| MS(metabolic syndrome) is both a kind of pathological state with multiple metabolic abnormalities and a complicated metabolic disorder syndrome concomitant with hypertension and abnormal metabolism of glucose and lipid, and also a risk factor of T2DM(type2diabetes mellitus) and cardio-cerebrovascular disease. A new worldwide definition of MS has been formulated by IDF(International Diabetes Federation) in which the core status of central obesity has been accentuated, and WC(waist circumference) is used as diagnostic criteria of central obesity. However, there are some limitations with this measurement index in clinical practice because of so many factors which could lead to the significant variability of the measurement of WC including difficulties with implementation of standardized method of measurement, inconvenience of measurement in winter, existence of racial and gender difference and impact of meal ingestion et al. Worse still, conspicuous individual difference is present. Hence, it is essential to establish a more convenient, viable anthropometry index with more stability which will provide scientific evidence for early prediction and prevention of MS, T2DM and cardiovascular diseases.NC(neck circumference) is the girth of the neck at the level of laryngeal prominence which is an important index reflecting the deposition of subcutaneous fat of the neck or fat surrounding the respiratory tract, also the degree of obesity and particularly the subcutaneous fat of the upper body. Recently, more and more studies indicate NC is closely related to abnormal glucose and lipid metabolism as well as hyperinsulinemia. NC has also been recommended as an effective screening index for assessing overweight and obesity. However, current studies pay more attention to the association between NC and obstructive sleep apnea syndrome and MS. Studies on correlation between NC and HUA (hyperuricemia) and NAFLD (non-alcoholic fatty liver disease) has rarely been seen. With the change of diet and lifestyle, the prevalence of HUA is increasing annually as that of T2DM and obesity. Accumulating evidence shows HUA is closely related to insulin resistance and plays a vital role in pathogenesis of MS and T2DM. With the global epidemic of obesity and MS, NAFLD has become not only the most common reason of liver enzyme abnormalities and chronic liver diseases, but also its incidence is increasing in Asian countries during the past20years with the onset of the disease occurring at a younger age. Consequently, how to prevent and treat metabolically disturbed patients with HUA, NAFLD and obesity et al. has become one of the key point in T2DM treatment and prevention and also a health-improving endeavor of great urgency. In view of this, this research subject was intended to observe and analyze the data from part of the population who had a physical check-up in Changhai hospital medical examination center combined with the data from type2diabetics in order to discuss viability and value of NC, NHtR(neck circumference-height ratio) and NWtR (neck circumference-weight ratio) in predicting various metabolic disorders. Effective, simple and easy monitoring and predicative indexes were expected to be derived from this research for clinical and community healthcare management practice.[Objectives] The aim of the study was to establish normal values of NC of healthy population, to compare NC with other simple anthropometry indexes and to discuss viability and value of NC in predicting various metabolic disorders.1.Influencing factors of NAFLD were observed and correlation between NC and NAFLD was discussed. Compared with other simple anthropometry indexes, the value of NC in predicting NAFLD was analyzed.2.Influencing factors of HUA were observed and correlation between NC and HUA was discussed. Compared with other simple anthropometry indexes, the value of NC in predicting HUA was analyzed.3.Clinical characteristics of type2diabetics with different courses and under different management status were analyzed and correlation between NC and the onset and development of T2DM was discussed.[Methods]1.We chose2761people who had physical check-ups in Changhai hospital medical examination center from the beginning of October,2012to the end of November,2012and grouped them according to different health status:(1) the population was grouped into healthy group (623cases) and unhealthy group (2138cases) according to whether they had the history of hypertension, diabetes mellitus and impaired glucose regulation, dyslipidemia, NAFLD, abdominal obesity, HUA and gout et al. and the results of check-ups;(2)According to the existence of NAFLD and other metabolic disorders including hypertension, diabetes mellitus and impaired glucose regulation, dyslipidemia, abdominal obesity, overweight and obesity, HUA and gout et al., subjects were divided into healthy group (623cases), NAFLD group (967cases) which include those with NAFL (697cases) and those with NASH (270cases) and group without NAFLD but complicated with other metabolic disorders (1171cases);(3) According to the existence of NAFLD and other metabolic disorders including hypertension, diabetes mellitus and impaired glucose regulation, dyslipidemia, abdominal obesity, overweight and obesity, NAFLD et al., subjects were divided into healthy group (623cases), HUA group (678cases) and group without HUA but complicated with other metabolic disorders (1460cases).2.We chose235T2DM patients with different courses and under different management patterns with complete medical files and according to the T2DM duration, we grouped them into group A (72cases with duration<1year), group B (23cases, with duration between1and5years), group C (29cases with duration between5and10years) and group D (111cases, with duration≥10years). Group D is further divided into group D1(intensified management group,63cases) and group D2(non-management group,48cases) according to their management status of the disease after its diagnosis.623healthy people from medical examination center served as healthy control group.3.The data of subjects were collected including gender, age, height, body weight, blood pressure, neck circumference, waist circumference, hip circumference and past history. Fasting blood samples were collected for the assay of FBG (Fasting blood-glucose), SUA (serum uric acid), TC(Total cholesterol), TG(Triglyceride), HDL-C(High density lipoprotein cholesterol), LDL-C (Low density lipoprotein cholesterol), ALT (Alanine aminotransferase),AST (Aspartate aminotransferase), TBIL (Total bilirubin), BUN (Blood urea nitrogen), Scr (Serum creatinine), FIns (Fasting insulin) and FCP (Fasting C-peptide). Abdominal ultrasound and carotid artery ultrasound(only on T2DM patients) et al. were performed with BMI, waist hip ratio, NHtR, NWtR, HOMA-IR and QUICKI being calculated.4.Medical reference ranges of NC, NHtR and NWtR were established, and correlations between simple anthropometry indexes (including NC、NHtR、NWtR、BMI、 WC and WHR) and age, gender, biochemical profiles, HOMA-IR and QUICKI of the population under different metabolic status were analyzed. Influencing factors of NAFLD and HUA were also analyzed and NC was compared with other simple anthropometry indexes in terms of the value in predicting various metabolic diseases. Correlations between NC and the onset and development of NAFLD, HUA, T2DM were discussed.[Results]1.Analysis from healthy population demonstrated the following results:(1)reference ranges for male:NC<38.51cm、NHtR<0.23、NwtR>0.49; those for female:NC<33.80cm、 NHtR<0.22、NWtR>0.51.(2) No correlation was found between NC, NWtR and age. No correlation between NC, NHtR, NWtR and age was found in male subjects but only NWtR was unrelated to age in female ones.(3) Greater correlations were found between NC and multiple metabolic indexes such as FBG、ALT、Scr and HDL-C et al. than those were found using other anthropometry indexes and this phenomenon was particularly obvious in female subjects.(4)NC had the greatest correlation with FBG and SBP and was independently correlated with DBP, Scr and ALT. NHtR had the greatest correlation with BUN and was independently correlated with SBP. As for NWtR, it was independently correlated with T-Ch.(5)In female patients, NC had the greatest correlation with TBIL、 DBIL、HOMA-IR、QUICKI and NHtR had the greatest correlation with HbA1c、FINS.(6)Regardless of gender, Correlations were found between NC and DBIL, FCP, HOMA-IR, QUICKI, beween NHtR and DBIL、FINS、HOMA-IR、QUICKI and between NWtR and FCP、QUICKI, respectively。(7)BMI was the independent anthropometry index affecting FINS and HOMA-IR in male subjects, whereas NC was the independent anthropometry index affecting FINS and HOMA-IR in female subjects.2.Correlation analysis between NC and NAFLD revealed the following results:(1)Of all2761surveyed personnel, up to35%of them had NAFLD of whom those with NAFL comprised25.2%and those with NASH comprised9.8%. Subjects without NAFLD but complicated with other metabolic disorders comprised42.4%of the population. There were more male patients with NAFL or NASH than their female counterparts.(2) NAFLD patients suffered aberrant multiple biochemical indexes plus anthropometry indexes including NC, NHtR, WC and BMI et al. to a more severe extent than both those without NAFLD but having other metabolic disturbances and healthy controls.(3)Patients with NAFLD was more liable to multiple metabolic disorders than those without NAFLD but having other metabolic abnormalities and the percentage of NAFLD patients with4or more metabolic disturbances was greater than that of the group with other disorders.(4)The incidence of NAFLD(including NAFL and NASH) increased with the increment of NC without gender difference.(5)NHtR and WHR were risk factors of NAFLD, whereas NWtR was the protective factor.(6)In NAFLD patients, WC had the greatest correlation with FIN, HOMA-IR in male, whereas NC had the greatest correlation with FINS and HOMA-IR in female.3.Correlation analysis between NC and HUA showed the following:(1)24.6%of2761surveyed personnel were complicated with HUA in whom male subjects markedly outnumbered female counterparts comprising33.5%and12.6%of total subjects of their respective gender.(2)No significant changes with age were detected in the prevalence of HUA in male patients, whereas the prevalence of it markedly increased with growing age in female counterparts, especially in those above50years of age. Patients with HUA tended to be younger than those with other metabolic disorders.(3)Multiple metabolic indexes such as blood pressure, TG, LDL-C, ALT, AST, AST, γ-GT, FINS, FCP, HOMA-IR et al. plus simple anthropometry indexes such as NC, NHtR, WC, BMI et al. were found to be significantly higher in patients with HUA than those with other metabolic disturbances and normal control.(4)The prevalence of HUA rose with increment of NC which was a independent risk factor of HUA in female. NC and WC were found to be risk factors of HUA in male.4.Correlation analysis showed the following:(1)NC and other simple anthropometry indexes were found to be markedly higher in type2diabetics than those in normal control and mean values of Scr, BUN and uric albumin elevated with the increment of duration.(2)Diabetics hospitalized immediately after initial diagnosis of the disease with duration less than1year were found to have both higher mean values of indexes such as FBG, TC, LDL-C, HDL-C, ALT, AST, γ-GT, HbAlc, FINS, HOMA-IR et al. and higher incidence of NAFLD, HUA, hypercholesterolemia, low HDL-C, overweight and obesity than the group with duration between1and5years.(3)Mean levels of WC, WHR, SBP, DBP, TG, Scr, HbAlc, FCP,2hCP, uric albumin/creatinine, CIMT et al. in intensified management group were found to be lower than those in non-management group, whereas the mean levels of HDL-C in intensified management group higher than those in non-management group with difference all being statistically significant(all p values<0.05).(4)Positive correlations were found between NC and FCP, SUA, whereas a inverse correlation was found between NC and HDL-C all without gender difference.(5) NC had the greatest correlation with Scr, HDL-C in male, whereas it has the greatest correlation with SUA, HDL-C in female.(6)NHtR was a better anthropometry index in the prediction of type2diabetics complicated with HUA than its counterparts.[Conclusion]1.Medical reference ranges:for healthy male NC<38.51cm、NHtR<0.23、NwtR>0.49; for healthy female NC<33.80cm、NHtR<0.22、NWtR>0.51.2.NC could serve as a sensitive index in assessing insulin sensitivity of healthy population and its prediction value outweighs other simple anthropometry indexes in female.3.The risk of suffering from NAFLD(including NAFL or NASH) rises with increasing measurement of NC.4. The incidence of HUA elevates with increasing measurement of NC. Both NC and WC are risk factors of HUA in male, whereas NC is a independent risk factor of HUA in female. 5.Type2diabetics are more liable to other metabolic disorders with higher measurement of NC.)NHtR was a better predictor of type2diabetics complicated with HUA than other indexes. |
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