Posted Material, as set forth athttp://nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of-use#LAAOBSERVATIONSNeck Circumferenceand InsulinResistance inChinese Adults: TheCardiometabolicRisk in Chinese(CRC) StudyNeck circumference (NC) is a proxyfor upper-body fat and a reliablescreening measure for the identiﬁ-cation of individuals with abnormal fatdistribution. Recently, compelling evi-dence indicates that NC is positively asso-ciated with insulin resistance (IR) and avariety of cardiometabolic abnormalities,independent of overall adiposity and cen-tral obesity in Caucasians (1) or Chinesediabetic patients (2). However, it remainsunknownwhetherNCaffectsIRinthegen-eral Chinese population.In the current study, we analyzed theassociations of NC with IR and cardio-metabolic risk factors in 2,588 apparentlyhealthy Chinese adults (20–87 years ofage) from the Cardiometabolic Risk inChinese (CRC) study (3). We found a sig-niﬁcant association between NC and anincreasing trend ofhomeostasismodelas-sessment of insulin resistance (HOMA-IR),adjusting for age and other cardiometa-bolic risk factors, in both men (P =0 . 0 2 )and women (P = 0.004). The differencesin HOMA-IR between the extreme quin-tiles of NC appeared more evident in menthan in women; however, the test for theheterogeneity between men and womenwas not signiﬁcant. Further adjustmentfor BMI and waist circumference (WC)didnotappreciablychangetheassociationsbetween NC and IR. In addition, high NCwas signiﬁcantly related to a decreasingtrend of HDL levels in both sexes andwas signiﬁcantly related to an increasingtrend of plasma triglyceride and uric acidlevels only in men (P for sex difference,0.03), after adjustment for covariatesincluding BMI or WC and HOMA-IR.We also found signiﬁcant interactionsof NC with BMI and WC (P for interaction,0.0001)inrelationtoHOMA-IR(Fig.1).ItappearsthattheassociationsbetweenNCand HOMA-IR were more evident in thosewith a higher BMI or WC.To our knowledge, the current study isamong the ﬁrst to assess the associations ofNC with IR and metabolic risk in a generalpopulation of Chinese adults. Our ﬁndingsare in line with the results from severalprevious studies in Caucasians and Chinesediabetic patients (1,2). In the FraminghamStudy, it was found that NC was associatedwith IR and cardiovascular risk factors in asex-speciﬁc manner (1). It has been docu-mented that high NC was a signiﬁcant pre-dictor of obstructive sleep apnea syndrome(4), which has been associated with risk ofIR and diabetes. Obstructive sleep apneasyndrome aggravates glycemic control,even at the earliest stages of glucose intoler-ance. In addition, intermittent hypoxemiaand sleep fragmentation increase the risk ofIR(5).Ourdata,togetherwithevidencefromother studies, suggest that body fat accumu-lated in the upper body segment may con-tributetotheadversemetabolicconsequence.In conclusion, we found signiﬁcantassociations of high NC with increasedrisk of IR and a variety of cardiometa-bolic risk factors in apparently healthyChinese adults, and found sexual dimor-phism for associations with certain riskfactors. Our ﬁndings support a recom-mendation for the inclusion of NC in theroutine clinical assessment of adults toidentify those at high risk of cardiometa-bolic diseases such as type 2 diabetes andheart disease.Figure 1—The joint effect of NC (in quintiles) with WC and BMI (low, medium, and high levels)on HOMA-IR.care.diabetesjournals.org DIABETES CARE, VOLUME 36, SEPTEMBER 2013 e145ONLINE LETTERSJUN LIANG, MD, PHD1FEI TENG, MS1YANPING LI, MD, PHD2XUEKUI LIU, BS1CAIYAN ZOU, MS1YU WANG, MS1HONGYAN LI, MS1LU QI, MD, PHD2,3From the1Department of Endocrinology, XuzhouCentral Hospital, Xuzhou Clinical School ofXuzhou Medical College, Afﬁliated Hospital ofSoutheast University, Xuzhou, Jiangsu, China;the2Department of Nutrition, Harvard School ofPublic Health, Boston, Massachusetts; and the3Channing Laboratory, Department of Medicine,Brigham and Women’s Hospital and HarvardMedical School, Boston, Massachusetts.Corresponding author: Lu Qi, nhlqi@channing.harvard.edu, or Jun Liang, mwlj521@163.com.J.L. and F.T. contributed equally to this study.DOI: 10.2337/dc13-1114© 2013 by the American Diabetes Association.Readers may use this article as long as the work isproperly cited, the use is educational and not forproﬁt, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ fordetails.Acknowledgments—L.Q.’s research is sup-ported by National Institutes of Healthgrants DK-091718 and HL-071981, theAmerican Heart Association Scientist De-velopment Award, and the Boston ObesityNutrition Research Center (DK-46200).J.L.’s research was sponsored by JiangsuHealth International Exchange Programand supported by a Xuzhou medical lead-ing talent grant and Xuzhou Science andTechnology Board Foundation grant(XF11C067).No potential conﬂicts of interest relevant tothis article were reported.J.L. wrote and reviewed the manuscript.F.T. wrote the manuscript. Y.L. and X.L. per-formed statistical analyses. C.Z. and Y.W.contributed to discussion. H.L. edited themanuscript. L.Q. researched data and wrotethe manuscript. L.Q. is the guarantor of thiswork and, as such, had full access to all thedata in the study and takes responsibility fortheintegrityofthedataandtheaccuracyofthedata analysis.The authors thank all subjects for partici-pating in this study.ccccccccccccccccccccccccReferences1. PreisSR,MassaroJM,HoffmannU,etal.Neckcircumference as a novel measure of cardio-metabolicrisk:theFraminghamHeartstudy.JClinEndocrinolMetab2010;95:3701–37102. YangGR,YuanSY,FuHJ,etal.;BeijingCom-munityDiabetesStudyGroup.Neckcircum-ferencepositivelyrelatedwithcentralobesity,overweight, and metabolic syndrome in Chi-nese subjects with type 2 diabetes: BeijingCommunity Diabetes Study 4. Diabetes Care2010;33:2465–24673 . L i a n gJ ,Z h o uN ,T e n gF ,e ta l .H e m o g l o b i nA1c levels and aortic arterial stiffness: theCardiometabolic Risk in Chinese (CRC)study. PLoS ONE 2012;7:e384854. Onat A, Hergenç G, Yüksel H, et al. Neck cir-cumference as a measure of central obesity:associationswithmetabolicsyndromeandob-structive sleep apnea syndrome beyond waistcircumference. Clin Nutr 2009;28:46–515. Steiropoulos P, Papanas N, Bouros D,Maltezos E. Obstructive sleep apnea aggra-vates glycemic control across the contin-uum of glucose homeostasis. Am J RespirCrit Care Med 2010;182:286e146 DIABETES CARE, VOLUME 36, SEPTEMBER 2013 care.diabetesjournals.orgOnline Letters

Neck Circumference and Insulin Resistance in Chinese Adults: The Cardiometabolic Risk in Chinese (CRC) Study

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Neck Circumference and Insulin Resistance in Chinese Adults: The Cardiometabolic Risk in Chinese (CRC) Study

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