Is Neck Circumference a Marker for Cardiovascular Risk in Obese Adolescents?


  • Bruno Faria Pediatrics Department – Escola Paulista de Medicina – UNIFESP, Rua Botucatu, 598- Vila clementino, Zip code: 04023-062. São Paulo-SP, Brazil
  • Maria Arlete Meil Schimith Escrivão Nutrology Discipline of the Pediatrics Department – Escola Paulista de Medicina – UNIFESP, Rua Loefgreen, 1647, Vila Clementino, Zip code 04040-032, São Paulo-SP, Brazil
  • Paulo Cesar Koch Nogueira Pediatrics Department – Escola Paulista de Medicina – UNIFESP, Rua Botucatu, 598- Vila clementino, Zip code: 04023-062. São Paulo-SP, Brazil



Neck circumference, obesity, adolescent, cardiovascular diseases, diagnosis.


Background: Weight excess has become a public health problem worldwide, reaching about 200 million children, of whom 40 to 50 million are obese. Obesity in childhood is associated with increased blood pressure (BP), high triglycerides, low HDL-cholesterol and abnormal glucose metabolism. Visceral fat is a stronger predictor of metabolic dysfunction and cardiovascular risk than total body adiposity. Assessment of neck circumference (NC) is an easy method, which can serve as screening to identify individuals with weight excess. Our study aim was to examine associations between NC with BP values, lipid profile, blood glucose and fasting insulin in obese adolescents and verify the reproducibility of measurements of NC.

Methods: 82 adolescents aged 10 to 17 years were included in the study, being 43 (22 boys and 21 girls) with obesity and 39 with normal weight (20 boys and 19 girls).

Results: Significant associations were observed between NC and BMI, BP, HDL cholesterol, insulin and HOMA-IR. Disagreement between both observers for NC was observed in 5.2% of the sample, only concerning obese individuals.

Conclusion: Our findings strengthen the knowledge about the potential value of NC as a tool for identifying patients at risk for hypertension, insulin resistance, and obesity. However as with the waist circumference it may be flawed in obese individuals.


Ogden CL, Carroll MD, Flegal KM. High body mass index for age among US children and adolescents, 2003-2006. JAMA 2008; 299(20): 2401-5.

Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 2000; 894: i-xii, 1-253.

Bhatia J. Editorial--the global epidemic of obesity. Ann Nutr Metab 2014; 64 Suppl 1: 5-6.

Daniels SR, Jacobson MS, McCrindle BW, Eckel RH, Sanner BM. American Heart Association Childhood Obesity Res-earch Summit Report. Circulation 2009; 119(15): e489-517.

Quak SH, Furnes R, Lavine J, Baur LA, Group OW. Obesity in children and adolescents. J Pediatr Gastroenterol Nutr 2008; 47(2): 254-9.

Steinberger J, Daniels SR, Eckel RH, Hayman L, Lustig RH, McCrindle B, et al. Progress and challenges in metabolic syndrome in children and adolescents: a scientific statement from the American Heart Association Atherosclerosis, Hypertension, and Obesity in the Young Committee of the Council on Cardiovascular Disease in the Young; Council on Cardiovascular Nursing; and Council on Nutrition, Physical Activity, and Metabolism. Circulation 2009; 119(4): 628-47.

Speiser PW, Rudolf MC, Anhalt H, Camacho-Hubner C, Chiarelli F, Eliakim A, et al. Childhood obesity. J Clin Endocrinol Metab 2005; 90(3): 1871-87.

Whitlock EP, Williams SB, Gold R, Smith PR, Shipman SA. Screening and interventions for childhood overweight: a summary of evidence for the US Preventive Services Task Force. Pediatrics 2005; 116(1): e125-44.

Phan TL, Maresca MM, Hossain J, Datto GA. Does body mass index accurately reflect body fat? A comparison of anthropometric measures in the longitudinal assessment of fat mass. Clin Pediatr (Phila) 2012; 51(7): 671-7.

Casazza K, Dulin-Keita A, Gower BA, Fernandez JR. Intrabdominal fat is related to metabolic risk factors in Hispanic Americans, African Americans and in girls. Acta Paediatr 2009; 98(12): 1965-71.

Lovejoy JC, de la Bretonne JA, Klemperer M, Tulley R. Abdominal fat distribution and metabolic risk factors: effects of race. Metabolism. 1996; 45(9): 1119-24.

Preis SR, Massaro JM, Robins SJ, Hoffmann U, Vasan RS, Irlbeck T, et al. Abdominal subcutaneous and visceral adipose tissue and insulin resistance in the Framingham heart study. Obesity (Silver Spring) 2010; 18(11): 2191-8.

de Onis M, Habicht JP. Anthropometric reference data for international use: recommendations from a World Health Organization Expert Committee. Am J Clin Nutr. 1996; 64(4): 650-8.

Pouliot MC, Després JP, Lemieux S, Moorjani S, Bouchard C, Tremblay A, et al. Waist circumference and abdominal sagittal diameter: best simple anthropometric indexes of abdominal visceral adipose tissue accumulation and related cardiovascular risk in men and women. Am J Cardiol. 1994; 73(7): 460-8.

Klein S, Allison DB, Heymsfield SB, Kelley DE, Leibel RL, Nonas C, et al. Waist Circumference and Cardiometabolic Risk: a Consensus Statement from Shaping America's Health: Association for Weight Management and Obesity Prevention; NAASO, the Obesity Society; the American Society for Nutrition; and the American Diabetes Association. Obesity (Silver Spring) 2007; 15(5): 1061-7.

Hatipoglu N, Mazicioglu MM, Kurtoglu S, Kendirci M. Neck circumference: an additional tool of screening overweight and obesity in childhood. Eur J Pediatr 2010; 169(6): 733-9.

Yang L, Samarasinghe YP, Kane P, Amiel SA, Aylwin SJ. Visceral adiposity is closely correlated with neck circumference and represents a significant indicator of insulin resistance in WHO grade III obesity. Clin Endocrinol (Oxf) 2010; 73(2): 197-200.

Coutinho CA, Longui CA, Monte O, Conde W, Kochi C. Measurement of neck circumference and its correlation with body composition in a sample of students in São Paulo, Brazil. Horm Res Paediatr 2014; 82(3): 179-86.

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: 159.

Arnold TJ, Schweitzer A, Hoffman HJ, Onyewu C, Hurtado ME, Hoffman EP, et al. Neck and waist circumference biomarkers of cardiovascular risk in a cohort of predominantly African-American college students: a preliminary study. J Acad Nutr Diet 2014; 114(1): 107-16.

Laakso M, Matilainen V, Keinänen-Kiukaanniemi S. Association of neck circumference with insulin resistance-related factors. Int J Obes Relat Metab Disord 2002; 26(6): 873-5.

Stabe C, Vasques AC, Lima MM, Tambascia MA, Pareja JC, Yamanaka A, et al. Neck circumference as a simple tool for identifying the metabolic syndrome and insulin resistance: results from the Brazilian Metabolic Syndrome Study. Clin Endocrinol (Oxf) 2013; 78(6): 874-81.

Kurtoglu S, Hatipoglu N, Mazicioglu MM, Kondolot M. Neck circumference as a novel parameter to determine metabolic risk factors in obese children. Eur J Clin Invest 2012; 42(6): 623-30.

Nafiu OO, Zepeda A, Curcio C, Prasad Y. Association of neck circumference and obesity status with elevated blood pressure in children. J Hum Hypertens 2014; 28(4): 263-8.

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(2): e306-10.

Adolescents NHBPEPWGoHBPiCa. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004; 114(2 Suppl 4th Report): 555-76.

Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985; 28(7): 412-9.

Sedgwick P. Limits of agreement (Bland-Altman method). BMJ 2013; 346: f1630.

Schwartz B, Jacobs DR, Moran A, Steinberger J, Hong CP, Sinaiko AR. Measurement of insulin sensitivity in children: comparison between the euglycemic-hyperinsulinemic clamp and surrogate measures. Diabetes Care 2008; 31(4): 783-8.

Onat A, Hergenç G, Yüksel H, Can G, Ayhan E, Kaya Z, et al. Neck circumference as a measure of central obesity: associations with metabolic syndrome and obstructive sleep apnea syndrome beyond waist circumference. Clin Nutr 2009; 28(1): 46-51.

da Silva CeC, Zambon MP, Vasques AC, Rodrigues AM, Camilo DF, Antonio M, et al. Neck circumference as a new anthropometric indicator for prediction of insulin resistance and components of metabolic syndrome in adolescents: Brazilian Metabolic Syndrome Study. Rev Paul Pediatr 2014; 32(2): 221-9.




How to Cite

Faria, B., Escrivão, M. A. M. S. ., & Nogueira, P. C. K. (2016). Is Neck Circumference a Marker for Cardiovascular Risk in Obese Adolescents?. International Journal of Child Health and Nutrition, 5(2), 79–85.



General Articles