Neck circumference as a metabolic health marker among women with polycystic ovary syndrome (PCOS): a systematic review and meta-analysis
Lizneva D, Suturina L, Walker W, Brakta S, Gavrilova-Jordan L, Azziz R. Criteria, prevalence, and phenotypes of polycystic ovary syndrome. Fertil Steril. 2016;106:6–15.
Google Scholar
Teede H, Tay CT, Laven J, Dokras A, Moran L, Piltonen T, et al. International evidence-based guideline for the assessment and management of polycystic ovary syndrome 2023. Monash University, Melbourne, Australia, 2023. https://doi.org/10.26180/24003834.v1.
DeUgarte CM, Bartolucci AA, Azziz R. Prevalence of insulin resistance in the polycystic ovary syndrome using the homeostasis model assessment. Fertil Steril. 2005;83:1454–60.
Google Scholar
Lim SS, Davies MJ, Norman RJ, Moran LJ. Overweight, obesity and central obesity in women with polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update. 2012;18:618–37.
Google Scholar
Legro RS, Kunselman AR, Dodson WC, Dunaif A. Prevalence and predictors of risk for type 2 diabetes mellitus and impaired glucose tolerance in polycystic ovary syndrome: a prospective, controlled study in 254 affected women. J Clin Endocrinol Metab. 1999;84:165–9.
Google Scholar
Zhao H, Zhang J, Cheng X, Nie X, He B. Insulin resistance in polycystic ovary syndrome across various tissues: an updated review of pathogenesis, evaluation, and treatment. J Ovarian Res. 2023;16:9-25.
Livadas S, Anagnostis P, Bosdou JK, Bantouna D, Paparodis R. Polycystic ovary syndrome and type 2 diabetes mellitus: a state-of-the-art review. World J Diabetes. 2022;13:5–26.
Google Scholar
Oliver-Williams C, Vassard D, Pinborg A, Schmidt L. Risk of cardiovascular disease for women with polycystic ovary syndrome: results from a national Danish registry cohort study. Eur J Prev Cardiol. 2021;28:e39–41.
Google Scholar
Lim SS, Kakoly NS, Tan JWJ, Fitzgerald G, Bahri Khomami M, Joham AE, et al. Metabolic syndrome in polycystic ovary syndrome: a systematic review, meta-analysis and meta-regression. Obes Rev. 2019;20:339–52.
Google Scholar
Mottillo S, Filion KB, Genest J, Joseph L, Pilote L, Poirier P, et al. The metabolic syndrome and cardiovascular risk a systematic review and meta-analysis. J Am Coll Cardiol. 2010;56:1113–32.
Google Scholar
Wilson PWF, D’Agostino RB, Parise H, Sullivan L, Meigs JB. Metabolic syndrome as a precursor of cardiovascular disease and type 2 diabetes mellitus. Circulation 2005;112:3066–72.
Google Scholar
Alberti KGMM, Zimmet P, Shaw J. Metabolic syndrome—a new world-wide definition. A Consensus Statement from the International Diabetes Federation. Diabet Med. 2006;23:469–80.
Google Scholar
Apridonidze T, Essah PA, Iuorno MJ, Nestler JE. Prevalence and characteristics of the metabolic syndrome in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2005;90:1929–35.
Google Scholar
Zhang J, Fan P, Liu H, Bai H, Wang Y, Zhang F. Apolipoprotein A-I and B levels, dyslipidemia and metabolic syndrome in south-west Chinese women with PCOS. Hum Reprod. 2012;27:2484–93.
Google Scholar
Bentley-Lewis R, Seely E, Dunaif A. Ovarian hypertension: polycystic ovary syndrome. Endocrinol Metab Clin North Am. 2011;40:433–49.
Google Scholar
Joshipura K, Muñoz-Torres F, Vergara J, Palacios C, Pérez CM. Neck circumference may be a better alternative to standard anthropometric measures. J Diabetes Res. 2016. https://doi.org/10.1155/2016/6058916.
Liu C, Ding L, Yang H, Chen Z. Neck circumference is independently associated with metabolic syndrome in women with polycystic ovary syndrome. Endocr J. 2022;69:809–18.
Google Scholar
Alberti G, Azizi F, Cahn J, Huxley R, James P, Kadowaki T, et al. Waist circumference and waist-hip ratio: report of a WHO Expert Consultation. World Health Organization, Geneva, Switzerland, 2008. https://www.who.int/publications/i/item/9789241501491.
Verweij LM, Terwee CB, Proper KI, Hulshof CT, Van Mechelen W. Measurement error of waist circumference: gaps in knowledge. Public Health Nutr. 2013;16:281–8.
Google Scholar
Preis SR, Massaro JM, Hoffmann U, D’Agostino RB, Levy D, Robins SJ, et al. Neck circumference as a novel measure of cardiometabolic risk: the Framingham Heart Study. J Clin Endocrinol Metab. 2010;95:3701–10.
Google Scholar
Ben-Noun L, Laor A. Relationship of neck circumference to cardiovascular risk factors. Obes Res. 2003;11:226–31.
Google Scholar
Laakso M, Matilainen V, Keinänen-Kiukaanniemi S. Association of neck circumference with insulin resistance-related factors. Int J Obes Relat Metab Disord. 2002;26:873–5.
Google Scholar
Pillai BP, Prasanna, Kumar H, Jayakumar RV, Alur VC, Sheejamol VS. The prevalence of metabolic syndrome in polycystic ovary syndrome in a South Indian population and the use of neck circumference in defining metabolic syndrome. Int J Diabetes Dev Ctries. 2015;35:469–75.
Google Scholar
Chen Y, Zheng X, Ma D, Zheng S, Han Y, Su W, et al. Neck circumference is a good predictor for insulin resistance in women with polycystic ovary syndrome. Fertil Steril. 2021;115:753–60.
Google Scholar
Zhuo X, Zhang P, Hoerger TJ. Lifetime direct medical costs of treating type 2 diabetes and diabetic complications. Am J Prev Med. 2013;45:253–61.
Google Scholar
Barton P, Andronis L, Briggs A, McPherson K, Capewell S. Effectiveness and cost effectiveness of cardiovascular disease prevention in whole populations: modelling study. BMJ. 2011. https://doi.org/10.1136/bmj.d4044.
Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2023. https://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25:603–5.
Google Scholar
Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJM, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17:1–12.
Google Scholar
De Cassai A, Boscolo A, Zarantonello F, Pettenuzzo T, Sella N, Geraldini F, et al. Enhancing study quality assessment: an in-depth review of risk of bias tools for meta-analysis—a comprehensive guide for anesthesiologists. J Anesth Analg Crit Care. 2023;3:1–8.
Google Scholar
Moskalewicz A, Oremus M. No clear choice between Newcastle-Ottawa Scale and Appraisal Tool for Cross-Sectional Studies to assess methodological quality in cross-sectional studies of health-related quality of life and breast cancer. J Clin Epidemiol. 2020; 120:94–103.
Herzog R, Álvarez-Pasquin MJ, Díaz C, Del Barrio JL, Estrada JM, Gil Á. Are healthcare workers intentions to vaccinate related to their knowledge, beliefs and attitudes? A systematic review. BMC Public Health. 2013;13:1–17.
Google Scholar
Alshabanat A, Zafari Z, Albanyan O, Dairi M, FitzGerald JM. Asthma and COPD Overlap Syndrome (ACOS): a systematic review and meta analysis. PLoS ONE. 2015. https://doi.org/10.1371/journal.pone.0136065.
Dixon JB, O’Brien PE. Neck circumference a good predictor of raised insulin and free androgen index in obese premenopausal women: changes with weight loss. Clin Endocrinol. 2002;57:769–78.
Google Scholar
Inci Coskun E, Omma T, Taskaldiran I, Firat SN, Culha C. Metabolic role of hepassocin in polycystic ovary syndrome. Eur Rev Med Pharm Sci. 2023;27:5175–83.
Google Scholar
Penaforte FRO, Japur CC, Diez-Garcia RW, Chiarello PG. Upper trunk fat assessment and its relationship with metabolic and biochemical variables and body fat in polycystic ovary syndrome. J Hum Nutr Diet. 2011;24:39–46.
Google Scholar
Malathi B, Maruthamuthu B, Ramanathan G. An analysis of hyperandrogenic features and other clinical characteristics in non obese PCOS—the phenotypic diagnostic criteria. World J Pharm Med Res. 2018;4:226–35.
El-Eshmawy MM, Ibrahim A, Bahriz R, Shams-Eldin N, Mahsoub N. Serum uric acid/creatinine ratio and free androgen index are synergistically associated with increased risk of polycystic ovary syndrome in obese women. BMC Endocr Disord. 2022. https://doi.org/10.1186/s12902-022-01240-y.
Shivakumar S, Urooj A. Assessment of body composition parameters and its association with serum uric acid in women with polycystic ovary syndrome—a case-control based exploratory study. Indian Obstet Gynaecol. 2022;12:33–40.
Shirvanizadeh F, Eidi A, Hafezi M, Eftekhari-Yazdi P. Abdominal obesity may play a significant role in inflammation exacerbation in polycystic ovary syndrome patients. JBRA Assist Reprod. 2023;27:682–8.
Google Scholar
Kamrul-Hasan ABM, Aalpona FTZ. Neck circumference as a predictor of obesity and metabolic syndrome in Bangladeshi women with polycystic ovary syndrome. Indian J Endocrinol Metab. 2021;25:226–31.
Google Scholar
Mohapatra I, Samantaray SR. BMI and polycystic ovary syndrome: demographic trends in weight and health. Cureus. 2024;16:e55439.
Google Scholar
Koduri P, Parimala C, Kunjummen AT, Yadav BK, Kapoor N, Sandhiya P, et al. Individualised lifestyle intervention in polycystic ovarian syndrome women who desire fertility: a feasibility study. J Hum Reprod Sci. 2024;17:207–15.
Google Scholar
Ebrahimi H, Mahmoudi P, Zamani F, Moradi S. Neck circumference and metabolic syndrome: a cross-sectional population-based study. Prim Care Diabetes. 2021;15:582–7.
Google Scholar
Zhao L, Huang G, Xia F, Li Q, Han B, Chen Y, et al. Neck circumference as an independent indicator of visceral obesity in a Chinese population. Lipids Health Dis. 2018;17:85–93.
Google Scholar
Díaz DA, Lera L, Márquez C, Valenzuela A, Saguez R, Weisstaub G, et al. Neck circumference cut-off points for identifying adiposity: association with chronic metabolic diseases in older people. J Pers Med. 2024;14:710–21.
Google Scholar
De Koning L, Merchant AT, Pogue J, Anand SS. Waist circumference and waist-to-hip ratio as predictors of cardiovascular events: meta-regression analysis of prospective studies. Eur Heart J. 2007;28:850–6.
Google Scholar
Jayedi A, Soltani S, Zargar MS, Khan TA, Shab-Bidar S. Central fatness and risk of all cause mortality: systematic review and dose-response meta-analysis of 72 prospective cohort studies. BMJ. 2020. https://doi.org/10.1136/bmj.m3324.
Ben-Noun LL, Sohar E, Laor A. Neck circumference as a simple screening measure for identifying overweight and obese patients. Obes Res. 2001;9:470–7.
Google Scholar
Dumesic DA, Akopians AL, Madrigal VK, Ramirez E, Margolis DJ, Sarma MK, et al. Hyperandrogenism accompanies increased intra-abdominal fat storage in normal weight polycystic ovary syndrome women. J Clin Endocrinol Metab. 2016;101:4178–88.
Google Scholar
Thomas DD, Corkey BE, Istfan NW, Apovian CM. Hyperinsulinemia: an early indicator of metabolic dysfunction. J Endocr Soc. 2019;3:1727–47.
Google Scholar
Saneei P, Shahdadian F, Moradi S, Ghavami A, Mohammadi H, Rouhani MH. Neck circumference in relation to glycemic parameters: a systematic review and meta-analysis of observational studies. Diabetol Metab Syndr. 2019;11:1–16.
Google Scholar
Yang L, Samarasinghe YP, Kane P, Amiel SA, Aylwin SJB. Visceral adiposity is closely correlated with neck circumference and represents a significant indicator of insulin resistance in WHO grade III obesity. Clin Endocrinol. 2010;73:197–200.
Google Scholar
Jurczewska J, Ostrowska J, Chełchowska M, Panczyk M, Rudnicka E, Kucharski M, et al. Abdominal obesity in women with polycystic ovary syndrome and its relationship with diet, physical activity and insulin resistance: a pilot study. Nutrients. 2023. https://doi.org/10.3390/nu15163652.
Goldstein BJ. Insulin resistance as the core defect in type 2 diabetes mellitus. Am J Cardiol. 2002;90:3G–10G.
Google Scholar
Yang G, Li C, Gong Y, Fang F, Tian H, Li J, et al. Assessment of insulin resistance in subjects with normal glucose tolerance, hyperinsulinemia with normal blood glucose tolerance, impaired glucose tolerance, and newly diagnosed type 2 diabetes (prediabetes insulin resistance research). J Diabetes Res. 2016. https://doi.org/10.1155/2016/9270768.
Kim JJ, Choi YM. Dyslipidemia in women with polycystic ovary syndrome. Obstet Gynecol Sci. 2013;56:137–42.
Google Scholar
Pappan N, Rehman A. Dyslipidemia. In: Ackley WB, Adolphe TS, Aeby TC, Agadi S, Agasthi P, Ahmad S et al. (eds). StatPearls [Internet]. StatPearls Publishing, Treasure Island, Florida, 2025. https://www.ncbi.nlm.nih.gov/books/NBK560891/.
Sarwar N, Danesh J, Eiriksdottir G, Sigurdsson G, Wareham N, Bingham S, et al. Triglycerides and the risk of coronary heart disease: 10,158 incident cases among 262,525 participants in 29 Western prospective studies. Circulation 2007;115:450–8.
Google Scholar
Miller M, Stone NJ, Ballantyne C, Bittner V, Criqui MH, Ginsberg HN, et al. Triglycerides and cardiovascular disease. Circulation 2011;123:2292–333.
Google Scholar
Legro RS, Kunselman AR, Dunaif A. Prevalence and predictors of dyslipidemia in women with polycystic ovary syndrome. Am J Med. 2001;111:607–13.
Google Scholar
Talbott E, Clerici A, Berga SL, Kuller L, Guzick D, Detre K, et al. Adverse lipid and coronary heart disease risk profiles in young women with polycystic ovary syndrome: results of a case-control study. J Clin Epidemiol. 1998;51:415–22.
Google Scholar
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.
Google Scholar
Vrbíková J, Cífková R, Jirkovská A, Lánská V, Platilová H, Zamrazil V, et al. Cardiovascular risk factors in young Czech females with polycystic ovary syndrome. Hum Reprod. 2003;18:980–4.
Google Scholar
Elting MW, Korsen TJM, Bezemer PD, Schoemaker J. Prevalence of diabetes mellitus, hypertension and cardiac complaints in a follow-up study of a Dutch PCOS population. Hum Reprod. 2001;16:556–60.
Google Scholar
Wild S, Pierpoint T, Jacobs H, McKeigue P. Long-term consequences of polycystic ovary syndrome: results of a 31 year follow-up study. Hum Fertil. 2000;3:101–5.
Google Scholar
Joham AE, Kakoly NS, Teede HJ, Earnest A. Incidence and predictors of hypertension in a cohort of Australian women with and without polycystic ovary syndrome. J Clin Endocrinol Metab. 2021;106:1585–93.
Google Scholar
Gambineri A, Pelusi C, Vicennati V, Pagotto U, Pasquali R. Obesity and the polycystic ovary syndrome. Int J Obes. 2002;26:883–96.
Google Scholar
Kirchengast S, Huber J. Body composition characteristics and body fat distribution in lean women with polycystic ovary syndrome. Hum Reprod. 2001;16:1255–60.
Google Scholar
Cascella T, Palomba S, De Sio I, Manguso F, Giallauria F, De Simone B, et al. Visceral fat is associated with cardiovascular risk in women with polycystic ovary syndrome. Hum Reprod. 2008;23:153–9.
Google Scholar
Svendsen PF, Nilas L, Nørgaard K, Jensen JEB, Madsbad S. Obesity, body composition and metabolic disturbances in polycystic ovary syndrome. Hum Reprod. 2008;23:2113–21.
Google Scholar
Ozkaya I, Yardimci B, Tunckale A. Appropriate neck circumference cut-off points for metabolic syndrome in Turkish patients with type 2 diabetes. Endocrinol Diabetes Nutr. 2017;64:517–23.
Google Scholar
Stabe C, Vasques ACJ, Lima MMO, Tambascia MA, Pareja JC, Yamanaka A, 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. 2013;78:874–81.
Google Scholar
Vallianou NG, Evangelopoulos AA, Bountziouka V, Vogiatzakis ED, Bonou MS, Barbetseas J, et al. Neck circumference is correlated with triglycerides and inversely related with HDL cholesterol beyond BMI and waist circumference. Diabetes Metab Res Rev. 2013;29:90–7.
Google Scholar
Li D, Zhao Y, Zhang L, You Q, Jiang Q, Yin X, et al. Association between neck circumference and diabetes mellitus: a systematic review and meta-analysis. Diabetol Metab Syndr. 2023.
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