BEN-NOUN, LIUBOV (LOUBA), EZRA SOHAR, AND ARIE LAOR. Neck circumference as a simple screening measure for identifying overweight and obesity patients. Obes Res. 2001;9:470 -477. Objective: There are numerous methods of assessing overweight and obesity. We undertook an observational study to test a method of identifying overweight or obese patients solely by measuring the circumference of the neck. Research Methods and Procedures:A test sample and a second validation sample included 979 subjects (460 men and 519 women), who visited a family medicine clinic in a southern Israeli urban district for any reason between the randomly chosen months of January and September 1998. Main outcome included neck, waist, and hip circumferences; body mass index (BMI); and waist:hip ratio measures. Results: Pearson's correlation coefficients indicated a significant association between neck circumference (NC) and: BMI (men, r ϭ 0.83; women, r ϭ 0.71; each, p Ͻ 0.0001), age (men, r ϭ 0.33; women, r ϭ 0.36; each, p Ͻ 0.0001), weight (men, r ϭ 0.7; women, r ϭ 0.81; each, p Ͻ 0.0001), waist circumference (men, r ϭ 0.86; women, r ϭ 0.85; each, p Ͻ 0.0001), hip circumference (men, r ϭ 0.62; women, r ϭ 0.56; each, p Ͻ 0.0001), and waist:hip ratio (men, r ϭ 0.66; women, r ϭ 0.87; each, p Ͻ 0.0001). NC Ն37 cm for men and Ն34 cm for women were the best cutoff levels for determining the subjects with BMI Ն25.0 kg/m 2 using the receiver output curve analysis. In the validation unrelated group, the test characteristics were excellent with 98% sensitivity, 89% specificity, and 94% accuracy for men, and 100% sensitivity, 98% specificity, and 99% accuracy for women. NC Ն39.5 cm for men and Ն36.5 cm for women were the best cutoff levels for determining the subjects with BMI Ն30 kg/m 2 using the receiver output curve analysis. In the validation unrelated group, the test characteristics were excellent with 93% sensitivity, 90% specificity, and 91% accuracy for men, and 93% sensitivity, 98% specificity, and 97% accuracy for women. Discussion: NC measurement is a simple and time-saving screening measure that can be used to identify overweight and obese patients. Men with NC Ͻ37 cm and women with NC Ͻ34 cm are not to be considered overweight. Patients with NC Ն37 cm for men and Ն34 cm for women require additional evaluation of overweight or obesity status.

BEN-NOUN, LIUBOV (LOUBA) AND ARIE LAOR.Relationship of neck circumference to cardiovascular risk factors. Obes Res. 2003;11:226 -231. Objective: To determine a relationship between neck circumference (NC) and risk factors for coronary heart disease by evaluating the components of the metabolic syndrome. Research Methods and Procedures:The study group included 561 subjects (231 men and 330 women) who had no known major medical conditions and were not receiving any medication therapy. The subjects were those who attended a family health clinic for any reason between 1998 and December 2001. Main indicators studied included NC, waist circumference, waist-to-hip ratio, body mass index, blood pressure, and lipoprotein, glucose, and uric acid levels. Results: Pearson's correlation coefficients indicated a significant association between NC and body mass index (men, r ϭ 0.71; women, r ϭ 0.81; each, p Ͻ 0.0001), waist circumference (men, r ϭ 0.75; women, r ϭ 0.79; each, p Ͻ 0.0001), waist-to-hip ratio (men, r ϭ 0.56; women, r ϭ 0.63; each, p Ͻ 0.0001), total cholesterol (men, r ϭ 0.50; women, r ϭ 0.66; each, p Ͻ 0.0001), low-density lipoprotein-cholesterol (men, r ϭ 0.42; women, r ϭ 0.60; each, p Ͻ 0.0001), triglycerides (men, r ϭ 0.48; women, r ϭ 0.49; each, p Ͻ 0.0001), glucose (men, r ϭ 0.21, p Ͻ 0.001; women, r ϭ 0.44; p Ͻ 0.0001), uric acid (men, r ϭ 0.50, p Ͻ 0.0001; women, r ϭ 0.60, p Ͻ 0.001), and systolic (men, r ϭ 0.53; women, r ϭ 0.69; each, p Ͻ 0.0001), and diastolic (men, r ϭ 0.55; women, r ϭ 0.65; each, p Ͻ 0.0001) blood pressure. Discussion: Higher NC is correlated positively with the factors of the metabolic syndrome; therefore, it is likely to increase the risk of coronary heart disease.

Changes in systolic BP and diastolic BP correlated positively with changes in NC and other components of the metabolic syndrome.

Various drugs are associated with adverse respiratory disorders (ARDs) ranging in severity from mild, moderate to severe and even fatal. Cardioselective and nonselective beta-blockers, calcium antagonists and dipyridamole can induce asthma. ACE inhibitors are mainly associated with cough. Amiodarone is related to a form of interstitial pneumonitis (IP) which can be fatal, tocainidine and flecainidine to a form of IP, and hydrochlorothiazide to a form of IP and pulmonary oedema. Antiasthmatic drugs can be associated with a paradoxical bronchospasm, while leukotriene antagonists are linked to the development of Churg-Strauss syndrome. Nonsteroidal anti-inflammatory drugs including aspirin (acetylsalicylic acid) may induce asthma. Gold is mainly related to IP, penicillamine to IP, systemic lupus erythematosus, bronchiolitis obliterans, and Goodpasture's syndrome. Acute respiratory reactions to nitrofurantoin include dyspnoea, cough, IP, and pleural effusion while IP and fibrosis are common in chronic reactions. Other antibacterials mainly evoke pneumonitis, pulmonary infiltrates and eosinophilia, and bronchiolitis obliterans. ARDs are similar for most categories of cytotoxic agents, with chronic pneumonitis and fibrosis being the most common. Noncardiogenic pulmonary oedema occurs as the most common respiratory complication in opioid agonist addiction. Psychotropic drugs such as phenothiazides, butyrophenones and tricyclic antidepressants can also induce pulmonary oedema. Oral contraceptives may produce asthma exacerbation, while long term use and/or high doses of postmenopausal hormone replacement therapy increase the risk of asthma. Bromocriptine is mainly associated with pleural effusion, while methysergide is usually associated with pleural effusion and fibrosis. Some anorectic agents have been linked to the development of primary pulmonary hypertension. The possibility of the occurrence of ARDs should be taken into account in each individual patient. Although in most cases the adverse effects are unpredictable, they can be reduced to a minimum or prevented if some drugs are avoided or stopped in time.