Original Article

Diagnostic Performance of Neck Circumference and Cut-off Values for Identifying Overweight and Obese Pakistani Children: A Receiver Operating Characteristic Analysis


  • Muhammad Asif
  • Muhammad Aslam
  • Justyna Wyszyńska
  • Saima Altaf
  • Shakeel Ahmad

Received Date: 25.12.2019 Accepted Date: 12.04.2020 J Clin Res Pediatr Endocrinol 0;0(0):0-0 [e-Pub] PMID: 32295325


Neck circumference (NC) is considered to be an alternative screening method for obesity. The aims of this investigation were (1) to examine the correlation between BMI and NC and (2) to determine diagnostic performance, the best cut-off points of NC for identification of overweight and obese Pakistani children.


We studied a sample of 7921 children aged 5-14 years by a cross-sectional survey carried-out in four major cities of Pakistan. Receiver operating characteristic (ROC) analysis was used to see the diagnostics performance of NC and to determine the optimal cut-off points for identifying children with overweight and obesity.


The mean of each anthropometric variable (i.e., height, weight, BMI and NC) increased with age in both sexes. In the overall sample studied, NC also had a good positive correlation (r=0.61, p <0.01) with BMI. NC optimal cut-off points for identifying overweight and obesity in Pakistani boys ranged between 25.00 to 30.35 cm and the corresponding values for the girls were 24.00 to 31.62 cm. In the prepubertal period, NC cut-off points indicative overweight, in both boys and girls were 26.36 cm and 25.27 cm, respectively; the corresponding values for obesity were 26.78 cm and 25.02 cm. The cut-off values of 28.32cm and 28.57cm for overweight and obesity; were reported in boys and 28.70 cm and 28.82 cm in girls at puberty stage.


NC could potentially be used as a simple and widely-acceptable indicator in clinical settings for identification of overweight and obesity with a reasonable accuracy in children.

Keywords: Body mass index; LMS method; Neck circumference; Obesity; Receiver operating characteristic curve