Home Evaluation of anthropometric parameters of central obesity in Pakistani children aged 5–12 years, using receiver operating characteristic (ROC) analysis
Article
Licensed
Unlicensed Requires Authentication

Evaluation of anthropometric parameters of central obesity in Pakistani children aged 5–12 years, using receiver operating characteristic (ROC) analysis

  • Muhammad Asif , Muhammad Aslam EMAIL logo and Saima Altaf
Published/Copyright: September 5, 2018
Journal of Pediatric Endocrinology and Metabolism
From the journal Journal of Pediatric Endocrinology and Metabolism Volume 31 Issue 9

Abstract

Background

Different anthropometric parameters have been proposed for assessing central obesity in children, but the ability of these anthropometric parameters to correctly measure central obesity in Pakistani children is questionable and needs to be assessed. The aims of this investigation were to examine the diagnostic performance of anthropometric parameters as indicators of central obesity in Pakistani children as measured by waist circumference (WC) and to determine the sex-specific best cut-off values for these parameters that would identify obese children.

Methods

Anthropometric measurements – height, weight, WC, waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), conicity index (CI) and neck circumference (NC) – from a cross-sectional sample of 5964 Pakistani children aged 5–12 years were analyzed. Receiver operating characteristics (ROC) analysis was used to examine the diagnostic performance and to determine the optimal cut-off point of each anthropometric parameter for identifying centrally obese children.

Results

It was found that WC had a significantly positive correlation with all studied anthropometric parameters. The ROC curve analysis indicated that all the parameters analyzed had good performance but WHtR had the highest value of the area under the curve (AUC). Optimal cut-off points associated with central obesity for boys and girls were, respectively, 0.47 and 0.48 for WHtR, 1.20 and 1.23 for CI, 0.96 and 0.96 for WHR and 26.36 and 26.54 cm for NC.

Conclusions

The sex-specific cut-off points for WHtR, CI, WHR and NC can be used to detect central obesity in Pakistani children.

Keywords: anthropometric parameters; central obesity; neck circumference; ROC curve; waist-to-height ratio
Corresponding author: Dr. Muhammad Aslam, PhD, Associate Professor, Department of Statistics, Bahauddin Zakariya University, Multan, Pakistan, Phone: +923009550007

Acknowledgments

We acknowledge our all data collection team members, the schools’ heads, and we are very thankful to all school teachers for their continuous cooperation during data collection. We are also very grateful to all the participating children and their parents for their active and unconditional cooperation.

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

References

1. Yanping L, Zhai F, Yang X, Schouten EG, Hu X, et al. Determinants of childhood overweight and obesity in China. Br J Nutr 2007;97:210–5.10.1017/S0007114507280559Search in Google Scholar PubMed

2. Mushtaq MU, Gull S, Mushtaq K, Shahid U, Shad MA, et al. Dietary behaviors, physical activity and sedentary lifestyle associated with overweight and obesity, and their socio-demographic correlates, among Pakistani primary school children. Int J Behav Nutr Phys Activity 2011;8:130.10.1186/1479-5868-8-130Search in Google Scholar PubMed PubMed Central

3. Dietz WH, Robinson TN. Overweight children and adolescents. N Engl J Med 2005;352:2100–9.10.1056/NEJMcp043052Search in Google Scholar PubMed

4. Lobstein T, Baur L, Uauy R. Obesity in children and young people: a crisis in public health. Obes Rev 2004;5(Suppl 1):4–85.10.1111/j.1467-789X.2004.00133.xSearch in Google Scholar PubMed

5. Afzal MN, Naveed M. Childhood obesity and Pakistan. J Coll Phys and Surg Pak: JCPSP 2004;14:189–92.Search in Google Scholar

6. Warraich HJ, Javed F, Faraz-ul-Haq M, Khawaja FB, Saleem S. Prevalence of obesity in school-going children of Karachi. PLoS One 2009;4:e4816.10.1371/journal.pone.0004816Search in Google Scholar PubMed PubMed Central

7. Jafar TH, Qadri Z, Islam M, Hatcher J, Bhutta ZA, et al. Rise in childhood obesity with persistently high rates of undernutrition among urban school-aged Indo-Asian children. Arch Dis Child 2008;93:373–8.10.1136/adc.2007.125641Search in Google Scholar PubMed PubMed Central

8. Mushtaq MU, Gull S, Abdullah HM, Shahid U, Shad MA, et al. Prevalence and socioeconomic correlates of overweight and obesity among Pakistani primary school children. BMC Public Health 2011;11:724.10.1186/1471-2458-11-724Search in Google Scholar PubMed PubMed Central

9. Sowers JR. Obesity as a cardiovascular risk factor. Am J Med 2003;115(Suppl 8A):37S–41.10.1016/j.amjmed.2003.08.012Search in Google Scholar PubMed

10. de Carvalho AB, Pires-Neto CS. Body composition by underwater weighing and bioelectrical impedance methods in college students. Rev Bras Cineantropom Des Hum 1999;1:18–23.Search in Google Scholar

11. Mushtaq MU, Gull S, Abdullah HM, Shahid U, Shad MA, et al. Waist circumference, waist-hip ratio and waist-height ratio percentiles and central obesity among Pakistani children aged five to twelve years. BMC Pediatr 2011;11:105.10.1186/1471-2431-11-105Search in Google Scholar PubMed PubMed Central

12. Mokha JS, Srinivasan SR, DasMahapatra P, Fernandez C, Chen W, et al. Utility of waist-to-height ratio in assessing the status of central obesity and related cardiometabolic risk profile among normal weight and overweight/obese children: the Bogalusa Heart Study. BMC Pediatr 2010;10:73.10.1186/1471-2431-10-73Search in Google Scholar PubMed PubMed Central

13. Pitanga FJ, Lessa I. Anthropometric indexes of obesity as an instrument of screening for high coronary risk in adults in the city of Salvador-Bahia. Arq Bras Cardiol 2005;85:26–31.Search in Google Scholar

14. Saka M, Türker P, Ercan A, Kızıltan G, Baş M. Is neck circumference measurement an indicator for abdominal obesity? A pilot study on Turkish adults. Afr Health Sci 2014;14:570–5.10.4314/ahs.v14i3.11Search in Google Scholar

15. Yang GR, Yuan SY, Fu HJ, Wan G, Zhu LX, et al. Neck circumference positively related with central obesity, overweight, and metabolic syndrome in Chinese subjects with type 2 diabetes: Beijing Community Diabetes Study 4. Diabetes Care 2010;33:2465–7.10.2337/dc10-0798Search in Google Scholar

16. Magalhães EI, Sant’Ana LF, Priore SE, Franceschini SD. Waist circumference, waist/height ratio, and neck circumference as parameters of central obesity assessment in children. Rev Paul de Pediatr 2014;32:273–82.Search in Google Scholar

17. Pelegrini A, Silva DA, de Lima Silva JM, Grigollo L, Petroski EL. Anthropometric indicators of obesity in the prediction of high body fat in adolescents. Rev Paul de Pediatr (English Edition) 2015;33:56–62.10.1016/S2359-3482(15)30031-2Search in Google Scholar

18. Bullappa A, Harish BR, Mahendra BJ. Evaluation of anthropometric measurements of central obesity as screening tools in children: multi receiver operating characteristic analysis. Int J Comm Med Pub Health 2017;4:251–5.10.18203/2394-6040.ijcmph20164748Search in Google Scholar

19. Sousa S, Pires N, Salvador EP, Barros AK, Polisel CG, et al. Anthropometric predictors of abdominal adiposity in adolescents. J Exer Physiol Online 2016;19:66–76.Search in Google Scholar

20. Pakistan Census Organization, Government of Pakistan. Census report of Pakistan 1998. Islamabad, Pakistan: Pakistan Bureau of Statistics, 1998.Search in Google Scholar

21. World Health Organization (WHO). Measuring obesity: classification and distribution of anthropometric data. Copenhagen, Denmark: World Health Organization, 1989.Search in Google Scholar

22. Valdez R, Seidell JC, Ahn YI, Weiss KM. A new index of abdominal adiposity as an indicator of risk for cardiovascular disease. A cross-population study. Int J Obes Relat Metab Disord 1993;17:77–82.Search in Google Scholar

23. Perkins NJ, Schisterman EF. The inconsistency of “optimal” cutpoints obtained using two criteria based on the receiver operating characteristic curve. Am J Epidemiol 2006;163:670–5.10.1093/aje/kwj063Search in Google Scholar PubMed PubMed Central

24. Swets JA. Measuring the accuracy of diagnostic systems. Science 1988;240:1285–93.10.1126/science.3287615Search in Google Scholar PubMed

25. Nafiu OO, Burke C, Lee J, Voepel-Lewis T, Malviya S, et al. Neck circumference as a screening measure for identifying children with high body mass index. Pediatrics 2010;126:e306–10.10.1542/peds.2010-0242Search in Google Scholar PubMed

26. Olshansky SJ, Passaro DJ, Hershow RC, Layden J, Carnes BA, et al. A potential decline in life expectancy in the United States in the 21st century. N Engl J Med 2005;352:1138–45.10.1056/NEJMsr043743Search in Google Scholar PubMed

27. Ogden CL, Kuczmarski RJ, Flegal KM, Mei Z, Guo S, et al. Centers for Disease Control and Prevention 2000 growth charts for the United States: improvements to the 1977 National Center for Health Statistics version. Pediatrics 2002;109:45–60.10.1542/peds.109.1.45Search in Google Scholar PubMed

28. Must A, Spadano J, Coakley EH, Field AE, Colditz G, et al. The disease burden associated with overweight and obesity. J Am Med Assoc 1999;282:1523–9.10.1001/jama.282.16.1523Search in Google Scholar PubMed

29. Wing RR, Jeffery RW, Burton LR, Thorson C, Kuller LH, et al. Change in waist-hip ratio with weight loss and its association with change in cardiovascular risk factors. Am J Clin Nutr 1992;55:1086–92.10.1093/ajcn/55.6.1086Search in Google Scholar

30. Pouliot MC, Després JP, Lemieux S, Moorjani S, Bouchard C, 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;73:460–8.10.1016/0002-9149(94)90676-9Search in Google Scholar

31. Ben-Noun LL, Sohar E, Laor A. Neck circumference as a simple screening measure for identifying overweight and obese patients. Obes Res 2001;9:470–7.10.1038/oby.2001.61Search in Google Scholar PubMed

32. Ben-Noun LL, Laor A. Relationship of neck circumference to cardiovascular risk factors. Obes Res 2003;11:226–31.10.1038/oby.2003.35Search in Google Scholar PubMed

33. Goran MI, Gower BA, Treuth M, Nagy TR. Prediction of intra-abdominal and subcutaneous abdominal adipose tissue in healthy pre-pubertal children. Int J Obesity 1998;22:549–58.10.1038/sj.ijo.0800624Search in Google Scholar PubMed

34. De Ridder CM, De Boer RW, Seidell JC, Nieuwenhoff CM, Jeneson JA, et al. Body fat distribution in pubertal girls quantified by magnetic resonance imaging. Int J Obes Relat Metab Disord 1992;16:443–9.Search in Google Scholar

35. Fox K, Peters D, Armstrong N, Sharpe P, Bell M. Abdominal fat deposition in 11-year-old children. Int J Obes Relat Metab Disord 1993;17:11–6.Search in Google Scholar

36. Hatipoglu N, Mazicioglu MM, Kurtoglu S, Kendirci M. Neck circumference: an additional tool of screening overweight and obesity in childhood. Eur J Pediatr 2010;169:733–9.10.1007/s00431-009-1104-zSearch in Google Scholar PubMed

37. Kavak V, Pilmane M, Kazoka D. Body mass index, waist circumference and waist-to-hip-ratio in the prediction of obesity in Turkish teenagers. Coll Antropol 2014;38:445–51.Search in Google Scholar

38. Ribeiro EA, Leal DB, Assis MA. Diagnostic accuracy of anthropometric indices in predicting excess body fat among seven to ten-year-old children. Rev Bras de Epidemiol 2014;17:243–54.10.1590/1415-790X201400010019ENGSearch in Google Scholar PubMed

39. de Pádua Cintra I, Passos MA, Dos Santos LC, da Costa Machado H, Fisberg M. Waist-to-height ratio percentiles and cutoffs for obesity: a cross-sectional study in Brazilian adolescents. J Health Popul Nutr 2014;32:411–9.Search in Google Scholar

40. Wang J, Thornton JC, Bari S, Williamson B, Gallagher D, et al. Comparisons of waist circumferences measured at 4 sites. Am J Clin Nutr 2003;77:379–84.10.1093/ajcn/77.2.379Search in Google Scholar PubMed

41. LaBerge RC, Vaccani JP, Gow RM, Gaboury I, Hoey L, et al. Inter-and intra-rater reliability of neck circumference measurements in children. Pediatr Pulmonol 2009;44:64–9.10.1002/ppul.20944Search in Google Scholar PubMed

42. Kondolot M, Horoz D, Poyrazoğlu S, Borlu A, Öztürk A, et al. Neck circumference to assess obesity in preschool children. J Clin Res Pediatr Endocrinol 2017;9:17.10.4274/jcrpe.3525Search in Google Scholar PubMed PubMed Central

43. Kroll C, Mastroeni SS, Czarnobay SA, Ekwaru JP, Veugelers PJ, et al. The accuracy of neck circumference for assessing overweight and obesity: a systematic review and meta-analysis. Ann Human Biol 2017;44:667–77.10.1080/03014460.2017.1390153Search in Google Scholar PubMed

44. Araki S, Dobashi K, Kubo K, Kawagoe R, Yamamoto Y, et al. Prevalence of obesity disease and metabolic syndrome in obese pediatric outpatients at the University Hospital of Occupational and Environmental Health, Japan. J UOEH 2008;30:309–19.10.7888/juoeh.30.309Search in Google Scholar PubMed

45. Browning LM, Hsieh SD, Ashwell M. A systematic review of waist-to-height ratio as a screening tool for the prediction of cardiovascular disease and diabetes: 0·50 could be a suitable global boundary value. Nutr Res Rev 2010;23:247–69.10.1017/S0954422410000144Search in Google Scholar PubMed

46. Panjikkaran ST, Kumari KS. Augmenting BMI and waist-height ratio for establishing more efficient obesity percentiles among school-going children. Indian J Comm Med 2009;34:135–9.10.4103/0970-0218.51233Search in Google Scholar PubMed PubMed Central

47. Marrodán MD, Martínez-Álvarez JR, González-Montero MD, Lopez-Ejeda N, Cabañas MD, et al. Diagnostic accuracy of waist to height ratio in screening of overweight and infant obesity. Med Clin (Barc) 2013;140:296–301.10.1016/j.medcli.2012.01.032Search in Google Scholar PubMed

48. Fujita Y, Kouda K, Nakamura H, Iki M. Cut-off values of body mass index, waist circumference, and waist-to-height ratio to identify excess abdominal fat: population-based screening of Japanese schoolchildren. J Epidemiol 2011;21: 191–6.10.2188/jea.JE20100116Search in Google Scholar PubMed PubMed Central

Received: 2018-04-28
Accepted: 2018-07-30
Published Online: 2018-09-05
Published in Print: 2018-09-25

©2018 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Original Articles
  3. Intracranial pathologies associated with central diabetes insipidus in infants
  4. Omentin-1 and NAMPT serum concentrations are higher and CK-18 levels are lower in children and adolescents with type 1 diabetes when compared to healthy age, sex and BMI matched controls
  5. Evaluation of anthropometric parameters of central obesity in Pakistani children aged 5–12 years, using receiver operating characteristic (ROC) analysis
  6. A lower energetic, protein and uncooked cornstarch intake is associated with a more severe outcome in glycogen storage disease type III: an observational study of 50 patients
  7. Untreated congenital hypothyroidism due to loss to follow-up: developing preventive strategies through quality improvement
  8. The effect of 17 years of increased salt iodization on the prevalence and nature of goiter in Croatian schoolchildren
  9. Is there an association between thyrotropin levels within the normal range and birth growth parameters in full-term newborns?
  10. Etiology of short stature in Indian children and an assessment of the growth hormone-insulin-like growth factor axis in children with idiopathic short stature
  11. Growth of patients with congenital adrenal hyperplasia due to 21-hydroxylase in infancy, glucocorticoid requirement and the role of mineralocorticoid therapy
  12. A personal series of 100 children operated for Cushing’s disease (CD): optimizing minimally invasive diagnosis and transnasal surgery to achieve nearly 100% remission including reoperations
  13. 12-Week aerobic exercise and nutritional program minimized the presence of the 64Arg allele on insulin resistance
  14. Letter to the Editor
  15. Successful treatment of life-threatening severe metabolic acidosis by continuous veno-venous hemodialysis in a child with diabetic ketoacidosis
  16. Case Reports
  17. Two siblings with metachromatic leukodystrophy caused by a novel identified homozygous mutation in the ARSA gene
  18. To diet or not to diet in neonatal diabetes responding to sulfonylurea treatment
  19. Van Wyk-Grumbach syndrome with hemangioma in an infant
  20. Maternal iodine excess: an uncommon cause of acquired neonatal hypothyroidism
https://doi.org/10.1515/jpem-2018-0193
Keywords for this article
anthropometric parameters; central obesity; neck circumference; ROC curve; waist-to-height ratio

Articles in the same Issue

  1. Frontmatter
  2. Original Articles
  3. Intracranial pathologies associated with central diabetes insipidus in infants
  4. Omentin-1 and NAMPT serum concentrations are higher and CK-18 levels are lower in children and adolescents with type 1 diabetes when compared to healthy age, sex and BMI matched controls
  5. Evaluation of anthropometric parameters of central obesity in Pakistani children aged 5–12 years, using receiver operating characteristic (ROC) analysis
  6. A lower energetic, protein and uncooked cornstarch intake is associated with a more severe outcome in glycogen storage disease type III: an observational study of 50 patients
  7. Untreated congenital hypothyroidism due to loss to follow-up: developing preventive strategies through quality improvement
  8. The effect of 17 years of increased salt iodization on the prevalence and nature of goiter in Croatian schoolchildren
  9. Is there an association between thyrotropin levels within the normal range and birth growth parameters in full-term newborns?
  10. Etiology of short stature in Indian children and an assessment of the growth hormone-insulin-like growth factor axis in children with idiopathic short stature
  11. Growth of patients with congenital adrenal hyperplasia due to 21-hydroxylase in infancy, glucocorticoid requirement and the role of mineralocorticoid therapy
  12. A personal series of 100 children operated for Cushing’s disease (CD): optimizing minimally invasive diagnosis and transnasal surgery to achieve nearly 100% remission including reoperations
  13. 12-Week aerobic exercise and nutritional program minimized the presence of the 64Arg allele on insulin resistance
  14. Letter to the Editor
  15. Successful treatment of life-threatening severe metabolic acidosis by continuous veno-venous hemodialysis in a child with diabetic ketoacidosis
  16. Case Reports
  17. Two siblings with metachromatic leukodystrophy caused by a novel identified homozygous mutation in the ARSA gene
  18. To diet or not to diet in neonatal diabetes responding to sulfonylurea treatment
  19. Van Wyk-Grumbach syndrome with hemangioma in an infant
  20. Maternal iodine excess: an uncommon cause of acquired neonatal hypothyroidism
Sign up now to receive a 20% welcome discount
Institutional Access
How does access work?
Have an idea on how to improve our website?
Please write us.
© 2025 De Gruyter Brill
Downloaded on 18.9.2025 from https://www.degruyterbrill.com/document/doi/10.1515/jpem-2018-0193/html
Scroll to top button