title: Association of neck circumference and high blood pressure in children and adolescents: a case-control study.
abstract: BACKGROUND
  High blood pressure (BP) is a serious, common and growing global public health problem. The aim of this study was to evaluate the associations between high NC (neck circumference) alone and in combinations with BMI (body mass index), WC (waist circumference), and high BP among Lithuanian children and adolescents aged 12 to 15 years.
  
  
  METHODS
  An epidemiological case-control study was performed between May 2012 and November 2013. NC, WC, hip circumference (HC), mid-upper arm circumference (MUAC), body height, weight, and BP were measured. The participants with high BP (≥ 90th percentile) were screened on two separate occasions. Data on NC, WC, HC, MUAC, BMI, body adiposity index (BAI), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), and BP were analyzed in 1947 children and adolescents aged 12-15 years. Age- and sex-adjusted odds ratios (aORs) with 95% confidence intervals (CI) for the associations were estimated using multivariate logistic regression models.
  
  
  RESULTS
  The prevalence rates of prehypertension (BP ≥ 90th- < 95th percentile) and hypertension (BP ≥ 95th percentile) was 6.3 and 25.1%, respectively. The overall prevalence of high NC (if NC was in the ≥ 90th percentile), overweight/obesity (as measured by BMI), and abdominal overweight/obesity (if WC was in the ≥ 75th percentile) were 14.3, 15.8, and 13%, respectively. After adjustment for age and sex, NC in the ≥ 90th percentile was significantly associated with an increased risk of elevated BP (prehypertension: aOR = 2.99; 95% CI, 1.88-4.77; hypertension aOR = 4.05; 95% CI, 3.03-5.41, and prehypertension/hypertension aOR = 3.75; 95% CI, 2.86-4.91), compared to the participants with NC in the <90th percentile. Overweight/obesity and abdominal overweight/obesity were also significantly associated with an elevated BP. The combinations including both risk factors (high NC with overweight/obesity, and high NC with abdominal overweight/obesity) showed higher aORs than those with either risk factor alone.
  
  
  CONCLUSIONS
  High NC alone-but particularly in combinations with overweight/obesity and abdominal overweight/obesity-was associated with an increased risk of high BP.
authors.affiliation: Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Sukileliu ave. 17, LT-50009, Kaunas, Lithuania. renatakuciene@yahoo.com.
authors.forename: Renata
authors.initials: R
authors.lastname: Kuciene
authors.affiliation: Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Sukileliu ave. 17, LT-50009, Kaunas, Lithuania. virginija.dulskiene@lsmuni.lt.
authors.forename: Virginija
authors.initials: V
authors.lastname: Dulskiene
authors.affiliation: Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Sukileliu ave. 17, LT-50009, Kaunas, Lithuania. jurate.medzioniene@lsmuni.lt.
authors.forename: Jurate
authors.initials: J
authors.lastname: Medzioniene
mesh_terms: D050154:Adiposity; D000293:Adolescent; D001794:Blood Pressure / Q000502:physiology*; D015992:Body Mass Index; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D008097:Lithuania / Q000453:epidemiology; D008297:Male; D009333:Neck / Q000033:anatomy & histology*; D009765:Obesity / Q000453:epidemiology; D058246:Prehypertension / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors