Archives of Obesity and Metabolism (비만대사연구학술지)

The Study of Obesity and Metabolic Syndrome, KAFM (대한가정의학회 비만대사증후군연구회)
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Neck Circumference Versus Neck Circumference-to-Height Ratio for Identifying Metabolic Syndrome in Korean Adults Aged ≥40 Years: A Sex-Specific Approach

40세 이상 한국 성인의 대사 증후군 선별 지표로서 목 둘레와 목 둘레 대비 신장 비율의 비교: 성별 특이적 분석

  • Phil-lip Yoon (Department of Family Medicine, Yongin Severance Hospital, Yonsei University College of Medicine) ;
  • Sung-Ho Ahn (Department of Family Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Byoungjin Park (Department of Family Medicine, Yongin Severance Hospital, Yonsei University College of Medicine) ;
  • Yong-Jae Lee (Department of Family Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Yu-Jin Kwon (Department of Family Medicine, Severance Hospital, Yonsei University College of Medicine)
  • 윤필립 (연세대학교 의과대학 용인세브란스병원 가정의학과) ;
  • 안성호 (연세대학교 의과대학 강남세브란스병원 가정의학과) ;
  • 박병진 (연세대학교 의과대학 용인세브란스병원 가정의학과) ;
  • 이용제 (연세대학교 의과대학 강남세브란스병원 가정의학과) ;
  • 권유진 (연세대학교 의과대학 세브란스병원 가정의학과)
  • Received : 2026.05.06
  • Accepted : 2026.06.02
  • Published : 2026.06.30
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Abstract

Background: Neck circumference (NC) is a simple marker of upper-body adiposity; however, whether NC or height-adjusted NC (neck-to-height ratio, NC/Ht ratio) better identifies metabolic syndrome (MetS) and whether the optimal index differs by sex remains unclear. Methods: This cross-sectional study analyzed 10,451 adults (4,685 male participants; 5,766 female participants) aged ≥40 years from the 2019-2021 Korea National Health and Nutrition Examination Survey. MetS was defined using the modified NCEP-ATP III criteria. The discriminatory performances of the two indices were compared using receiver operating characteristic curve analysis with DeLong's test, and the optimal cutoffs were determined using the Youden index with bootstrap confidence intervals. Sex-stratified multivariate logistic regression was adjusted for age, body mass index, alcohol use, smoking, and physical activity. Results: Both indices were higher in the MetS group for both sexes (all P<0.001). NC showed superior discrimination in male participants (area under the curve, 0.733 vs. 0.708, P<0.001), whereas the NC/Ht ratio outperformed NC in female participants (0.755 vs. 0.733, P<0.001). The optimal cutoffs were an NC of 37.9 cm for male and an NC/Ht ratio of 20.92 for female participants. The highest versus the lowest quartile was associated with higher odds of prevalent MetS (male participants: odds ratio, 2.99 for NC; female participants: 5.00, for NC/Ht ratio). Conclusion: The sex-specific use of these indices, NC for male and the NC/Ht ratio for female participants, may enhance MetS screening in this population. Further prospective validation is required.

Keywords

References

  1. Kim KY, Moon HR, Yun JM. Neck circumference as a predictor of metabolic syndrome in Koreans: a cross-sectional study. Nutrients 2021;13:3029. https://doi.org/10.3390/nu13093029
  2. Huh JH, Lee JH, Moon JS, Sung KC, Kim JY, Kang DR. Metabolic syndrome severity score in Korean adults: analysis of the 2010-2015 Korea National Health and Nutrition Examination Survey. J Korean Med Sci 2019;34:e48. https://doi.org/10.3346/jkms.2019.34.e48
  3. Lee BJ, Kim JY. Identification of metabolic syndrome using phenotypes consisting of triglyceride levels with anthropometric indices in Korean adults. BMC Endocr Disord 2020;20:29. https://doi.org/10.1186/s12902-020-0510-0
  4. Laohabut I, Udol K, Phisalprapa P, et al. Neck circumference as a predictor of metabolic syndrome: a cross-sectional study. Prim Care Diabetes 2020;14:265-73. https://doi.org/10.1016/j.pcd.2019.08.007
  5. Cho S, Jung JH, Nam GE, et al. 2024 Obesity fact sheet in Korea: prevalence of obesity, abdominal obesity, obesity defined by body fat percentage, and underweight in adults in Korea from 2013 to 2022. J Obes Metab Syndr 2025;34:405-13. https://doi.org/10.7570/jomes25039
  6. Kim Y, Choi Y, Lee KN, et al. Disparities in trends of metabolic syndrome in Korea from 2007 to 2022 by age, sex, and lifestyle factors. Sci Rep 2025;15:21185. https://doi.org/10.1038/s41598-025-04193-z
  7. Baik I. Gender-specific associations among neck circumference, the rs9939609 FTO gene polymorphism, and the 14- year risk of metabolic syndrome in the Korean adult population. Epidemiol Health 2024;46:e2024072. https://doi.org/10.4178/epih.e2024072
  8. Girdhar K, Rijhwani P, Sarna M, Agarwal P, Garg S, Shoaib M. To evaluate the association of neck circumference and midarm circumference to the components of metabolic syndrome. J Mahatma Gandhi Univ Med Sci Tech 2022;7:72-4.
  9. Namazi N, Larijani B, Surkan PJ, Azadbakht L. The association of neck circumference with risk of metabolic syndrome and its components in adults: a systematic review and meta-analysis. Nutr Metab Cardiovasc Dis 2018;28:657-74. https://doi.org/10.1016/j.numecd.2018.03.006
  10. Luo Y, Ma X, Shen Y, et al. Neck circumference as an effective measure for identifying cardio-metabolic syndrome: a comparison with waist circumference. Endocrine 2017;55:822-30. https://doi.org/10.1007/s12020-016-1151-y
  11. Haapakangas SM, Koskenkari NVS, Hurskainen EL, Arffman RK, Ollila MM, Piltonen TT. Neck circumference as a metabolic health marker among women with polycystic ovary syndrome (PCOS): a systematic review and meta-analysis. Int J Obes (Lond) 2025;49:998-1012. https://doi.org/10.1038/s41366-025-01753-1
  12. Cresswell E, Basty N, Atabaki Pasdar N, Karpe F, Pinnick KE. The value of neck adipose tissue as a predictor for metabolic risk in health and type 2 diabetes. Biochem Pharmacol 2024;223:116171.
  13. Zhou JY, Ge H, Zhu MF, et al. Neck circumference as an independent predictive contributor to cardio-metabolic syndrome. Cardiovasc Diabetol 2013;12:76. https://doi.org/10.1186/1475-2840-12-76
  14. Alirezaei T, Soori H, Irilouzadian R, Najafimehr H. Novel anthropometric indices as screening tools for obesity: a study on healthy Iranians. J Nutr Metab 2023;2023:6612411. https://doi.org/10.1155/2023/6612411
  15. Kim M, Lee Y, Lee JY, Lee JW. Assessment of neck to height ratio as a predictive tool for metabolic dysfunction-associated steatotic liver disease in Korean adults: a cross-sectional analysis from the Korea National Health and Nutrition Examination Survey 2019-2021. Korean J Fam Med 2026;47:201-9. https://doi.org/10.4082/kjfm.24.0216
  16. Lee KR. Neck to waist circumference ratio and insulin resistance in adult Korean population under 50 years. Metab Syndr Relat Disord 2025;23:422-5. https://doi.org/10.1177/15578518251379854
  17. Sahay N, Acharya RV, Sahay K, Sahay M. To establish the utility of neck circumference as a novel and simple risk marker for detection of metabolic syndrome and cardiometabolic risk factors in Indians. J Assoc Physicians India 2024;72:40-3. https://doi.org/10.59556/japi.72.0773
  18. Kweon S, Kim Y, Jang MJ, et al. Data resource profile: the Korea National Health and Nutrition Examination Survey (KNHANES). Int J Epidemiol 2014;43:69-77. https://doi.org/10.1093/ije/dyt228
  19. Oh K, Kim Y, Kweon S, et al. Korea National Health and Nutrition Examination Survey, 20th anniversary: accomplishments and future directions. Epidemiol Health 2021;43:e2021025. https://doi.org/10.4178/epih.e2021025
  20. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985;28:412-9. https://doi.org/10.1007/BF00280883
  21. Keskin M, Kurtoglu S, Kendirci M, Atabek ME, Yazici C. Homeostasis model assessment is more reliable than the fasting glucose/insulin ratio and quantitative insulin sensitivity check index for assessing insulin resistance among obese children and adolescents. Pediatrics 2005;115:e500-3. https://doi.org/10.1542/peds.2004-1921
  22. Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA 2002;287:356-9. https://doi.org/10.1001/jama.287.3.356
  23. Stabe C, Vasques AC, Lima MM, et al. Neck circumference as a simple tool for identifying the metabolic syndrome and insulin resistance: results from the Brazilian Metabolic Syndrome Study. Clin Endocrinol (Oxf) 2013;78:874-81. https://doi.org/10.1111/cen.2013.78.issue-6
  24. Chan V, Cao L, Wong MMH, Lo K, Tam W. Diagnostic accuracy of waist-to-height ratio, waist circumference, and body mass index in identifying metabolic syndrome and its components in older adults: a systematic review and meta-analysis. Curr Dev Nutr 2023;8:102061.
  25. Mirr M, Skrypnik D, Bogdański P, Owecki M. Newly proposed insulin resistance indexes called TyG-NC and TyG-NHtR show efficacy in diagnosing the metabolic syndrome. J Endocrinol Invest 2021;44:2831-43. https://doi.org/10.1007/s40618-021-01608-2
  26. Huang Y, Gu L, Li N, et al. The product of waist and neck circumference outperforms traditional anthropometric indices in identifying metabolic syndrome in Chinese adults with type 2 diabetes: a cross-sectional study. Diabetol Metab Syndr 2021;13:35. https://doi.org/10.1186/s13098-021-00653-4
  27. Strack C, Behrens G, Sag S, et al. Gender differences in cardiometabolic health and disease in a cross-sectional observational obesity study. Biol Sex Differ 2022;13:8. https://doi.org/10.1186/s13293-022-00416-4
  28. Hsieh SD, Yoshinaga H, Muto T. Waist-to-height ratio, a simple and practical index for assessing central fat distribution and metabolic risk in Japanese men and women. Int J Obes Relat Metab Disord 2003;27:610-6. https://doi.org/10.1038/sj.ijo.0802259
  29. Smith U, Kahn BB. Adipose tissue regulates insulin sensitivity: role of adipogenesis, de novo lipogenesis and novel lipids. J Intern Med 2016;280:465-75. https://doi.org/10.1111/joim.2016.280.issue-5
  30. Kim JE, Kim JS, Jo MJ, et al. The roles and associated mechanisms of adipokines in development of metabolic syndrome. Molecules 2022;27:334. https://doi.org/10.3390/molecules27020334
  31. Rabiee A, Hossain MA, Poojari A. adipose tissue insulin resistance: a key driver of metabolic syndrome pathogenesis. Biomedicines 2025;13:2376. https://doi.org/10.3390/biomedicines13102376
  32. Liu Y, Tong G, Tong W, Lu L, Qin X. Can body mass index, waist circumference, waist-hip ratio and waist-height ratio predict the presence of multiple metabolic risk factors in Chinese subjects? BMC Public Health 2011;11:35. https://doi.org/10.1186/1471-2458-11-35
  33. Zanuncio VV, Sediyama CMNO, Dias MM, et al. Neck circumference and the burden of metabolic syndrome disease: a population-based sample. J Public Health (Oxf) 2022;44:753-60. https://doi.org/10.1093/pubmed/fdab197
  34. Abboud M, Haidar S, Mahboub N, Papandreou D, Rizk R. Abdominal volume index, waist-to-height ratio, and waist circumference are optimal predictors of cardiometabolic abnormalities in a sample of Lebanese adults: a cross-sectional study. PLOS Glob Public Health 2023;3:e0002726.
  35. Libardi MC, Martins CA, Ferreira JRS, et al. Neck circumference cutoff point as a predictor of metabolic syndrome in Brazilian rural workers. PLoS One 2025;20:e0316090. https://doi.org/10.1371/journal.pone.0316090
  36. Liu Y, Liu A, Xu X, et al. Predictive values of neck circumference and TyG index on polycystic ovary syndrome with metabolic syndrome. Sci Rep 2025;15:24055. https://doi.org/10.1038/s41598-025-09001-2