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

Objective: Neck circumference (NC) is considered to be an alternative screening method for obesity. The aims were: (1) to examine the correlation between body mass index (BMI) and NC; and (2) to determine diagnostic performance including the best cut-off values of NC for identification of overweight and obese Pakistani children.
Methods: The study sample was 7,921 children, aged 5-14 years, by cross-sectional survey carried-out in four major cities of Pakistan. Receiver operating characteristic analysis was used to investigate the diagnostics performance of NC and to determine the optimal cut-off points for identifying children with overweight and obesity.
Results: The mean of each anthropometric variable (i.e., height, weight, BMI and NC) increased with age in both sexes. In the whole sample, NC had a strong 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. During puberty, the cut-off values for overweight and obesity respectively were 28.32 cm and 28.57 cm in boys and 28.70 cm and 28.82 cm in girls.
Conclusion: NC may be used as a simple and widely applicable measure for identification of overweight and obesity with reasonable accuracy in Pakistani children.