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- Hindawi Publishing Corporation
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- Copyright © 2021 Hui Wang. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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- 2040-2295
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- 10.1155/2021/1274627
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Abstract
Hindawi Journal of Healthcare Engineering Volume 2021, Article ID 1274627, 6 pages https://doi.org/10.1155/2021/1274627 Research Article Analyzing Neck Circumference as a Tool for Evaluating Overweight and Obesity in Chinese Adolescents Hui Wang Department of Physical Education, Xiamen University TKK College, Zhangzhou 363105, China Correspondence should be addressed to Hui Wang; wanghui@xujc.com Received 16 July 2021; Accepted 31 August 2021; Published 6 October 2021 Academic Editor: Fazlullah Khan Copyright © 2021 Hui Wang. +is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Overweight and obesity at an early age are important criteria for predicting chronic diseases. Each anthropometric method available to assess obesity has its limitations. Recently, neck circumference (NC) has received greater attention as a new evaluation index. +is study aimed to investigate the relationship between NC and overweight in Chinese Yi adolescents. A total of 647 Chinese Yi male and female students, aged 13–18 years, were randomly selected from a junior high school and a senior middle school in Leshan, Sichuan Province of China. +e measurement indexes included height, weight, waist circumference (WC), and NC, and clinical information was collected by trained physicians. +e neck cutoff values were determined through the receiver operating characteristic (ROC) curve and the area under the curve (AUC). +e correlation among NC, body mass index (BMI), and WC was determined by Pearson’s correlation coefficient. +e ROC analysis revealed that the AUC values were 0.79–0.95 for boys and 0.83–0.91 for girls. +e correlation among NC, BMI, and WC in obese boys and girls was higher than 0.70 in both genders. In addition, the NC cutoff values of high BMI ranged from 31.0 cm to 36.1 cm for boys and 31.2 cm to 34.5 cm for girls, respectively. +ere was a significant positive correlation between NC and obesity in Chinese Yi adolescents. +e NC can be used as an additional index to predict the obesity of Chinese Yi adolescents. investigated the association between obesity and its 1. Introduction markers with a variety of chronic diseases and even cor- Overweight and obesity can lead to a variety of chronic relation with malignancies that may threaten public health diseases, such as metabolic syndrome, hypertension, and in China. From 1985 to 2015, for 7–18-year-old Chinese Yi diabetes mellitus. Obesity also increases the incidence of individuals (formerly called Lolo or Wuman) living in cardiovascular diseases and cancer and reduces physical Leshan, Sichuan Province of China, the obesity rate of fitness. In children, the incidence of obesity has increased up males increased from 0.08% to 2.65%, while the obesity rate to 300% over the last 30 years. +e National Health and of females increased from 0.10% to 2.02%, respectively Nutrition Examination Survey (2009–2010) found 30% of [4, 5]. An important approach to control obesity and overweight would be to develop a practical method of children between 5 and 19 years of age to be overweight. Obesity varied from 15 to 40% in different European diagnosis for this disease which is simple, reliable, and low populations [1, 2]. cost for the assessment of adolescents, especially in primary Obesity has grown rapidly in Chinese children and healthcare. +ere are several anthropometric methods used adolescents in the past 30 years. +e rate of overweight and to assess obesity and overweight. ome techniques are ap- obesity among Chinese children and adolescents within plicable for evaluation of obesity like measurement of waist, 6–17 years of age was 9.6% and 6.2%, respectively, in 2012, hip circumference, weight, and height; however, there is and this was increased by 113.3% and 195.2%, respectively, still controversy about the effectiveness of some methods in 2002 [3]. Likewise, the abdominal obesity rate was for measuring overweight and obesity in children and 12.29% in Chinese minority groups. Several studies have adolescents [6–8]. 2 Journal of Healthcare Engineering Body mass index (BMI, weight/height ) is considered to 2. Materials and Methods be the main anthropometric measure for evaluating over- 2.1. Subject. +is study was approved by the Research Ethics weight due to its low cost and ease of application. However, Committee of the Xiamen University, Zhengzhou, China. In despite these advantages, several studies have shown nu- the present study, a total of 647 Chinese Yi adolescents, who merous shortcomings about its application to the correct were 13–18 years old, were recruited. Among these subjects, diagnosis of obesity composition and that the BMI cannot 305 subjects were girls and 342 subjects were boys, and these clearly distinguish the distribution of body fat [9, 10]. One children were admitted to a middle school and a primary major shortcoming is that BMI indexes both fat mass (FM) school in Leshan. +e participants have no other disorders, and fat-free mass (FFM) and, within populations, the ratio of and children with trauma, thyroid disease, superficial lymph FM to FFM varies considerably at any given BMI. At the node enlargement of the neck, and cervical malformations same time, BMI cannot reliably index regional body com- that can affect the normal development of the neck were position, and it is understood that centrally deposited and excluded from the present study. visceral FM contributes significantly to variability in met- abolic risk [11]. +e use of imaging methods (e.g., MRI and X-ray) to measure adipose tissue depots is the best way but 2.2. Anthropometric Measurements. Anthropometric mea- may be limited by cost, time, and access to equipment. Body surements are quantitative measurements of the muscle, composition proxies that go beyond BMI, but are simple, bone, and adipose tissue used to evaluate the structure of the scalable, and reliably indicative of relative disease risk, have body. +e core elements of anthropometry are height, thus been sought [12, 13]. Several studies have revealed that weight, body mass index (BMI), and body circumferences waist circumference (WC), waist-to-hip ratio (WHR), and such as waist, hip, and limb. In this study, the anthropo- waist-to-height ratio (WHtR) are suitable indicators to metric measurements, including height, weight, WC, and evaluate chronic metabolic diseases associated with obesity NC, were obtained. +ese subjects were instructed to wear and overweight [10]. In addition, neck circumference (NC) light clothing and no shoes. +e height and weight tests were is a new indicator to assess obesity in children, when performed under the “National student physical health compared with WC, WHR, and WHtR. It mainly reflects the survey report 2010” [20] physique and health test conditions, upper body subcutaneous fat (UBSF) distribution to esti- and BMI was calculated by dividing weight (kg) by height mate central obesity, and results have revealed that the (cm) squared (m ). During the WC test, the subjects were method is easy to accomplish, convenient, and accurate [14]. instructed to stand upright with their arms open and sag- NC has also received wide interest as a proxy for upper body ging, to reveal their abdominal skin. +e WC test point was FM depots, with studies conducted in children, adolescents, 2 cm above the navel, the position of the body side was and adults in a range of populations. Across these studies, located between the lower ribs and the top of the iliac crest, NC correlated with other anthropometric parameters (e.g., and the measured value was recorded up to 0.1 cm. Data WC and BMI), as well as single and clustered car- were collected using a weighing machine, height measuring diometabolic risk factors, and performed well as a tool to scale, and flexible measuring tape. Height was measured identify those with, or at risk of, metabolic syndrome with help of a stadiometer, and each individual was trained [15–17]. to stand barefoot and head held in horizontal plane to the +ere are 55 minorities in China. However, few studies nearest 0.1 cm. +e weight of each subject was measured by have focused on the correlation between NC and obesity, using a calibrated electronic weighing scale, to the nearest especially for the Yi nationality. +e Yi nationality is the 0.1 kg. Neck circumference was measured between the mid- sixth-largest minority in China, with a population of cervical spine and mid-anterior neck, using a flexible 8,714,393 (2010 National census statistics). +e region of measuring tape with the subjects in the standing position, Liangshan Yi Autonomous Prefecture is the main strong- head held erect, and eyes facing forwards and neck in the hold of Chinese Yi individuals. In the context of the rapid horizontal plane at the level of the most prominent position, pace of population movement in modern society, the pace of the thyroid cartilage. Informed consent was obtained from population integration has further accelerated. Maintaining the head of the school and assent was obtained from the the uniqueness of the physical characteristics of ethnic school students. Informed consent was also taken from minorities has become very urgent [18, 19]. +erefore, in- parents. Approval was obtained from the Institutional Ethics vestigating the unique characteristics of minorities is nec- Committee before instating the study. +e demographic and essary. However, to the best of our knowledge, no study has anthropometric data are represented in Table 1. investigated the reference data on NC in adolescents of Chinese Yi. +erefore, the present study aimed to investigate the correlation among NC, WC, and BMI in Chinese Yi 2.3. Statistical Analysis. +e ROC analysis was used to de- adolescents and determined the best NC cutoff points to termine the predictive validity of NC and evaluate the cutoff identify obesity in Chinese Yi adolescents, thereby im- values for identifying overweight or obese children. +e proving the Chinese national physical health database. ROC curve represents a plot of the true-positive rate +e rest of the paper is organized as follows: Section 2 (sensitivity) against the false-positive rate (specificity) describes the methodology of the proposed work, Section 3 [21, 22]. +e AUC describes the probability that a test would illustrates the results, the results are discussed in Section 4, correctly identify a pair of patients. Normally, the AUC is and finally, the conclusion is given in Section 5. less than 0.5, indicating that the method or index is almost Journal of Healthcare Engineering 3 inefficient. When the AUC is closer to 1, this means a better obese girls ranged from 31.2 cm to 34.5 cm, respectively. +e diagnosis [23]. According to the Youden Index, if sensitivity sensitivity interval of obese boys was 70.0%–87.5%, and the specificity interval was 74.8%–87.3%. Likewise, the sensi- and specificity are diagnostically equally significant, the Youden index will specify the performance at a given cutoff. tivity interval of obese girls was 80.3%–88.6%, and specificity +e Youden index is a common summary measure of the was 72.1%–87.5%, respectively. +ese results reveal a sig- ROC curve. +e maximum value of the Youden index is 1 nificant difference in both genders (p< 0.01). (perfect test), and the minimum is 0 when the test has no +e correlation coefficient among BMI, WC, and NC is diagnostic value. Pearson’s correlation coefficient was used shown in Table 5. It was found that the correlation coeffi- to determine the relationship among BMI, WC, and NC. cients among BMI and NC (BMI-NC) ranged from 0.76 to Obesity was distinguished according to the “Overweight and 0.88 for boys and 0.81 to 0.91 for girls, respectively. Similarly, obesity screening criteria for Chinese school-aged children the correlation coefficient of NC and WC varied from 0.74 to 0.85 for boys and ranged from 0.75 to 0.90 for girls. Likewise, and adolescents” [24–27]. +e descriptive statistics were produced by both of the genders for age, weight, height, the correlation coefficients between BMI and WC ranged from 0.69 to 0.87 for boys and 0.71 to 0.83 for girls, re- BMI, NC, and WC. Continuous variables were represented as mean± standard deviation. +e T-test was used to spectively. All correlation coefficients have a significant compare the mean anthropometric values between boys and difference in both gender and age (p< 0.001). In genral, NC girls. +e results were considered statistically significant showed a strong relationship with BMI and WC in both when p< 0.05. All the statistical analyses were carried out males and females. using Statistical Package for Social Sciences Software (SPSS, Windows version 20.0, Chicago, IL, USA). 4. Discussion th At the beginning of the 20 century, overweight and obesity 3. Results were rare. In the year 1997, the World Health Organization +e present study recruited 647 participants between 13 and (WHO) officially reported obesity as a global epidemic. 18 years. Among the 647 subjects, 342 were male subjects, According to the WHO report, 65% of the world’s pop- the mean age observed was 14.38 years, and 305 were fe- ulation live in countries where overweight and obesity kill males. +e results of the descriptive statistics (Table 1) more people than underweight. +e incidence of obesity is revealed that the age between boys and girls has no sig- rising at an alarming speed, and the harmful effects are nificant difference (p> 0.05). +e weight, height, NC, and prominent [5–7]. Obesity has become the major problem WC were higher in boys than in girls, but the BMI was lower that affects global public health, and pose a greater threat to in girls. All anthropometric values were significantly dif- the health of young people. +e WHR is commonly used to ferent in both genders (p< 0.05). recognize individuals with obesity and overweight. How- Table 2 shows Pearson’s correlation coefficients between ever, the WC is less specific and can vary in the postprandial NC and the other anthropometric values, including age, period, in the menstrual period, and according to bowel weight, height, BMI, and WC. Overall, the NC of obese boys function. NC reflects the deposits of adipose tissue in the and girls and other body measurement correlation coeffi- neck and can be used as the best indicator of subcutaneous cients were higher than those in the normal group. +e adipose tissue in the upper body [11, 12]. Previous studies correlation coefficient of NC and age in normal boys and have suggested that abdominal adiposity among children girls was 0.204 (r � 0.204) and 0.275 (r � 0.275), respectively, and adolescents has an increasing trend in developing or which shows a weak relationship. However, there is no developed countries [15]. At present, there are many indi- significant difference in both genders (p> 0.05). Likewise, cators to evaluate obesity. In 1957, the wideness of the neck the correlation coefficient of age and obese boys and girls was used to evaluate the distribution of upper body fat for was 0.213 (r � 0.213) and 0.360 (r � 0.360), respectively. the first time, and the distribution of neck fat was revealed to However, the correlation between NC and height in the be closely correlated to whole body fat [17]. Later, NC normal group and obese group had no significant difference became a prominent research hotspot for researchers. +e (p> 0.05), and the maximum correlation coefficient was neck is the junction between the trunk and head not covered only 0.246, presenting a low correlation between these by clothing and is convenient for measurement. In addition, groups. In the obese group, NC revealed a moderate or high NC measurements are less invasive than the measurement of correlation (Min � 0.71, Max � 0.84) with weight, BMI, and WC and less cumbersome than assessing BMI. WC in both genders. +e correlation coefficient for the In the present study, a significant association between obesity group was higher than that for the normal group, NC and other anthropometric values of obesity was found in showing an obvious difference (p< 0.001). both gender and all ages. +ese results also show that the NC Tables 3 and 4 represent the results of the ROC analysis measurement can be used as an easy and convenient method in obese boys and girls for NC, respectively. +ese results for overweight and obesity surveys on the Chinese Yi na- show that the AUC values of boys ranged from 0.79 to 0.95, tionality. Many researchers have found that the advantages while the values for girls ranged from 0.83 to 0.91 (Table 4). of NC mainly focus on the following three points when Furthermore, the AUC values were close to 1 in both gender compared with other methods. First, WHtR and WC and all ages. +e cutoff values of the NC of obese boys ranged methods may be time consuming and culturally or envi- from 31.0 cm to 36.1 cm, while the cutoff values of the NC of ronmentally problematic, especially in the winter season, 4 Journal of Healthcare Engineering Table 1: General characteristics of the study population. Variable Boys Girls p Age (years) 15.4 ± 1.6 15.5 ± 1.5 0.517 Weight (kg) 47.2 ± 10.8 46.6 ± 11.0 0.001 Height (cm) 158.4 ± 11.3 152.8 ± 11.2 0.001 BMI (kg/m ) 18.7 ± 5.1 19.9 ± 4.8 0.002 NC (cm) 32.9 ± 3.0 31.5 ± 3.2 0.014 WC (cm) 67.4 ± 10.7 64.5 ± 11.2 0.001 BMI: body mass index; NC: neck circumference; WC: waist circumference. T-test was used to compare the difference between boys and girls. p values<0.05 were considered significant. Table 2: +e relationship between NC and other anthropometric variables in normal and obese adolescents by gender. Normal boys Obese boys Normal girls Obese girls Variable r p r p r p r p Age 0.204 0.043 0.213 0.060 0.275 0.035 0.360 0.440 Height (cm) 0.183 0.106 0.430 0.074 0.246 0.080 0.160 0.133 Weight (kg) 0.569 0.001 0.745 0.001 0.651 0.001 0.805 0.001 BMI (kg/m ) 0.588 0.050 0.726 0.001 0.783 0.001 0.710 0.001 WC (cm) 0.541 0.001 0.769 0.001 0.675 0.001 0.840 0.001 Table 3: AUCs, optimal cutoff values, sensitivities, and specificities for NC associated with obesity in 13–18-year-old boys. Age (years) N AUC (95% CI) Cutoff Sensitivity (%) Specificity (%) p 13 57 0.95 (0.87–0.98) 31.0 72.2 80.1 0.008 14 57 0.90 (0.74–0.92) 33.3 70.0 76.0 0.001 15 58 0.94 (0.79–0.98) 33.7 71.4 85.3 0.001 16 56 0.79 (0.68–0.89) 34.9 72.7 87.3 0.001 17 57 0.92 (0.82–0.99) 35.2 87.5 83.0 0.001 18 57 0.89 (0.84–0.99) 36.1 86.3 74.8 0.001 Table 4: AUCs, optimal cutoff values, sensitivities, and specificities for NC associated with obesity in 13–18-year-old girls. Age (years) N AUC (95% CI) Cutoff Sensitivity (%) Specificity (%) p 13 52 0.91 (0.77–0.98) 31.2 86.6 75.0 0.005 14 51 0.83 (0.69–0.98) 32.0 71.1 87.5 0.003 15 51 0.84 (0.73–0.95) 32.5 76.6 74.9 0.003 16 51 0.86 (0.51–0.99) 33.7 80.3 76.7 0.001 17 50 0.90 (0.81–0.99) 33.1 85.7 72.1 0.001 18 50 0.87 (0.68–0.91) 34.5 88.6 78.4 0.001 Table 5: Pearson’s correlation coefficients of anthropometric indexes by age and gender. BMI-NC NC-WC BMI-WC Age Male Female p Male Female p Male Female p 13 0.84 0.81 <0.001 0.74 0.79 <0.001 0.87 0.78 <0.001 14 0.80 0.88 <0.001 0.82 0.90 <0.001 0.75 0.80 <0.001 15 0.83 0.85 <0.001 0.76 0.83 <0.001 0.78 0.83 <0.001 16 0.82 0.91 <0.001 0.85 0.75 <0.001 0.69 0.77 <0.001 17 0.76 0.83 <0.001 0.77 0.84 <0.001 0.84 0.71 <0.001 18 0.88 0.81 <0.001 0.82 0.79 <0.001 0.74 0.82 <0.001 because clothes have to be removed for obtaining accurate have suggested that BMI cannot accurately identify the and precise measurements [16]. Second, NC is not affected specific distribution of fat because it is affected by height, by other physical indicators. For example, previous studies age, and race differences [18]. In the present study, it was Journal of Healthcare Engineering 5 found that the correlation coefficient of NC and height was this study. +e measurement indexes included height, lower than 0.30, demonstrating that height has little effect on weight, WC, BMI, and NC. +e correlation among NC, body NC. +ird, NC can effectively identify recessive obesity. mass index (BMI), and WC was determined by Pearson’s Recessive obesity refers to the normal look from the physical correlation analysis. +e present study validated that NC is a form, whereas fat mainly accumulates in the visceral part simple and easy tool to screen and identify overweight and [19]. Even if WC is normal, the visceral fat may be excessive obese adolescents when compared to other methods used for because fatness is implicated, and the measurement of WHR obesity determination. Results revealed a significant positive has the same limitations [19]. correlation among NC, WC, and BMI in excess weight +e present study revealed that the AUC values for boys among Chinese Yi adolescents. +e NC could be used as an ranged from 0.85 to 0.94, while the AUC values for girls additional index for evaluating overweight and obesity in ranged from 0.83 to 0.91, respectively, and the minimum Chinese Yi adolescents. +e present study concluded that value of the AUC was 0.83, which was close to 1. +is means NC is a valuable tool for screening obesity among adoles- that NC performed better in diagnosing obesity. It was also cents with reasonable sensitivity and specificity. reported that there was a higher correlation between NC and BMI and WC (r> 0.70). +ese results were consistent with a Data Availability previous study, in which the increase in obesity in the ad- olescent group was positively correlated with the increase in +e data used to support the findings of this study are in- NC [20]. +is suggests that NC is a simple and convenient cluded within the article. measurement to identify children and adolescents who are overweight and obese [21]. Other studies have also suggested Conflicts of Interest that NC can be used with great reliability to predict over- weight and obese children and identify those with a high +e author declares that there are no conflicts of interest. BMI [22]. In general, the comprehensive results of this study confirmed that there is a significant correlation between NC Acknowledgments and obesity in children and adolescents. 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Journal
Journal of Healthcare Engineering – Hindawi Publishing Corporation
Published: Oct 6, 2021