Supplemental data Strathmann et al., 2025

This document contains supplemental data for a publication by Strathmann et al., 2025

Background: Neck circumference (NC) was proposed as promising marker to assess body fat distribution and cardiometabolic risk.
Objectives: We aimed to assess associations of NC with anthropometric traits, cardiometabolic risk markers and self-reported cardiometabolic diseases.
Methods: NC was measured in a subsample (5,865 participants) of the German National Cohort (NAKO Gesundheitsstudie, NAKO), study region Kiel. Linear and logistic regression models were applied to assess associations of NC with anthropometric and cardiometabolic risk markers and self-reported cardiometabolic diseases, including diabetes, heart failure, gout, and a composite endpoint ‘clinical CVD’ (combining history of angina pectoris, stroke, myocardial infarction, and peripheral artery disease). Models were adjusted for sex and age, cardiovascular risk factors (systolic blood pressure, diabetes, LDL-cholesterol, use of lipid-lowering and antihypertensive medication, smoking status), and BMI.
Results: Mean NC values (± SD) were 39.5±3.0 in men and 33.6±2.7 cm in women. NC was positively associated with anthropometric traits, visceral adipose tissue [cm] (β=1.45 [95% confidence interval 0.88; 2.02]), systolic (β=0.37 [0.19; 0.56]) and diastolic (β=0.17 [0.05; 0.29]) blood pressure, HbA1c (β=0.02 [0.01; 0.02]), non-fasting glucose (β=0.57 [0.31; 0.83]), and inversely associated with HDL-cholesterol (β=-0.73 [-0.91; -0.54]). Furthermore, NC showed associations with diabetes (OR=1.08 [1.02; 1.15]), heart failure (OR=1.12 [1.02; 1.23]) and gout (OR=1.09 [1.01; 1.17]). Association with ‘clinical CVD’ did not remain statistically significant after BMI adjustment.
Conclusions: NC was associated with several cardiometabolic risk factors, including glycemic and lipid traits and self-reported cardiometabolic diseases. These observations suggest that NC may be a useful surrogate marker for cardiometabolic risk.