Abstract：
Objective: To investigate the predictive value of neck circumference on cardiometabolic risk in children. Methods: This was a cross-sectional study of natural sources. As the prediction cohort, clinical data were collected from 3 443 children aged 5-14 years who underwent physical examination in the Department of Child Healthcare, Children\'s Hospital of Nanjing Medical University from July 2021 to September 2022. As the validation cohort for external validation, clinical data were collected from 604 children aged 5-14 years who underwent physical examination in the Department of Child Healthcare, Children\'s Hospital of Nanjing Medical University from October 2022 to March 2023. Height, weight, neck circumference, waist circumference and body composition were measured in both groups, and body mass index, neck circumference to height ratio (NHtR), waist circumference to height ratio, body fat percentage and skeletal muscle percentage were calculated. Systolic blood pressure, diastolic blood pressure, fasting blood glucose, blood lipid and uric acid and other cardiovascular and metabolic risk indicators were collected in both groups. The prediction cohort was further stratified into clustered and non-clustered groups based on the clustering of cardiometabolic risk factors (CCRF). Various variables between these 2 groups were compared using the Mann-Whitney U test. Pearson correlation and binary Logistic regression were conducted to investigate the correlations between neck circumference and cardiovascular metabolic risk factors. The accuracy of NHtR in predicting the CCRF was evaluated using the area under the curve (AUC) of receiver operating characteristic (ROC). The cutoff value was determined using the Youden index. The validation cohort was then divided into groups above and below the cutoff value, and the detection rate of CCRF between the 2 groups was compared using the χ2 test for validation. Results: In the prediction cohort of 3 443 children (2 316 boys and 1 127 girls), 1 395 (40.5%) children were overweight or obese, and 1 157 (33.6%) children had CCRF. Pearson correlation analysis revealed all significant positive correlations (all P<0.01) between neck circumference and systolic blood pressure (r=0.47, 0.39), diastolic blood pressure (r=0.27, 0.21), uric acid (r=0.36, 0.30), and triglycerides (r=0.20, 0.20) after adjusting for age in both males and females. Among both males and females, neck circumference both showed significant negative correlation (both P<0.01) with high-density lipoprotein cholesterol (r=-0.27, -0.28), and no correlation with fasting glucose levels (r=0.03, -0.03, both P>0.05). After adjusting for gender, age, and body fat percentage, increased body mass index, neck circumference, or waist circumference increased the risks of hypertension (OR=1.23, 1.39, 1.07, all P<0.001), hyperuricemia (OR=1.16, 1.23, 1.05, all P<0.001), hypertriglyceridemia (OR=1.08, 1.16, 1.02, all P<0.01), low high-density lipoprotein cholesterol (OR=1.10, 1.27, 1.03, all P<0.01), and the CCRF (OR=1.51, 1.73, 1.15, all P<0.01). The areas under the ROC curves of NHtR in predicting CCRF was 0.73, with sensitivity and specificity at 0.66 and 0.71, respectively. The corresponding optimal cut-off value was 0.21. Validation with 604 children confirmed that the detection of CCRF in the NHtR≥0.21 group was 3.29 times (60.5% (112/185) vs. 18.7% (79/422),χ2=107.82, P<0.01) higher compared to the NHtR <0.21 group. Conclusions: Neck circumference is associated with cardiovascular metabolic risks such as hypertension, hyperlipidemia, hyperglycemia, and hyperuricemia in children. When the NHtR is ≥0.21, there is an increased likelihood of CCRF.
目的： 探讨儿童颈围对心血管代谢风险的预测价值。 方法： 自然来源的横断面研究，选取 2021年7月至2022年9月在南京医科大学附属儿童医院儿童保健门诊健康体检的3 443名5~14岁儿童作为预测组，选取2022年10月至2023年3月在南京医科大学附属儿童医院儿童保健门诊健康体检的604名5~14岁儿童作为验证组。两组儿童均测量身高、体重、颈围、腰围及体成分，并计算体质指数、颈围身高比、腰围身高比、体脂百分比和骨骼肌百分比，收集收缩压、舒张压、空腹血糖、血脂及尿酸等心血管代谢风险指标。根据心血管代谢危险因素的聚集（CCRF）情况将预测组分为CCRF组及非CCRF组，采用Mann-Whitney U检验比较各变量在两组之间的差异；应用Pearson分析、二元Logistic回归进行颈围与儿童心血管代谢危险因素之间的相关分析，以受试者工作特征曲线的曲线下面积（AUC）评估颈围身高比预测CCRF的准确性，并通过计算约登指数确定其截断值。根据确定的截断值将验证组分组，采用χ2检验进行组间比较、验证。 结果： 3 443名预测组儿童中男2 316名、女1 127名，超重和肥胖儿童1 395名（40.5%），CCRF组1 157名（33.6%）。男、女童在校正年龄后颈围与收缩压（r=0.47、0.39）、舒张压（r=0.27、0.21）、尿酸（r=0.36、0.30）及甘油三酯（r=0.20、0.20）均呈正相关（均P<0.01），与高密度脂蛋白胆固醇（r=-0.27、-0.28）均呈负相关（均P<0.01），与空腹葡萄糖（r=0.03、-0.03）之间均无相关性（均P>0.05）。校正性别、年龄及体脂百分比后，体质指数、颈围及腰围均是高血压（OR=1.23、1.39、1.07，均P<0.001）、高尿酸血症（OR=1.16、1.23、1.05，均P<0.001）、高甘油三酯（OR=1.08、1.16、1.02，均P<0.001）、低高密度脂蛋白胆固醇（OR=1.10、1.27、1.03，均P<0.01）及CCRF（OR=1.51、1.73、1.15，均P<0.001）的危险因素。颈围身高比预测CCRF的AUC为0.73，灵敏度和特异度分别为0.66及0.71，其相对应的最佳截断值为0.21。验证604名儿童，颈围身高比≥0.21组CCRF检出率是颈围身高比<0.21组的3.29倍［60.5%（112/185）比18.7%（79/422），χ2=107.82，P<0.01］。 结论： 颈围与儿童高血压、高血脂、高血糖及高尿酸血症等多种心血管代谢风险相关，当颈围身高比≥0.21时，容易出现CCRF现象。.
目的： 探讨儿童颈围对心血管代谢风险的预测价值。 方法： 自然来源的横断面研究，选取 2021年7月至2022年9月在南京医科大学附属儿童医院儿童保健门诊健康体检的3 443名5~14岁儿童作为预测组，选取2022年10月至2023年3月在南京医科大学附属儿童医院儿童保健门诊健康体检的604名5~14岁儿童作为验证组。两组儿童均测量身高、体重、颈围、腰围及体成分，并计算体质指数、颈围身高比、腰围身高比、体脂百分比和骨骼肌百分比，收集收缩压、舒张压、空腹血糖、血脂及尿酸等心血管代谢风险指标。根据心血管代谢危险因素的聚集（CCRF）情况将预测组分为CCRF组及非CCRF组，采用Mann-Whitney U检验比较各变量在两组之间的差异；应用Pearson分析、二元Logistic回归进行颈围与儿童心血管代谢危险因素之间的相关分析，以受试者工作特征曲线的曲线下面积（AUC）评估颈围身高比预测CCRF的准确性，并通过计算约登指数确定其截断值。根据确定的截断值将验证组分组，采用χ2检验进行组间比较、验证。 结果： 3 443名预测组儿童中男2 316名、女1 127名，超重和肥胖儿童1 395名（40.5%），CCRF组1 157名（33.6%）。男、女童在校正年龄后颈围与收缩压（r=0.47、0.39）、舒张压（r=0.27、0.21）、尿酸（r=0.36、0.30）及甘油三酯（r=0.20、0.20）均呈正相关（均P<0.01），与高密度脂蛋白胆固醇（r=-0.27、-0.28）均呈负相关（均P<0.01），与空腹葡萄糖（r=0.03、-0.03）之间均无相关性（均P>0.05）。校正性别、年龄及体脂百分比后，体质指数、颈围及腰围均是高血压（OR=1.23、1.39、1.07，均P<0.001）、高尿酸血症（OR=1.16、1.23、1.05，均P<0.001）、高甘油三酯（OR=1.08、1.16、1.02，均P<0.001）、低高密度脂蛋白胆固醇（OR=1.10、1.27、1.03，均P<0.01）及CCRF（OR=1.51、1.73、1.15，均P<0.001）的危险因素。颈围身高比预测CCRF的AUC为0.73，灵敏度和特异度分别为0.66及0.71，其相对应的最佳截断值为0.21。验证604名儿童，颈围身高比≥0.21组CCRF检出率是颈围身高比<0.21组的3.29倍［60.5%（112/185）比18.7%（79/422），χ2=107.82，P<0.01］。 结论： 颈围与儿童高血压、高血脂、高血糖及高尿酸血症等多种心血管代谢风险相关，当颈围身高比≥0.21时，容易出现CCRF现象。.
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