Head fat is a novel method of measuring metabolic disorder in Chinese obese patients
© Wang et al.; licensee BioMed Central Ltd. 2014
Received: 13 May 2014
Accepted: 8 July 2014
Published: 12 July 2014
Body adiposity, especially ectopic fat accumulation, has a range of metabolic and cardiovascular effects. The aim of this study was to investigate the association between head fat and metabolic values in Chinese obese patients.
Data of this cross-sectional study from 66 obese patients were collected. Fat distribution was measured by dual-energy X-ray absorptiometry, and data of body weight, body mass index (BMI), neck circumference (NC), waist circumference (WC), hip circumference (HC), visceral index, basal metabolism (BM), glucose metabolism, lipid levels, uric acid (UA) had been collected.
1) Head fat was significantly associated with BMI, WC, HC, visceral index, BM, total fat and total fat excluding head fat in both males and females (p < 0.05). Head fat was positively correlated with upper limb fat, trunk fat, weight, fasting plasma C peptide, fasting plasma insulin and UA in women(p < 0.05), and the association was not statistically significant in male (p > 0.05). Head fat was positively corrected with NC in males (p < 0.05) but not females (p > 0.05). There was no significant correlation between head fat and fasting plasma glucose, total choleslerolemia, triglyceridemia, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and free fat acid in either gender (p > 0.05). 2) Receiver operating characteristic analysis showed that a head fat of 1925.6 g and a head fat of 1567.85 g were the best cut-off values to determine subjects with low high-density lipoprotein cholesterol and hyperuricemia respectively.
Head fat accumulation was closely associated with increased body fat, hyperinsulinemia, hyperuricemia, and impared lipid profile, suggesting it might be used as an indicator for dyslipidemia and hyperuricemia.
KeywordsObesity Head fat Regional fat Lipid profile Hyperuricemia
Obesity is a public health problem that has become a global epidemic. According to the World Health Organization (WHO), there will be about 2.3 billion overweight people aged 15 years and above, and over 700 million obese people worldwide in 2015. Substantial literature has emerged to show that overweight and obesity are major causes of co-morbidities, including type II diabetes mellitus (T2DM), hyperlipidemia, hyperuricemia and cardiovascular disease. Body adiposity, especially ectopic fat accumulation, has a range of metabolic and cardiovascular effects.
Previous studies have already shown that overweight or obese patients who have the same amount of total body fat may have different risk factor profiles . Therefore, regional fat distribution is better than the total fat in the prediction of cardiovascular disease and metabolic disease. As we know, the accumulation of abdominal fat also called central obesity is strongly associated with metabolic syndrome, T2DM, and cardiovascular disease [2–4]. Excess abdominal visceral adiposity is the key correlate of metabolic syndrome and upper body fat distribution is commonly associated with increased visceral fat and an abnormal metabolic profile [5–8]. In addition, previous data also suggest that fat accumulation peripherally such as in the lower extremities is inversely associated with adiposity-related biological factors and risk of metabolic syndrome . The regional obesity also relates to obstructive sleep apnea syndrome (OSAS) as neck fat is one of risk factors of OSAS, and a predictor of the severity of OSAS . Additionally, neck circumference (NC), which mainly reflects the fat deposit around respiratory tract or subcutaneous fat in the neck, is a proxy for upper-body fat and a reliable screening measure for the identification of patients with abnormal fat distribution. NC can be used as a marker to reflect central obesity and cardio-metabolic syndrome [11–13].
The relationship between regional fat accumulation of head fat and metabolic risks in obese patients remains unknown. Thus, we conducted this study to investigate whether head fat is related to regional fat distribution,metabolic values, and whether head fat can as used as a predictor for dyslipidemia, impaired fasting glucose, hyperinsulinemia and hyperuricemia in obese Chinese patients.
Baseline characteristics of patients
Baseline study sample characteristics according to genders
Age, years old
29.45 ± 8.65
31.37 ± 10.10
Head fat, g
1829.43 ± 337.66
1638.01 ± 321.99
Body weight, kg
102.13 ± 19.74
83.37 ± 12.07
BMI, kg/m 2
33.24 ± 4.46
31.85 ± 4.25
42.01 ± 4.66
38.30 ± 9.54
109.58 ± 14.69
99.50 ± 8.59
112.79 ± 11.13
107.48 ± 8.25
17.64 ± 6.37
12.19 ± 5.73
2062.22 ± 339.91
1623.66 ± 189.49
5.80 ± 1.75
5.43 ± 1.40
Fasting insulin, uU/ml
24.42 ± 13.78
23.75 ± 11.32
Fasting CP, ng/ml
3.85 ± 1.38
3.51 ± 1.26
4.90 ± 1.29
4.97 ± 0.96
1.79 ± 0.78
1.75 ± 1.59
1.06 ± 0.26
1.24 ± 0.31
2.86 ± 1.22
2.84 ± 0.68
0.61 ± 0.22
0.61 ± 0.28
442.64 ± 92.08
368.43 ± 103.09
Upper limbs fat, g
5328.93 ± 1274.17
5493.33 ± 1304.78
Lower limbs fat, g
9843.77 ± 2838.54
10430.69 ± 2948.71
Total limbs fat, g
15172.70 ± 3746.38
15924.02 ± 3891.50
Trunk fat, g
17554.45 ± 3782.72
16420.15 ± 3596.75
Total fat except head, g
32731.45 ± 6787.01
32347.40 ± 6747.21
Total fat, g
34516.35 ± 6987.79
33989.90 ± 6875.77
Total fat, %
34.72 ± 4.41
41.30 ± 4.28
Correlation of head fat with anthropological and metabolic variables
Correlation of head fat with anthropological metabolic variables and fat distribution
Body weight, kg
BMI, kg/m 2
Fasting insulin, uU/ml
Fasting CP, ng/ml
Upper limbs fat, g
Trunk fat, g
Lower limbs fat, g
Total limbs fat, g
Total fat except head, g
Total fat, g
Optimal cut-off points of head fat for abnormal lipid metabolism
Comparison of sensitivity, specificity, Youden index of high density lipoprotein cholesterol with different head fat point
Head fat (g)
Optimal cut-off points of head fat for IFG and hyperinsulinemia
The prevalence of impaired fasting glucose (IFG) was 22.95% in this obese population. Area under ROC curve is 0.553 (p = 0.548). The prevalence of hyperinsulinemia was 71.67% and area under ROC curve is 0.605 (p = 0.209).
Optimal cut-off points of head fat for hyperuricemia
Comparison of sensitivity, specificity, Youden index of uric acid with different head fat point
Head fat (g)
Obesity is a public health problem that has raised concern worldwide. Accumulating evidence shows that regional fat distribution is a clinical indicator for the risk of T2DM and cardiovascular disease. Few articles focus on the association between head fat accumulation and metabolic disorders. In this study, we demonstrated that the regional accumulation of fat around the head was associated with classic obesity markers such as BMI, WC, HC, visceral index and BM in both genders. Head fat was also positively correlated with total fat, total fat excluding head fat, upper limb fat and trunk fat in females. Additionally, head fat correlated positively with fasting insulin, fasting C peptide and UA in female. We further revealed head fat might be a predictor for metabolic abnormalities including low HDL-C and hyperuricemia. Receiver operating characteristic analysis showed that a head fat of 1925.6 g was the best cut-off point to determine subjects with low HDL-C and a head fat of 1567.85 g was the best cut-off point to determine subjects with hyperuricemia in female. These results not only further confirmed the clinical significance of NC but also the metabolic impact of regional fat accumulation in the head.
Previous studies have shown that NC which represents neck fat deposit is a reliable anthropometric index to indicate central obesity . In this study, we showed that head fat correlated positively with total fat and total fat excluding head fat in both genders. Additionally, head fat is closely related to upper limb fat and trunk fat in females. These results showed that head fat might also be associated with central obesity and upper body fat. The association between head fat and other regional fat was not significantly in males, probably because of the limited sample size.
The association between head fat and other regional fat indicated the importance of the head fat in predicting upper body fat, thus head fat might be used as a contributor to cardiometabolic risk. As we known, increased regional lipid content in the liver and muscle are associated with insulin resistance [15, 16]. NC is not only associated with obesity and regional fat distribution, but also can be used for clinical screening of insulin resistance in high risk populations [17, 18]. The analysis of our study revealed head fat was correlated positively with fasting insulin and fasting C peptide in females, suggesting head fat deposit might be a key feature of hyperinsulinemia and insulin resistance.
Elevated UA is a strong risk factor for cardiovascular disease and it plays an important role in the development of metabolic syndrome [19–21]. Studies indicate that weight gain is a risk factor for hyperuricemia while weight loss reduces the risk . Hyperuricemia may be affected by differences in body fat distribution in obesity . A previous study showed visceral fat may have a greater adverse effect on the metabolism of UA than BMI or subcutaneous fat . Epicardial adipose tissue (EAT) thickness in children is associated with hyperuricaemia . Similarly, our study also showed head fat was correlated with UA in female and 1572.75 gs is optimal cut-off point of head fat for hyperuricemia in females.
In addition, previous studies have shown that visceral fat mass is associated with elevated TG in obese women . Visceral fat area has high positive correlations with TG level and a negative correlation with the HDL-C level in both genders . Peripheral fat accumulation such as leg fat mass is favorably associated with cardiometablic risks factors [28, 29]. NC what presents for peripheral fat of neck fat is associated with serum TCH, TG, increased LDL-C and decreased HDL-C in healthy adults . Studies have also shown that NC is corrected with decreased HDL–C and increased TG [31–33]. Additionally, other studies reported that increased upper body subcutaneous fat is associated with increased LDL-C and decreased HDL-C . The association between head fat and lipid levels in our study was not obvious. However, data analysis on lipid levels showed the prevalence of high TG, high LDL-C and high TCH were 61.82%, 48.07% and 32.14% respectively. The prevalence of low HDL-C was 38.89% and 1925.6 g emerged as optimal cut-off point of head fat for low HDL-C.
There were some limitations in this study. Firstly, the primary limitation of this study was the use of a cross-sectional design. Therefore, we cannot infer causality from our results. Secondly, the sample of the present study was relatively small. Finally, our result might not be applied to other racial or age groups because the studied subjects were predominantly Chinese adults. Therefore, further studies are necessary to prove these conclusions in larger sample size and with longitudinal studies.
This study demonstrated that head fat was significantly associated with metabolic values among Chinese adults. Besides, receiver operating characteristic analysis showed the cut-off point of head fat to determine subjects with low HDL-C and hyperuricemia. Our findings might provide new insight into the role of head fat accumulation in the development of obesity-related diseases.
A cross-sectional survey based on data from outpatient of Shanghai Tenth People’s Hospital was conducted among obese patients with BMI over 28 kg/m2 who had been seen in clinic between September 2011 and December 2013. The inclusion criteria included: 1) patients diagnosed with obesity (Obesity was defined as BMI ≥ 28 kg/m2) and 2) patients aged from 18–60 years old. People with medical illnesses such as clinical or laboratory evidence of cardiac, renal, liver or severe systemic diseases (e.g., cancer and heart failure) were excluded. A total of 229 obese subjects with measurement of dual-energy X-ray absorptiometry were enrolled for analysis. In addition to DEXA measurement, physical examination, including NC, WC, HC, and body weight, BMI, viscera index, BM, all subjects also underwent lab testing including fasting plasma glucose, fasting insulin, fasting C peptide, TCH, TG, HDL-C, LDL-C, FFA and UA. We excluded those patients lacking appropriate data (n = 163). After the appropriate exclusions, data of 66 patients were included in our analysis. The study protocol was approved by the ethics committee of Shanghai Tenth People's Hospital and written informed consent was obtained from each participant.
Weight, BMI, visceral index and BM were measured with light clothes and without shoes by Omron HBF-358 (Q40102010L01322F, Japan). WC was measured at the level midway between the lower rib margin and the iliac crest. NC was measured with head erect and eyes facing forward, horizontally at the upper margin of laryngeal prominence (Adam’s apple). HC was measured at the fullest point around the buttocks. These parameters were measured twice and the average was used for analysis.
Body composition was measured using DEXA (Hologic QDR4500, USA). DEXA is a method for testing body composition and has high accuracy and good reproducibility, and is especially accurate for the determination of fat content and fat distribution . DEXA was measured with the patient in the supine position. DEXA data including total fat%, upper limbs fat, lower limbs fat, trunk fat, total fat except the head, total fat, head fat. We calculated total fat in each limb.
Blood samples were obtained after fasting over 8 hours for the measurement of lab testing including fasting plasma glucose, fasting insulin, fasting C peptide, TCH, TG, HDL-C, LDL-C, FFA and UA.
Definition of dyslipidemia, impaired fasting glucose tolerance hyperinsulinemia and hyperuricemia
In this study, high TG was defined as fasting plasma TG ≥ 1.7 mmol/L, low HDL-C was defined as fasting HDL-C < 1.04 mmol/L,high LDL-C was defined as LDL-C ≥ 3.37 and high TCH was defined as TCH ≥ 5.18 mmol/L . IFG was defined as fasting plasma glucose ≥ 5.6 mmol/l . Hyperinsulinemia was defined as fasting plasma insulin ≥15 mU/L . Hyperuricemia was defined as serum uric acid concentration ≥ 7 mg/dl (≥417 umol/L) in men, and ≥ 6 mg/dl (≥357 umol/L) in women .
All data were analyzed using SPSS 17.0 software. All continuous data are presented as means ± standard deviation (SD). Quantitative data were analyzed by t-test between the two groups, the correlation between different variables were assessed using correlation analysis. ROC analyses was performed to assess the accuracy of head fat as diagnostic tests for dyslipidemia, IFG, hyperinsulinemia and hyperuricemia to determine optimal head fat cut-off in relation to dyslipidemia and hyperuricemia. Youden index (sensitivity + specificity −1) was used for determining the head fat cut-off point. All tests of significance were two tailed with a value of p < 0.05.
Body mass index
World Health Organization
Type II diabetes mellitus
Obstructive sleep apnea syndrome
Dual-energy X-ray absorptiometry
High density lipoprotein cholesterol
Low density lipoprotein cholesterol
Free fatty acid
Impaired fasting glucose
Means ± standard deviation
Receiver operating characteristic
Fasting plasma glucose
The authors gratefully acknowledge the financial from the Shanghai Shenkang Prevention Prog of Disease (No. SHDC12012303) and Chinese Medical Association Fund (No. 12020550355). No conflict of interest exists.
- Despres JP, Moorjani S, Lupien PJ, Tremblay A, Nadeau A, Bouchard C: Regional distribution of body fat, plasma lipoproteins, and cardiovascular disease. Arteriosclerosis. 1990, 10: 497-511. 10.1161/01.ATV.10.4.497View ArticlePubMedGoogle Scholar
- Despres JP, Lemieux I: Abdominal obesity and metabolic syndrome. Nature. 2006, 444: 881-887. 10.1038/nature05488View ArticlePubMedGoogle Scholar
- Carey VJ, Walters EE, Colditz GA, Solomon CG, Willett WC, Rosner BA, Speizer FE, Manson JE: Body fat distribution and risk of non-insulin-dependent diabetes mellitus in women. The Nurses’ Health Study. Am J Epidemiol. 1997, 145: 614-619. 10.1093/oxfordjournals.aje.a009158View ArticlePubMedGoogle Scholar
- Fox KA, Despres JP, Richard AJ, Brette S, Deanfield JE: Does abdominal obesity have a similar impact on cardiovascular disease and diabetes? A study of 91, 246 ambulant patients in 27 European countries. Eur Heart J. 2009, 30: 3055-3063. 10.1093/eurheartj/ehp371View ArticlePubMedGoogle Scholar
- Carr MC, Brunzell JD: Abdominal obesity and dyslipidemia in the metabolic syndrome: importance of type 2 diabetes and familial combined hyperlipidemia in coronary artery disease risk. J Clin Endocrinol Metab. 2004, 89: 2601-2607. 10.1210/jc.2004-0432View ArticlePubMedGoogle Scholar
- Despres JP: Is visceral obesity the cause of the metabolic syndrome?. Ann Med. 2006, 38: 52-63. 10.1080/07853890500383895View ArticlePubMedGoogle Scholar
- Kissebah AH, Krakower GR: Regional adiposity and morbidity. Physiol Rev. 1994, 74: 761-811.PubMedGoogle Scholar
- Bjorntorp P: Metabolic implications of body fat distribution. Diabetes Care. 1991, 14: 1132-1143. 10.2337/diacare.14.12.1132View ArticlePubMedGoogle Scholar
- Zhang X, Hu EA, Wu H, Malik V, Sun Q: Associations of leg fat accumulation with adiposity-related biological factors and risk of metabolic syndrome. Obesity (Silver Spring). 2013, 21: 824-830. 10.1002/oby.20028View ArticleGoogle Scholar
- Bruno E, Alessandrini M, Napolitano B, De Padova A, Di Daniele N, De Lorenzo A: Dual-energy X-ray absorptiometry analysis of body composition in patients affected by OSAS. Eur Arch Otorhinolaryngol. 2009, 266: 1285-1290. 10.1007/s00405-008-0844-0View ArticlePubMedGoogle Scholar
- Ben-Noun L, Sohar E, Laor A: Neck circumference as a simple screening measure for identifying overweight and obese patients. Obes Res. 2001, 9: 470-477. 10.1038/oby.2001.61View ArticlePubMedGoogle Scholar
- Ben-Noun L, Laor A: Relationship of neck circumference to cardiovascular risk factors. Obes Res. 2003, 11: 226-231. 10.1038/oby.2003.35View ArticlePubMedGoogle Scholar
- Zhou JY, Ge H, Zhu MF, Wang LJ, Chen L, Tan YZ, Chen YM, Zhu HL: Neck circumference as an independent predictive contributor to cardio-metabolic syndrome. Cardiovasc Diabetol. 2013, 12: 76- 10.1186/1475-2840-12-76PubMed CentralView ArticlePubMedGoogle Scholar
- LaBerge RC, Vaccani JP, Gow RM, Gaboury I, Hoey L, Katz SL: Inter- and intra-rater reliability of neck circumference measurements in children. Pediatr Pulmonol. 2009, 44: 64-69. 10.1002/ppul.20944View ArticlePubMedGoogle Scholar
- Koska J, Stefan N, Permana PA, Weyer C, Sonoda M, Bogardus C, Smith SR, Joanisse DR, Funahashi T, Krakoff J, Bunt JC: Increased fat accumulation in liver may link insulin resistance with subcutaneous abdominal adipocyte enlargement, visceral adiposity, and hypoadiponectinemia in obese individuals. Am J Clin Nutr. 2008, 87: 295-302.PubMedGoogle Scholar
- Yoshimura E, Kumahara H, Tobina T, Matono S, Kiyonaga A, Kimura M, Tsukikawa H, Kono S, Etou T, Irie S, Anzai K, Tanaka H: Relationships between fat deposition in the liver and skeletal muscle and insulin sensitivity in Japanese individuals: a pilot study. Diabetes Metab Syndr Obes. 2011, 4: 35-43.PubMed CentralView ArticlePubMedGoogle Scholar
- Laakso M, Matilainen V, Keinanen-Kiukaanniemi S: Association of neck circumference with insulin resistance-related factors. Int J Obes Relat Metab Disord. 2002, 26: 873-875.View ArticlePubMedGoogle Scholar
- Yang L, Samarasinghe YP, Kane P, Amiel SA, Aylwin SJ: Visceral adiposity is closely correlated with neck circumference and represents a significant indicator of insulin resistance in WHO grade III obesity. Clin Endocrinol (Oxf). 2010, 73: 197-200.Google Scholar
- Fang J, Alderman MH: Serum uric acid and cardiovascular mortality the NHANES I epidemiologic follow-up study, 1971–1992. National Health and Nutrition Examination Survey. Jama. 2000, 283: 2404-2410. 10.1001/jama.283.18.2404View ArticlePubMedGoogle Scholar
- Chien KL, Chen MF, Hsu HC, Chang WT, Su TC, Lee YT, Hu FB: Plasma uric acid and the risk of type 2 diabetes in a Chinese community. Clin Chem. 2008, 54: 310-316. 10.1373/clinchem.2007.095190View ArticlePubMedGoogle Scholar
- Heinig M, Johnson RJ: Role of uric acid in hypertension, renal disease, and metabolic syndrome. Cleve Clin J Med. 2006, 73: 1059-1064. 10.3949/ccjm.73.12.1059View ArticlePubMedGoogle Scholar
- Choi HK, Atkinson K, Karlson EW, Curhan G: Obesity, weight change, hypertension, diuretic use, and risk of gout in men: the health professionals follow-up study. Arch Intern Med. 2005, 165: 742-748. 10.1001/archinte.165.7.742View ArticlePubMedGoogle Scholar
- Matsuura F, Yamashita S, Nakamura T, Nishida M, Nozaki S, Funahashi T, Matsuzawa Y: Effect of visceral fat accumulation on uric acid metabolism in male obese subjects: visceral fat obesity is linked more closely to overproduction of uric acid than subcutaneous fat obesity. Metabolism. 1998, 47: 929-933. 10.1016/S0026-0495(98)90346-8View ArticlePubMedGoogle Scholar
- Takahashi S, Yamamoto T, Tsutsumi Z, Moriwaki Y, Yamakita J, Higashino K: Close correlation between visceral fat accumulation and uric acid metabolism in healthy men. Metabolism. 1997, 46: 1162-1165. 10.1016/S0026-0495(97)90210-9View ArticlePubMedGoogle Scholar
- Schusterova I, Leenen FH, Jurko A, Sabol F, Takacova J: Epicardial adipose tissue and cardiometabolic risk factors in overweight and obese children and adolescents. Pediatr Obes. 2014, 9: 63-70. 10.1111/j.2047-6310.2012.00134.xView ArticlePubMedGoogle Scholar
- Marcus MA, Murphy L, Pi-Sunyer FX, Albu JB: Insulin sensitivity and serum triglyceride level in obese white and black women: relationship to visceral and truncal subcutaneous fat. Metabolism. 1999, 48: 194-199. 10.1016/S0026-0495(99)90033-1View ArticlePubMedGoogle Scholar
- Shiina Y, Homma Y: Relationships between the visceral fat area on CT and coronary risk factor markers. Intern Med. 2013, 52: 1775-1780. 10.2169/internalmedicine.52.9190View ArticlePubMedGoogle Scholar
- Wu H, Qi Q, Yu Z, Sun Q, Wang J, Franco OH, Sun L, Li H, Liu Y, Hu FB, Lin X: Independent and opposite associations of trunk and leg fat depots with adipokines, inflammatory markers, and metabolic syndrome in middle-aged and older Chinese men and women. J Clin Endocrinol Metab. 2010, 95: 4389-4398. 10.1210/jc.2010-0181View ArticlePubMedGoogle Scholar
- Sakai Y, Ito H, Egami Y, Ohoto N, Hijii C, Yanagawa M, Satoh S, Jingu S: Favourable association of leg fat with cardiovascular risk factors. J Intern Med. 2005, 257: 194-200. 10.1111/j.1365-2796.2004.01432.xView ArticlePubMedGoogle Scholar
- Ben-Noun LL, Laor A: Relationship between changes in neck circumference and cardiovascular risk factors. Exp Clin Cardiol. 2006, 11: 14-20.PubMedGoogle Scholar
- Fitch KV, Stanley TL, Looby SE, Rope AM, Grinspoon SK: Relationship between neck circumference and cardiometabolic parameters in HIV-infected and non-HIV-infected adults. Diabetes Care. 2011, 34: 1026-1031. 10.2337/dc10-1983PubMed CentralView ArticlePubMedGoogle Scholar
- Preis SR, Massaro JM, Hoffmann U, D’Agostino RB, Levy D, Robins SJ, Meigs JB, Vasan RS, O’Donnell CJ, Fox CS: Neck circumference as a novel measure of cardiometabolic risk: the Framingham Heart study. J Clin Endocrinol Metab. 2010, 95: 3701-3710. 10.1210/jc.2009-1779PubMed CentralView ArticlePubMedGoogle Scholar
- Preis SR, Pencina MJ, D’Agostino RB, Meigs JB, Vasan RS, Fox CS: Neck circumference and the development of cardiovascular disease risk factors in the Framingham Heart Study. Diabetes Care. 2013, 36: e3-PubMed CentralView ArticlePubMedGoogle Scholar
- Wohl D, Scherzer R, Heymsfield S, Simberkoff M, Sidney S, Bacchetti P, Grunfeld C: The associations of regional adipose tissue with lipid and lipoprotein levels in HIV-infected men. J Acquir Immune Defic Syndr. 2008, 48: 44-52. 10.1097/QAI.0b013e31816d9ba1PubMed CentralView ArticlePubMedGoogle Scholar
- Eston RG, Rowlands AV, Charlesworth S, Davies A, Hoppitt T: Prediction of DXA-determined whole body fat from skinfolds: importance of including skinfolds from the thigh and calf in young, healthy men and women. Eur J Clin Nutr. 2005, 59: 695-702. 10.1038/sj.ejcn.1602131View ArticlePubMedGoogle Scholar
- Onat A, Hergenc G, Yuksel H, Can G, Ayhan E, Kaya Z, Dursunoglu D: Neck circumference as a measure of central obesity: associations with metabolic syndrome and obstructive sleep apnea syndrome beyond waist circumference. Clin Nutr. 2009, 28: 46-51. 10.1016/j.clnu.2008.10.006View ArticlePubMedGoogle Scholar
- Genuth S, Alberti KG, Bennett P, Buse J, Defronzo R, Kahn R, Kitzmiller J, Knowler WC, Lebovitz H, Lernmark A, Nathan D, Palmer J, Rizza R, Saudex C, Shaw J, Steffes M, Stern M, Tuomilehto J, Zimmet P: Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care. 2003, 26: 3160-3167.View ArticlePubMedGoogle Scholar
- Back Giuliano Ide C, Caramelli B, Pellanda L, Duncan B, Mattos S, Fonseca FH: [I guidelines of prevention of atherosclerosis in childhood and adolescence]. Arq Bras Cardiol. 2005, 85 Suppl 6: 4-36.PubMedGoogle Scholar
- Ryu KA, Kang HH, Kim SY, Yoo MK, Kim JS, Lee CH, Wie GA: Comparison of nutrient intake and diet quality between hyperuricemia subjects and controls in Korea. Clin Nutr Res. 2014, 3: 56-63. 10.7762/cnr.2014.3.1.56PubMed CentralView ArticlePubMedGoogle Scholar
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