Neck circumference - A simple and valid screening tool for obesity in school children

Year 2021, , 1184 - 1187, 01.12.2021

Sreelatha P R Chinchilu R V

https://doi.org/10.28982/josam.899255

Abstract

Background/Aim: Childhood obesity is on a rise worldwide with an estimated prevalence of over 8% and 6% in boys and girls, respectively. Being a forerunner of adult obesity and its consequences, this has to be detected earlier and appropriate interventions instituted timely for better health outcomes. Neck Circumference is a simple screening tool for detecting obesity. This study aimed to find out the correlation between neck circumference and body mass index (BMI) and measures of central obesity like waist circumference (WC), hip circumference (HC), and waist-hip ratio (WHR). It also tried to find out the age and gender-specific cut-off values for overweight and obesity in schoolchildren aged 6 to 16 years.
Methods: This was a cross-sectional observational study conducted in the primary and secondary schools of a sub-urban region of south Kerala, India. The anthropometric measurements, including weight, height, neck circumference, waist and hip circumferences of children aged 6-16 years who satisfied the inclusion criteria were obtained by health professionals, and their BMIs were compared with WHO standards to detect overweight and obesity. The correlation between BMI and NC, sensitivity, and specificity of NC in detecting overweight and obesity, and age-related cut-off values of NC were calculated using appropriate statistical methods. The correlation of NC with indicators of central obesity like waist circumference, hip circumference, and waist-hip ratio were also determined.
Results: A total of 1797 students were studied. Neck circumference showed a significant positive correlation (r = +.6 to + .8, P<0.001) with body mass index, waist circumference, and hip circumference but not with waist-hip ratio (r =+0.3 to -0.2). In ROC analysis, age-specific cut-off values of NC for obesity and overweight were obtained age- and gender-wise, with sensitivities of 87.5% and 100%, and specificities of 52.2% - 88.9%, respectively.
Conclusion: Neck circumference is a valid and simple tool to detect overweight and obesity in schoolchildren. It is also an indicator of the central distribution of fat in children aged 6 to 16 years.

Keywords

Neck circumference, Body Mass Index, overweight, obesity, Waist circumference, Hip circumference

References

• 1. Dietz WH, Robinson TN. Clinical practice. Overweight children and adolescents . N Engl J Med. 2005;352:2100–9.
• 2. Gill P, Baur LA, Bauman AE, Steinbeck KS. Establishing a standard definition for child overweight and obesity worldwide: International survey. Br Med J. 2000;320:1240–3.
• 3. Cornier, Marc-Andre, Despre´s, Jean-Pierre Davis N, Davis DA, Klein S, Lamarche B, Lopez-Jimenez, Francisco Rao G, St-Onge M-P, et al. Assessing Adiposity A Scientific Statement From the American Heart Association. Circulation. 2011;124:1996–2019.
• 4. Vucenik I, Stains JP. Obesity and cancer risk: Evidence, mechanisms, and recommendations. Ann N Y Acad Sci. 2012;1271:37–43.
• 5. Flodmark CE, Lissau I, Moreno LA, Pietrobelli A, Widhalm K. New insights into the field of children and adolescents’ obesity: The European perspective. Int J Obes. 2004;28:1189–96.
• 6. Nelson text book of Paediatrics,21th edition. 2019. 345–346 p.
• 7. Gupta AK AA. Childhood obesity and hypertension. Indian Pediatr. 1990;27:333–7.
• 8. Laffel L SB. Epidemiology, presentations, and diagnosis of type 2 diabetes mellitus in children and adolescents. UpToDate. 2013;
• 9. Kasmini K, Idris MN, Fatimah A, Hanafiah S, Iran H, Asmah MN. Prevalence of overweight and obese school children aged between 7 to 16 years amongst the major 3 ethnic groups in Kuala Lumpur, Malaysia. Asia Pac J Clin Nutr. 1997;6:172–4.
• 10. Nafiu OO, Burke C, Lee J, Voepel-Lewis T, Malviya S, Tremper KK. Neck circumference as a screening measure for identifying children with high body mass index. Pediatrics. 2010;126.
• 11. Vedavati S, Jayashree R, Mohammad R. Erratum: Prevalence of overweight and obesity in affluent adolescent girls in Chennai in 1981 and 1998 (Indian Pediatrics (August 2003). Indian Pediatr [Internet]. 2003;40:926.
• 12. Aswathappa J, Garg S, Kutty K, Shankar V. Neck circumference as an anthropometric measure of obesity in diabetics. N Am J Med Sci. 2013;5:28–31.
• 13. Hassan Farman W, M Majeed H. Overweight and Obesity Among Children and Adolescents in Baladrouz City. Diyala J Med. 2019;16:31–8.
• 14. Cintra IP ; Passos MAZ ; Santos LC ; Machado HC and Fisberg M. Waist -to- Height Ratio Percentiles and Cutoffs for Obesity: A Cross-sectional Study in Brazilian Adolescents. J Heal Popul NUTR. 2014;32:411–9.
• 15. WHO. Obesity.Preventing and managing global epidemic. 2000;153–238. Available from: http://whqlibdoc.who.int/trs/WHO_TRS_894_(part4).pdf
• 16. Flynn JT, Daniels SR, Hayman LL, Maahs DM, McCrindle BW, Mitsnefes M, et al. American Heart Association Atherosclerosis, Hypertension and Obesity in Youth Committee of the Council on Cardiovascular Disease in the Young. Update: Ambulatory blood pressure monitoring in children and adolescents: A scientific statement from the Americ. Hypertension. 2014;63.
• 17. Algina J, Keselman HJ. Comparing squared multiple correlation coefficients: Examination of a confidence interval and a test significance. Psychol Methods. 1999;4:76–83.
• 18. Bonett DG. Meta-Analytic Interval Estimation for Bivariate Correlations. Psychol Methods. 2008;13:173–81.
• 19. Bobko P. Correlation and regression: Applications for industrial organizational psychology and management. Thousand Oaks, CA Sage Publ. 2001;5:200–1.
• 20. Nafiu OO, Burke C, Lee J, Voepel-Lewis T, Malviya S, Tremper KK. Neck circumference as a screening measure for identifying children with high body mass index. Pediatrics [Internet]. 2010;126. Available from:
• 21. Taheri M, Kajbaf TZ, Taheri MR, Aminzadeh M. Neck circumference as a useful marker for screening overweight and obesity in children and adolescents. Oman Med J. 2016;31:170–5.
• 22. Patnaik L, Pattnaik S, Rao EV, Sahu T. Validating neck circumference and waist circumference as anthropometric measures of overweight/obesity in adolescents. Indian Pediatr. 2017;54:377–80.
• 23. Katz SL, Vaccani JP, Clarke J, Hoey L, Colley RC, Barrowman NJ. Creation of a reference dataset of neck sizes in children: Standardizing a potential new tool for prediction of obesity-associated diseases? BMC Pediatr. 2014;14.
• 24. Kim Y, Lee J-M, Laurson K, Bai Y, Gaesser GA, Welk GJ. Accuracy of Neck Circumference in Classifying Overweight and Obese US Children. ISRN Obes. 2014;2014:1–6.
• 25. Hassan NE, Atef A, El-Masry SA, Ibrahim A, Al-Tohamy M, Rasheed EA, et al. Is neck circumference an indicator for metabolic complication of childhood obesity? Maced J Med Sci [Internet]. 2015;3:26–31.