Identification of neck circumference cut-off points for insulin resistance as a marker in adolescents

MELO, Ingrid Ribeiro da Cruz; SOUZA, Márcia Ferreira Cândido de; BARRETO, Íkaro Daniel de Carvalho; SILVA, Danielle Góes da; GURGEL, Ricardo Queiroz

doi:10.1590/1678-9865202134e200190

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Brasil

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Sumário

Original • Rev Nutr 34 • 2021 • https://doi.org/10.1590/1678-9865202134e200190 copy

Identification of neck circumference cut-off points for insulin resistance as a marker in adolescents

Identificação de pontos de corte da circunferência do pescoço como marcador da resistência à insulina em adolescentes

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To identify cut-off points of neck circumference measurement to predict insulin resistance in adolescents.

Methods

Cross-sectional analysis with data derived from the Study of Cardiovascular Risks in Adolescents, nationwide, multicenter, school-based survey. We evaluated 901 adolescents, aged 12 to 17, from public and private schools in two cities of Sergipe state in Brazil. We measured demographic, anthropometric, and biochemical data, and insulin resistance using Homeostasis Model Assessment-Insulin Resistance. We used multiple linear regression and logistic analysis to evaluate the association between dependent variables (biochemical) and independent variables (anthropometric) controlled by body mass index, age, gender, and Tanner’s stage. We used the Receiver operating characteristic curve to determine cut-off points of neck circumference that can identify insulin resistance.

Results

The multiple linear regression analysis showed a positive association between neck circumference measurement with fasting glycemia and glycated hemoglobin (p<0.001) and a negative association with insulin (p<0.024). Furthermore, in logistic regression, the measurement of neck circumference was the only anthropometric indicator positively correlated with homeostasis model assessment-insulin resistance. The cut-off points of neck circumference for predicting insulin resistance were: 30.55cm for female pubertal and 32.10cm for post-pubertal adolescents; 35.90cm for male pubertal adolescents and 36.65cm for post-pubertal adolescents.

Conclusions

The measurement of neck circumference is a simple, practical anthropometric indicator and can be used as a screening tool to identify insulin resistance in adolescents.

Keywords
Adolescent; Anthropometry; Insulin resistance; Neck

Variables		Pubertal staging
		Pubertal			Post-Pubertal			Total
		Female	Male	p-value	Female	Male	p-value	Female	Male	p-value
		n (%)^* * Relative frequency by percentage.	n (%)^* * Relative frequency by percentage.		n (%)^* * Relative frequency by percentage.	n (%)^* * Relative frequency by percentage.		n (%)^* * Relative frequency by percentage.	n (%)^* * Relative frequency by percentage.
Scholl type
	Public	143 (49.5)	105 (44.9)	0.294^† † Pearson’s Chi-square test p<0.05;	106 (46.3)	75 (50.3)	0.441^† † Pearson’s Chi-square test p<0.05;	249 (48.1)	180 (47.0)	0.750^†
	Private	146 (50.5)	129 (55.1)	0.294^† † Pearson’s Chi-square test p<0.05;	123 (53.7)	74 (49.7)	0.441^† † Pearson’s Chi-square test p<0.05;	269 (51.9)	203 (53.0)	0.750^†
Level of education
	Elementary School	137 (47.4)	130 (55.6)	0.064^† † Pearson’s Chi-square test p<0.05;	78 (34.1)	49 (32.9)	0.813^† † Pearson’s Chi-square test p<0.05;	215 (41.5)	179 (46.7)	0.118^† † Pearson’s Chi-square test p<0.05;
	High School	152 (52.6)	104 (44.4)	0.064^† † Pearson’s Chi-square test p<0.05;	151 (65.9)	100 (67.1)	0.813^† † Pearson’s Chi-square test p<0.05;	303 (58.5)	204 (53.3)	0.118^† † Pearson’s Chi-square test p<0.05;
	Age (years)
	12-14	158 (54.7)	134 (53.0)	0.702^† † Pearson’s Chi-square test p<0.05;	88 (38.4)	47 (31.5)	0.172^† † Pearson’s Chi-square test p<0.05;	246 (47.5)	171 (44.6)	0.398^† † Pearson’s Chi-square test p<0.05;
	15-17	131(45.3)	110 (47.0)	0.702^† † Pearson’s Chi-square test p<0.05;	141 (61.6)	102 (68.5)	0.172^† † Pearson’s Chi-square test p<0.05;	272 (52.5)	212 (55.4)	0.398^† † Pearson’s Chi-square test p<0.05;
Nutritional Status
	Low Weight	11 (3.8)	15 (6.4)	0.002^† † Pearson’s Chi-square test p<0.05;	3 (1.3)	5 (3.4)	0.265	14 (2.7)	20 (5.2)	0.029^† † Pearson’s Chi-square test p<0.05;
	Normal Weight	222 (75.8)	159 (67.9)		157 (68.6)	110 (68.6)		379 (73.2)	269 (70.2)
	Overweight	43 (14.9)	30 (12.8)		47 (20.5)	24 (16.1)		90 (17.4)	54 (14.1)
	Obesity	13 (4.5)	30 (12.8)		22 (9.6)	10 (6.7)		35 (6.8)	40 (10.4)
Anthro. measures		M (IQR)	M (IQR)		M (IQR)	M (IQR)		M (IQR)	M (IQR)
Weight (kg)		50.2 (44.1-57.1)	55.8 (46.3-67.5)	<0.001^†† †† Mann-Whitney test p<0.05.	55.7 (48.6-63.4)	59.4 (52.5-70.4)	<0.001^†† †† Mann-Whitney test p<0.05.	52.2 (45.5-59.6)	57.3 (49-68.5)	<0.001^†† †† Mann-Whitney test p<0.05.
BMI (kg/m²)		19.4 (17.4-22.5)	20.1 (17.4-23)	0.244^†† †† Mann-Whitney test p<0.05.	21.6 (19.5-24.4)	20.5 (18.5-23.4)	0.006^†† †† Mann-Whitney test p<0.05.	20.4 (18.2-23.3)	20.3 (17.9-23.2)	0.329^†† †† Mann-Whitney test p<0.05.
WC (cm)		67.2 (63-72.3)	70.3 (64.8-77.1)	<0.001^†† †† Mann-Whitney test p<0.05.	70.8 (65.3-76.8)	71.1 (68-79)	0.079^†† †† Mann-Whitney test p<0.05.	68.5 (64.3-73.9)	70.5 (66.1-78.4)	<0.001^†† †† Mann-Whitney test p<0.05.
NC (cm)		30.3 (29.4-31.6)	32.5 (31-35.6)	<0.001^†† †† Mann-Whitney test p<0.05.	30.9 (30-32.2)	34.3 (32.8-36.8)	<0.001^†† †† Mann-Whitney test p<0.05.	30.5 (29.6-32)	33.9 (32-36.1)	<0.001^†† †† Mann-Whitney test p<0.05.
WHtR (cm)		0.425 (0.39-0.45)	0.422 (0.4-0.46)	0.317^†† †† Mann-Whitney test p<0.05.	0.443 (0.41-0.47)	0.415 (0.399-0.45)	<0.001^†† †† Mann-Whitney test p<0.05.	0.433 (0.40-0.46)	0.419 (0.4-0.46)	0.047^†† †† Mann-Whitney test p<0.05.
Biochemical Tests
	FPG (mg/dL)	84 (80-88)	85 (81-89)	0.033^†† †† Mann-Whitney test p<0.05.	82 (79-87)	85 (81-90)	<0.001^†† †† Mann-Whitney test p<0.05.	83 (79-88)	85 (81-89)	<0.001^†† †† Mann-Whitney test p<0.05.
	HbA1c (mg/dL)	5.4 (5.2-5.6)	5.4 (5.2-5.7)	0.203^†† †† Mann-Whitney test p<0.05.	5.4 (5.2-5.6)	5.4 (5.2-5.6)	0.632^†† †† Mann-Whitney test p<0.05.	5.4 (5.2-5.6)	5.4 (5.2-5.6)	0.443.
	Insulin (IU/mL)	8.2 (6.3-11)	7.1 (4.7-9.8)	<0.001^†† †† Mann-Whitney test p<0.05.	8.8 (6.2-12.2)	6.8 (4.5-9.4)	<0.001^†† †† Mann-Whitney test p<0.05.	8.4 (6.2-11.4)	6.9 (4.6-9.5)	<0.001^†† †† Mann-Whitney test p<0.05.
	HOMA-IR	1.7 (1.25-2.31)	1.46 (0.97-2.03)	<0.001^†† †† Mann-Whitney test p<0.05.	1.78 (1.23-2.57)	1.4 (0.95-1.97)	<0.001^†† †† Mann-Whitney test p<0.05.	1.73 (1.24-2.41)	1.44 (0.95-2)	<0.001^†† †† Mann-Whitney test p<0.05.

Variables	Female				Male
Variables	BMI	NC	WC	WHtR	BMI	NC	WC	WHtR
FGP (mg/dL)	0.014^ Spearman correlation p<0.001.	-0.022^ Spearman correlation p<0.001.	0.038^ Spearman correlation p<0.001.	0.069^ Spearman correlation p<0.001.	0.073^ Spearman correlation p<0.001.	-0.019	0.034	0.105
HbA1c (mg/dL)	0.011^ Spearman correlation p<0.001.	-0.024^ Spearman correlation p<0.001.	0.050^ Spearman correlation p<0.001.	0.050^ Spearman correlation p<0.001.	0.019^ Spearman correlation p<0.001.	-0.011	-0.023	-0.015
Insulin (UI/mL)	0.248^ Spearman correlation p<0.001.	0.218^ Spearman correlation p<0.001.	0.316^ Spearman correlation p<0.001.	0.291^ Spearman correlation p<0.001.	0.347^ Spearman correlation p<0.001.	0.111^* * Spearman correlation p<0.05.	0.372^ Spearman correlation p<0.001.	0.427^ Spearman correlation p<0.001.
HOMA-IR	0.240^ Spearman correlation p<0.001.	0.206^ Spearman correlation p<0.001.	0.306^ Spearman correlation p<0.001.	0.288^ Spearman correlation p<0.001.	0.338^ Spearman correlation p<0.001.	0.101^* * Spearman correlation p<0.05.	0.357^ Spearman correlation p<0.001.	0.415^ Spearman correlation p<0.001.

Dependent variable	Independent variable^* ***** In centimeters;	R²	R² adj	B	CI95%	β	p-value^* * Multiple linear regression;	VIF
FGP (mg/dl)^* * Multiple linear regression;	WC	0.985	0.985	-0.28	-0.52;-0.03	-0.234	0.027	660.93
	NC			2.00	1.74;2.26	0.757	<0.001	147.53
	WHTR			169.03	133.86;204.19	0.874	<0.001	508.09
HbA1c (mg/dl)^* * Multiple linear regression;	WC	0.990	0.990	-0.01	-0.02;0.004	-0.112	0.184	660.93
	NC			0.13	0.11;0.14	0.754	<0.001	147.53
	WHtR			8.09	6.31;9.87	0.659	<0.001	508.09
Insulina (UI/ml)^* * Multiple linear regression;	WC	0.447	0.443	0.19	-0.06;0.45	0.935	0.144	660.93
	NC			-0.31	-0.58;-0.04	-0.685	0.024	147.53
	WHtR			22.24	-14.29;58.76	0.670	0.232	508.09
HOMA-IR^* * Multiple linear regression;	WC	0.133	0.126	0.05	-0.08;0.19	0.618	0.44	660.93
	NC			-0.10	-0.24;0.05	-0.497	0.19	147.53
	WHtR			11.82	-7.65;31.29	0.837	0.234	508.09
				OR	CI95%		p-value^ Logistic Regression;
HOMA-IR p75^ Logistic Regression;	WC			1.02	0.95-1.09		0.545
	NC			1.19	1.01-1.41		0.033
	WHtR			1.03	0.91-1.17		0.639

		Gold Standard HOMA-IR (P75)	Cut-off points NC (cm)	%				Youden^* * Youden Index= Sensitivity+Specificity-1;
		Gold Standard HOMA-IR (P75)	Cut-off points NC (cm)	S	E	PPV	NPV	Youden^* * Youden Index= Sensitivity+Specificity-1;
Female
	Pubertal	2.31	30.55	91.7	72.3	52.4	96.3	0.640
	Post-pubertal	2.57	32.10	86.0	85.5	66.2	94.8	0.714
Male
	Pubertal	2.03	35.90	62.1	89.8	66.7	87.8	0.518
	Post-pubertal	1.97	36.65	70.3	87.5	65.0	89.9	0.578

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[1] Correspondence to: MFC SOUZA. E-mail: nutrimarciacandido@gmail.com.