Available online on 15.01.2025 at http://jddtonline.info

Journal of Drug Delivery and Therapeutics

Open Access to Pharmaceutical and Medical Research

Copyright  © 2025 The   Author(s): This is an open-access article distributed under the terms of the CC BY-NC 4.0 which permits unrestricted use, distribution, and reproduction in any medium for non-commercial use provided the original author and source are credited

Open Access Full Text Article                                                                                      Research Article

The Relationship Between Body Mass Index, Waist Circumference, Neck Circumference and Cardiovascular Risk Factors

Mehmet Kasım AYDIN ^1,* , Mitat BAHÇECI ²

¹ Department of Gastroenterology, Mersin University School of Medicine, Mersin, Turkey

² Department of Endocrinology and Metabolism, Izmir Kent Hospital, Izmir, Turkey

 

 

INTRODUCTION

Obesity is recognised as a worldwide epidemic and the rate continues to rise. According to the latest figures from the World Health Organisation (WHO) ¹, approximately 13% of the world's adult population is obese and it is estimated that 50% of the US adult population will be obese by 2030 ². Obesity is more common in women than men, especially in middle and older age groups ^3,4. 

WHO defines obesity and overweight as abnormal or excessive fat accumulation at a level that may impair health ⁵. Excessive adiposity greatly increases chronic disease morbidity and mortality, including cardiovascular disease (CVD) ⁶.  Although measures of adiposity such as body mass index (BMI) or waist circumference (WC) are not the best markers for CVD compared with other cardiovascular risk factors, increased adiposity is strongly associated with the development of insulin resistance, diabetes mellitus (DM).  BMI is the most widely used measure of obesity due to its simplicity and reproducibility ^5,7. However, it does not take into account fat distribution. Fat accumulation in the trunk is associated with atherogenic dyslipidemia, type 2 DM, hypertension and inflammation, all of which increase CVD risk ⁸. BMI is a more precise indicator of visceral fat accumulation and an adverse metabolic profile than BMI7. However, the two indices are strongly correlated and therefore have similar associations with cardiovascular risk ⁹. Another recently used anthropometric measurement is neck circumference (NP), which has been found to be positively correlated with metabolic syndrome elements in studies ^10,11. 

This study was conducted to evaluate the relationship between Body Mass Index (BMI), Waist Circumference (WC) and Neck Circumference (NC) with major cardiometabolic risk factors and to confirm whether BMI, WC and NC are independently associated with these risk factors.

MATERIALS AND METHODS 

Between May-2002 and September-2003, 199 male and female adults from Dicle University Faculty of Medicine and Diyarbakır province were included in the study. A total of 199 individuals aged between 20 and 73 years (mean age 35 ± 11 years), 86 females (mean age 33.8 ± 11.7 years) and 113 males (mean age 36.5 ± 11.3 years), with BMI ranging from 16.3 kg/m2 to 41 kg/m2 (mean 25.7 ± 4.5 kg/m2 ) were included. University staff and healthy relatives of patients with no history of any disease or drug use were included in the study.

Anthropometric measurements

Waist circumference: Waist circumference was measured in centimetres around the midpoint between the spina iliaca anterior superior and the costal arch. 

Body mass index (BMI): It was obtained by the ratio of body weight to the square of height. 

Neck circumference: Measured in centimetres from the centre of the neck. 

Blood pressure: Systolic and diastolic blood pressures were measured twice with a mercury sphygmomanometer with an appropriate cuff size on the right arm after a rest period of 5 min in a sitting position. 

Biochemical methods: Blood samples for serum lipids (triglycerides, total cholesterol, HDL-cholesterol, HDL-k, LDL-k, VLDL-k), fasting blood glucose and basal insulin measurements were obtained from each subject between 08-09 hours in the morning after 12 hours of fasting. LDL-cholesterol. Calculated using the Freidwald equation (LDL-cholesterol=Total-cholesterol-(HDL-k+Triglyceride/5)). insulin resistance: Measured by HOMA-IR test. 

HOMA (Homeostasis-model assessment) = insulin (µU/ml) x Glucose (mmol/1)/ 22.5

Statistical Analysis

Pearson's correlation (2 tailed) was applied to all individuals included in the study, male and female groups separately without considering waist circumference, BMI and neck circumference. P<0.05 was accepted as significant. As subgroups, two groups were formed for men (waist circumference < 102, waist circumference > 102) and two groups for women (waist circumference < 88, waist circumference > 88). Two subgroups were formed as BMI < 25 kg/m2 and BMI > 25 kg/m2 for men and women. Independent t-test was applied to subgroups. Mean ± standard deviations were used in group comparisons. P<0.05 was accepted as significant. Statistical analyses were performed with SPSS version 8.

RESULTS

General study parameters in men and women: Systolic and diastolic blood pressures, body mass indexes, total cholesterol and LDL cholesterol levels, insulin and glucose levels were similar in men and women. In men, height was taller, weight, waist circumference, neck circumference, triglyceride levels were higher and HDL-cholesterol levels were lower ( table I ).

Table I: Characteristics of the study group

n	Male	Female
199	113	86
AGE (year)	36,5 ± 11,3	33,8 ± 11,7
SP (mmHg)	117,6 ± 15,1	113 ± 15,6
DP(mmHg)	74,4 ± 9,9	69,8 ± 11,7
HEIGHT (m)	173 ± 5,9	160 ± 6,7
WEIGHT (kg)	77,1 ± 11,4	65,7 ± 13,8
Waist circumference (cm)	94 ± 10,6	83,7 ± 13,4
NECK (cm)	38,6 ± 2,7	34,3 ± 3,1
TRG (mg/dl)	164 ± 71	132 ± 118
T.CHOL (mg/dl)	178 ± 37	185 ± 44
HDL-C (mg/dl)	35 ± 6,6	41,5 ± 12,2
LDL-C (mg/dl)	112 ± 35	109 ± 43
INSULIN (iU/ml)	10,1 ± 8,1	9,4 ± 11
BMI (kg/m2)	25,7 ± 3,4	25,6 ± 5,6
GLUKOZ (mg/dl)	99±32	95±22

LDL-k; LDL-cholesterol, T-CHOL; Total-cholesterol, TRG; TriglycerideHDL-k; HDL-cholesterol, SP; Systolic pressure, DP; Diastolic pressure, BMI; Body mass index

Study parameters showing the correlation between waist circumference, body mass index (BMI), neck circumference and cardiovascular risk factors (table II) Among anthropometric measurements, waist circumference was more strongly correlated with cardiovascular risk factors than BMI and neck circumference (p < 0.001). Waist circumference showed the strongest negative correlation with HDL-cholesterol. The strongest correlation between systolic and diastolic blood pressures and anthropometric measurements was with waist circumference.

 

 

 

 

 

Table II: Correlations between anthropometric measurements and cardiovascular risk factors

	STA	DTA	VYK	T.KOL	TG	HDL-k	LDL-k
Waist circumference (cm)	r=0,426 p<0,001	r=0,414  p<0,001	r=0,795  p<0,001	r=0,450  p<0,001	r=0,556  p<0,001	r=0,261* p<0,001	r=0,486 p<0,001
BMI (kg/m2)	r=0,339	r=0,314	r=0,849	r=0,431	r=0,386	r=0 151*	r=0,464
	p<0,001	p<0,001	p<0,001	p<0,001	p<0,001	P=0,055	p<0,001
Neck  circumference	r=0,260	r=0,290	r=0,318	r=0,534	r=0,365	r=0,131*	r=0,406
	p<0,001	p<0,001	p<0,001	p<0,001	p<0,001	p=0,223	p<0,001

BMI; Body mass index             *; Negatively correlated

 

 

DISCUSSION

In our study, we investigated the relationship between body anthropometric measurements and lipid parameters. As a result, hyperglycemia, dyslipidemia, hypertension and obesity-related complications were determined. Blood pressure, total cholesterol, triglycerides, glucose, HOMA-IR, body fat mass, and total cholesterol, total cholesterol, triglycerides, glucose, HOMA-IR were found to be increased in the groups with a waist circumference of 102 cm and a BMI above 25 kg/m2 for men and in the groups with a waist circumference of 88 cm and a BMI above 25 kg/m2 for women. Waist circumference better reflected the risk of cardiovascular disease than BMI (table II). Waist circumference was more strongly correlated with systolic and diastolic blood pressure, total cholesterol, triglycerides, LDL-cholesterol. There was a strong correlation between waist circumference and triglycerides in both men and women and this correlation was higher than other anthropometric measurements (r = 0;556). Triglyceride level increases with increasing waist circumference and this condition is called hypertriglyceridemic waist. Studies indicate that hypertriglyceridemic waist can be used as the only criterion to reflect cardiovascular risk factors ¹². As waist circumference and BMI increase, HDL-cholesterol level decreases. The negative correlation between waist circumference and HDL-cholesterol was stronger than BMI (r = - 0.261, p < 0.001). Waist circumference measurements showed a similarly strong correlation with BMI (r = 0.865) and body weight (r = 0.819). In our study, we found that waist circumference and BMI were correlated with cardiovascular risk factors independently of each other. When the measurement parameters were taken into consideration, it was found that waist circumference was more closely correlated with cardiovascular risk factors in men and women than BMI. However, body fat mass was better correlated with BMI. 

In reality, an inherent difficulty with the use of BMI as an indicator of adiposity is that BMI consists of two components ¹³; fat mass (fat mass, FM) and fat free mass (free fat mass, FFM). 

BMI= (fat mass + fat free mass) / m2 = FM /m2 + FFM / m2 

FM I m2-+ is used as fat mass index, FFM / m2 -+ as lean mass index.

The use of BMI as a substitute for both FM and adiposity may affect different health problems. Waist circumference, on the other hand, is not affected much by height ¹⁴, so it is unnecessary to divide waist by height when waist circumference is used as an index of adiposity. Due to these features, waist circumference is more advantageous than BMI as it is easily applicable and correlates more strongly with body weight and lipid parameters. Waist circumference has been widely used in recent epidemiological studies ^15,16,17. Recent recommendations for the use of waist circumference as a single measure of body fat and fat distribution are now accepted by many major public health agencies and organisations ^18,19,20. Pauliot et al. found increased cardiovascular risk in men with a waist circumference over 87 cm and in women with a waist circumference over 78 cm ²¹. The Framingham Heart Study also found that waist circumference was more powerful than other anthropometric measurements in predicting mortality ²². The World Health Organisation recommends waist circumference as a basic anthropometric measurement along with BMI ²³.

In many consecutive large-scale studies, an association between waist circumference and diabetes and cardiovascular risk factors has been found (the US Third National Health and Nutrition Examination Survey ²⁴ and the Italian olivetti heart study ²⁵. Recent studies have found that waist circumference is closely associated with insulin resistance in women ²⁶. In our study, the HOMA-IR method was used to evaluate insulin resistance. In women, the relationship between body mass index and insulin resistance (r=0.415, p<0.001) was stronger than the relationship between waist circumference and insulin resistance (r=0.333, p=0.02). In men, we found a positive correlation between waist circumference and HOMA-IR (r=0.271, p=0.04). In our study, we did not find a correlation between BMI and HOMA-IR in men. In recent studies, waist circumference has been found to be closely associated with insulin resistance syndrome in women ²⁶, type 2 diabetes in men ¹⁵, breast cancer in women ²⁷ and colon cancer in men ²⁸. In this respect, waist circumference measurements can be used as a method to assess general health risks. In our study, we evaluated nuchal circumference in addition to anthropometric measurements. Nuchal circumference was correlated with body weight (r=0.760), waist circumference (r=0.732), total cholesterol (r=0.534), triglycerides (r=0.365), LDL cholesterol (r=0.406), BMI (r=0, 568), systolic blood pressure (r=0.260), diastolic blood pressure (r=0.290), glucose (r=0.280) and p < 0.001 in all correlations. Long neck circumference was positively correlated with metabolic syndrome elements ^10,11.

CONCLUSION

Obesity may lead to increased blood pressure, dyslipidemia and insulin resistance. 

There is a relationship between BMI, waist circumference, neck circumference and dyslipidemia in determining obesity characteristics. 

A tighter relationship was found between waist circumference and metabolic parameters. 

Waist circumference may reflect cardiovascular disease risk better than BMI.

Neck circumference measurement, which is a new obesity indicator, can also be used as an obesity assessment method.

Conflict of Interest: The authors declare no potential conflict of interest with respect to the contents, authorship, and/or publication of this article.

Author Contributions: All authors have equal contribution in the preparation of manuscript and compilation.

Source of Support: Nil

Funding: The authors declared that this study has received no financial support.

Informed Consent Statement: Informed consent was obtained from all subjects involved in the study. 

Data Availability Statement: The data presented in this study are available on request from the corresponding author. 

Ethics approval: Not applicable

REFERENCES

1 WHO Obesity factsheet.html [Internet]. [cited 2023 Mar 1]. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight

2. C.M. Hales, M.D. Carroll, C.D. Fryar, C.L. Ogden. Prevalence of obesity and severe obesity among adults: United States, 2017-2018 key findings data from the national health and nutrition examination survey [Internet] (2017) https://www.cdc.gov/nchs/products/index.html   

3. I. Lambrinoudaki, M. Brincat, C.T. Erel, M. Gambacciani, M.H. Moen, K. Schenck-Gustafsson, et al.EMAS position statement: managing obese postmenopausal womenMaturitas, 2010;66(3):323-326 https://doi.org/10.1016/j.maturitas.2010.03.025 PMid:20434858

4. M. Li, W. Gong, S. Wang, Z. LiTrends in body mass index, overweight and obesity among adults in the USA, the NHANES from 2003 to 2018: a repeat cross-sectional survey BMJ Open, 2022;12(12):Article e065425 https://doi.org/10.1136/bmjopen-2022-065425 PMid:36526312 PMCid:PMC9764609

5. World Health Organization Obesity and Overweight. World Health Organization Website. [(accessed on 11 October 2022)]. Available online: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight 

6. Hruby A., Hu F.B. The Epidemiology of Obesity: A Big Picture. PharmacoEconomics. 2014;33:673-689. https://doi.org/10.1007/s40273-014-0243-x PMid:25471927 PMCid:PMC4859313

7. The Emerging Risk Factors Collaboration Separate and combined associations of body-mass index and abdominal adiposity with cardiovascular disease: Collaborative analysis of 58 prospective studies. Lancet. 2011;377:1085-1095. https://doi.org/10.1016/S0140-6736(11)60105-0 PMid:21397319

8. Neeland I.J., Poirier P., Després J.-P. Cardiovascular and Metabolic Heterogeneity of Obesity: Clinical Challenges and Implications for Management. Circulation. 2018;137:1391-1406. https://doi.org/10.1161/CIRCULATIONAHA.117.029617 PMid:29581366 PMCid:PMC5875734

9. Visseren F.L.J., Mach F., Smulders Y.M., Carballo D., Koskinas K.C., Bäck M., Benetos A., Biffi A., Boavida J.-M., Capodanno D., et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice: Developed by the Task Force for cardio-vascular disease prevention in clinical practice with representatives of the European Society of Cardiology and 12 medical societies With the special contribution of the European Association of Preventive Cardiology (EAPC) Eur. Heart J. 2021;42:3227-3337. https://doi.org/10.1093/eurheartj/ehab484 PMid:34458905

10. Sjostrom CD, Hakangard AC, Lissner L, Sjostrom C. Body Compartment and Subcutaneous adipose tissue distribution-risk factors Pateros in obes subjects.Obes Res 1995;3:9-22 https://doi.org/10.1002/j.1550-8528.1995.tb00116.x PMid:7712364

11. Ben-Noun L, Laor A. Relationship of neck circumference to Cardiovascular risk factors: Obes Res 2003 feb;l 1(2):226-31. https://doi.org/10.1038/oby.2003.35 PMid:12582218

12. Solati M, Ghambarian A, Rahmani M, Sarbazi N, Allahverdian S, Azizi. F. Cardiovascular rise factors in males with hypertriglycemic waist.Int. J Obes Relat Metab Disord. 2004 Feb 10 https://doi.org/10.1038/sj.ijo.0802582 PMid:14770189

13. Van Itallie TB, Yang MU, Boileau RA, et al. Applications of body composition technology in clinical medicine: Some issues and problems. In: Krai JG, Van TB (eds) Recent Developments in Body Composition Analysis: Methods and Applications. London: Smith-Gordon 1993;87-97

14. Han TS, Seidell JC, Curral JEP, Morrison CE, Durenberg P, Lean MEJ.The influences of height and age on waist circumference as an indeks of adiposity in adults. Int J Obes 1997;71:111-89

15. Chan JM, Stamper MJ, Rimm EB, Walter CW, Coditz GA. Obesity fat distribution and weight gain as risk factors for clinical diabetes in man. Diabetes Care 1994;9:961-9 https://doi.org/10.2337/diacare.17.9.961 PMid:7988316

16. Hartz AJ, Rupley DC Jr. Kaklhoff RD, Rimm AA. Relationship of obesity to diabetes: influence of obesity level and body fat distribution. Prev Med. 1983;12:351-7 https://doi.org/10.1016/0091-7435(83)90244-X PMid:6878197

17. Kannel WB, Capples LA, Ramaswami R, Stokes J III, Kregel BE, Higgins M. Regional obesity and risk of Cardiovascular disease: the Framingham Study J Clin Epidemiol 1991;44:183-90 https://doi.org/10.1016/0895-4356(91)90265-B PMid:1995775

18. National Institutes of Health, National Heart, Lung and Blood Institute. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults- the evidence report. Bethesda, MD: NIH, 1998 (June).

19. Scottish Intercollegiate Guidelines Network. Obesity m Scotland. Integrating Prevention with Weight Management Edinburgh: Scottish Intercollegiate Guidelines Network, 1996.

20. Han TS; Lean MEJ. Lower leg lenght as an index of stature in adults. Int J Obes 1996;20:21-27.

21. Pauliot M-C, Despres J-P, Lemieux S, Moorjanii S, Bouchard C, Tremblas A, et al. Waist circumference and abdominal sagittal diameter: best antropometric indext!s of abdominal visceral tissue accumulation and related cardiovascular risk in men and women. Am J Cardiol 1994;73:460-8 https://doi.org/10.1016/0002-9149(94)90676-9 PMid:8141087

22. Higgins M, Kannel W, Garrison R, Pinsky J, Stokes J III. Hazards of obesity the Framingham experience. Acta Medic Scandinavica (suppl). 1988;723:23-36 https://doi.org/10.1111/j.0954-6820.1987.tb05925.x PMid:3164971

23. World Health Organisation. Obesity preventing and managing. the global epidemic. Report of a WHO Consultation on obesity. Geneva: WHO,1998

24. Zhu SK, Wang ZM, Heska S, et al.Waist circumference and obesity-associated risk factors among whites in the Third National Health and Nutrition Survey. Am J Clin Nutr 2002;76:743-749 https://doi.org/10.1093/ajcn/76.4.743 PMid:12324286

25. Siani AS, Cappucio FP, Barba G, et al. The relationship of waist circumference to blood pressure; The Olivetti Heart Study. Am J Hyperens 2002;15:780-786 https://doi.org/10.1016/S0895-7061(02)02976-X PMid:12219872

26. Edwards KL, Austin MA, Newman B, Mayer A, Krauss RM, Selby JV.Multivaiate analysis of insulin resistance syndrome in women. Arterioscler Throm l 994;14:1940-5 https://doi.org/10.1161/01.ATV.14.12.1940 PMid:7981183

27. Den Tonkelaar I, Seidell JC, Collette HJA. Body fat distribution in relation to breast cancer in women participating in the DOM-Project. Breast Cancer Research and Treatment 1995;34:55-61 https://doi.org/10.1007/BF00666491 PMid:7749160

28. Giovannucci E, Ascherio A, Rimm EB, Coditz GA, Stampfer MJ, Willett WC. Physical activity, obesity and risk for Colon cancer and adenoma in men. Ann intern Med. 1995;122:327-34 https://doi.org/10.7326/0003-4819-122-5-199503010-00002 PMid:7847643