Home Ahead of print Instructions
About us Current issue Subscribe
Editorial board Archives Contact us
Search Submit article Login 
Print this page Email this page

 Table of Contents  
Year : 2013  |  Volume : 10  |  Issue : 2  |  Page : 82-85

Neck circumference: An upcoming tool of adiposity indices

1 Department of Anatomy, Faculty of Medicine, Bayero University, Kano, Nigeria
2 Department of Anatomy, Faculty of Basic Medical Sciences, University of Ilorin, Ilorin, Kwara, Nigeria

Date of Web Publication7-Dec-2013

Correspondence Address:
Lawan Hassan Adamu
Department of Anatomy, Faculty of Medicine, Bayero University, Kano, P M B-3011 Kano
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0331-8540.122766

Rights and Permissions

Context: Obesity is one of the most significant contributors to ill health competing with under-nutrition and infectious diseases. Aims: The aims of the study were to determine the presence and level of sexual dimorphism in adiposity indices, correlation of neck circumference (NC) and body mass index (BMI) with other adiposity indices such as waist circumference (WC), waist-hip ratio (WHR) and waist-height ratio (WHtR) and also to encourage the uses of neck circumferences as valuable tool in assessing upper body central adiposity index. Settings and Design: The study population included 71 undergraduate participants (41 Males and 30 Females) with mean age of 22.68 ΁ 4.23 years. Subjects and Methods: Anthropometric measurements of height, weight, NC, WC and HC were obtained following standard protocols. Statistical Analysis Used: Independent t-test and Pearson's correlation were employed to compare and find the relationship between the variables, using SPSS version 17. Significance level was considered at P ≤ 0.05. Results: The result shows that there was statistically significant (P < 0.05) sexual dimorphism in mean WC, WHR and NC between the sexes. BMI showed strongest correlation with WHtR (r = 0.8, P < 0.001) followed by HC (r = 0.7, P < 0.001), WC (r = 0.7, P < 0.001). On the other hand the NC shows a significant correlation (P < 0.05) with all the variables. Conclusions: Despite the low level of correlation of NC with other adiposity indices compared to the BMI, the NC may serve as an important tool for the assessment of upper body adiposity.

Keywords: Adiposity indices, anthropometry, neck circumferences, Nigeria, obesity

How to cite this article:
Adamu LH, Asuku AY, Taura MG, Tela IA, Datti S, Imam A. Neck circumference: An upcoming tool of adiposity indices. Niger J Basic Clin Sci 2013;10:82-5

How to cite this URL:
Adamu LH, Asuku AY, Taura MG, Tela IA, Datti S, Imam A. Neck circumference: An upcoming tool of adiposity indices. Niger J Basic Clin Sci [serial online] 2013 [cited 2023 Jun 10];10:82-5. Available from: https://www.njbcs.net/text.asp?2013/10/2/82/122766

  Introduction Top

Obesity is characterised by increased adipose tissue mass which results both from increased fat-cell number (hyperplasia) and increased fat-cell size. [1] Obesity is now very common in the world's population, and is competing with under-nutrition and infectious diseases as one of the major significant contributor to ill health. [2] Many studies have confirmed association between body mass index (BMI), waist circumference (WC), body fat mass, [3] abdominal fat content, [4] neck circumferences (NC), [5],[6],[7],[8],[9] and other obesity markers.

However, when considered the non-invasive and inexpensive nature of NC measurement, it applications will be of paramount importance in a given population. Furthermore, there is a paucity of literature on the adiposity indices of Africans, particularly in the Northern part of Nigeria. Based on this, the present study aims to determine among the students of Bayero University Kano, Nigeria (1). The level of sexual dimorphism in NC, BMI, WC, waist-hip ratio (WHR), hip circumference (HC) and waist to height ratio (WHtR), (2). How NC and BMI correlate with other adiposity indices such as WC, WHR and WHtR, (3). The level of correlation between BMI and NC, (4). The possibility of introducing NC as a useful tool in assessing upper body central adiposity index.

  Subjects and Methods Top

The participants were randomly selected using simple random technique from the Medical students of Hausa ethnic group. The population included 71 participants (41 Males and 30 Females) who were apparently healthy with no congenital malformation or history of surgical operation on the neck or trunk. Prior to the commencement of the study, informed consent was obtained from the participants and all the procedures were explained to them.

The waist, hip and neck circumferences were measured using inelastic tape (Butterfly model - made in China), graduated in cm (0-150). The waist circumference was measured midway between the lowest rib and the iliac crest, with the participant in the upright position. [10] Hip circumference was measured at the level of the greater trochanter, with the participant standing erect and the medial borders of the feet in contact. [11] The neck circumference (cm) was measured in a horizontal plane with subject in standing position, at the level of inferior border of the thyroid cartilage and perpendicular to the vertical axis of the neck in anatomical position. While taking this reading the subject was asked to look straight ahead, with shoulders down, but not hunched. [12] For height and weight measurement, a vertical wooden bar calibrated in centimeters (0-200 cm) with a movable horizontal bar which could be adjusted to touch the vertex of the participant's head was used to measure the height of the participants. A portable bathroom weighing scale (Camry, BR9015A, Zhongshan, China) was used to measure body weight to the nearest kilogram. The participants' weights and heights were used to calculate the BMI as kilograms per meter square (kg/m 2 ), WC was then divided by HC and height to obtain WHR and WHtR respectively. The mean and standard deviations were calculated for all variables, while independent t-test was used to compare values obtained for the male and female participants. Pearson's correlation was used to find the relationship of WC, HC, WHR, and WHtR to BMI and NC. Significance level was considered at P ≤ 0.05. SPSS version 17 was used for the statistical analyses.

  Results Top

The age range of the study population was 16-39 years, with a mean age of 22.68 ± 4.23 years.

In [Table 1], there was no significant sexual dimorphism between genders for BMI and WHtR. However, the mean Weight, Height, WC, WHR and NC shows statistically significantly differences, with higher value (P < 0.05, P < 0.001) in males (62.59 ± 9.10 cm, 173.70 ± 5.88 cm, 75.08 ± 8.82 cm, 0.84 ± 0.07 cm and 35.15 ± 1.78 cm) than females (56.42 ± 8.16 cm, 161.17 ± 6.00 cm, 70.69 ± 8.50 cm, 0.74 ± 0.05 cm and 31.53 ± 2.41cm), respectively. But for HC, females had higher value (94.90 ± 8.22 cm) then males (89.65 ± 8.47 cm).
Table 1: t test showing difference in mean statistic between male and female for the measured variables

Click here to view

[Table 2] shows Pearson's correlation coefficients of WC, HC, WHR, and WHtR with BMI and NC. BMI showed the strongest significant (r = 0.815; P < 0.001) correlation with WHtR, followed by HC and WC. BMI has no significant correlation with WHR. On the other hand the NC shows a significant correlation with all the variables with HC and WHR showing strongest correlation (r = 0.642, P < 0.001; r = 0.555, P < 0.001 respectively) and WC and WHtR showing weakest correlation (r = 0.242, P < 0.05; r = 0.434, P < 0.05 respectively).
Table 2: Pearson's correlation coefficients of WC, HC, WHR, and WHtR with BMI and NC

Click here to view

The linear relationship between NC and BMI was shown in [Figure 1] with r = 0.36 P = 0.002.
Figure 1: Scatter plot showing correlation of neck circumference (NC; cm) with body mass index (BMI; kilograms per meter square) in the study population

Click here to view

  Discussion Top

Body mass index has been identified by most health professionals as the most useful epidemiological measure of obesity. [13] In the assessment of obesity, the central distribution of body fat cannot be overlooked, hence, the use of other anthropometric indices such as WC, WHR, [14] and WHtR [15],[16],[17],[18] as measures of adiposity. Another anthropometric index of interest is NC, which has recently been used to identify overweight and obesity and is observed to have good correlation with age, weight, WC, HC, WHR, and BMI for both sexes. [19] Furthermore, NC is also considered as an index of upper body obesity and correlates positively with changes in systolic and diastolic blood pressure and other components of the metabolic syndrome. [20]

The present study used the BMI, WC, HC, WC, WHR, WHtR and NC as anthropometric measurements of adiposity. The general characteristic of the population shows that the mean values of these variables fall within the expected value for healthy population as seen in other studies. [9],[21] In the present study males showed significantly higher values in height, body weight, WC, WHR and NC when compared to females. This is in agreement with previous studies. [9],[22],[23],[24] Among Turkish children, Mazicioglu et al.,[24] also found the percentiles and mean values for NC to be greater in boys as compared to girls, both before and after puberty. For the females only HC shows statistically significant differences. This also agreed with previous works, [22],[23],[24],[25] with the exception of BMI [22],[23] which show significant higher value in male. Although the difference is not statistically significant, but the reverse trend seen in this study may be linked to different life style in females which vary from one population to another.

The comparative correlation between NC and BMI with other adiposity indices, show that BMI strongly associate with WC, HC and WHtR with no significant correlation with WHR, whereas the NC strongly correlated with HC and WHR and weakly with WHtR and WC in the study population. This indicates that the BMI is still stronger then the NC but one advantage of NC over BMI is its stronger correlation with WHR. This implies that NC may serve as a measure to determine overweight and obesity with level of accuracy of 91-95% for men and 97-98% for female. [19] Moreover, WHR and WC have also been shown to have significant role in identification of obese and overweight individuals. [26] In another study [27],[28] BMI and WC have been identified as diagnostic for fatness. The NC and BMI also show a significant correlation in the present study. This agrees with previous studies which observed the relationship of NC with conventional anthropometric parameters of obesity [5],[7],[9] including BMI. Similarly Yang et al., [6] found relationships between NC and BMI, WC, and metabolic syndrome among Chinese population. As it is always more desirable to have the simplest and inexpensive measure for use in the field situation and for emergency clinical diagnosis, the NC in this study proves to be one of such non-invasive and inexpensive methods that may become useful tools for adiposity indices in Nigeria.

  Conclusions Top

This study showed a significant linear trend between BMI and NC. The two variables also show statistically significant relationship with all the adiposity indices considered in the study except for WHR which does not correlate well with BMI. Hence, despite the low level of correlation of NC with other adiposity indices considered in the study compared to the BMI, the NC may serve as an important upper body adiposity index among the students population which participated in this study.

  References Top

1.Camp HS, Ren D, Leff T. Adipogenesis and fat-cell function in obesity and diabetes. Trends Mol Med 2002;8:442-7.  Back to cited text no. 1
2.Al-Nozha MM, Al-Mazrou YY, Al-Maatouq MA, Arafah MR, Khalil MZ, Khan NB, et al. Obesity in Saudi Arabia. Saudi Med J 2005;26:824-9.  Back to cited text no. 2
3.Kopelman PG. Obesity as a medical problem. Nature 2000;404:635-43.  Back to cited text no. 3
4.Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: Executive summary. Expert Panel on the Identification, Evaluation, and Treatment of Overweight in Adults. Am J Clin Nutr 1998;68:899-917.  Back to cited text no. 4
5.Onat A, Hergenc G, Yuksel 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;28:46-51.  Back to cited text no. 5
6.Yang GR, Yuan SY, Fu HJ, Wan G, Zhu LX, Bu XL, et al. Beijing Community Diabetes Study Group. 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.  Back to cited text no. 6
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;169:733-9.  Back to cited text no. 7
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:e306-10.  Back to cited text no. 8
9.Hingorjo MR, Qureshi MA, Mehdi A. Neck circumference as a useful marker of obesity: A comparison with body mass index and waist circumference. J Pak Med Assoc 2012;62:36-40.  Back to cited text no. 9
10.World Health Organization. Obesity: Preventing and managing the global epidemic. Report of a WHO consultation on obesity; 1998 (WHO Technical Report Series 894).  Back to cited text no. 10
11.McArdle WD, Katch FI, Katch VL. Training the anaerobic energy systems. Essentials of exercise physiology. 2 nd ed. Philadelphia: Lippincott Williams and Wilkins; 2000.  Back to cited text no. 11
12.World Health Organization. Measuring Obesity: Classification and Distribution of Anthropometric Data. Copenhagen: World Health Organization; 1989.  Back to cited text no. 12
13.World Health Organization. (2000). Obesity: Preventing and managing the global epidemic. Geneva (WHO Technical Report Series, N0 894). Available from: http://whqlibdoc.who.int/trs/WHO. [Last accessed date on 2013 Mar 24].  Back to cited text no. 13
14.Welborn TA, Dhaliwal SS, Bennet SA. Waist-hip ratio is the dominant risk factor predicting cardiovascular death in Australia. Med J Aust 2003;179:580-5.  Back to cited text no. 14
15.Ashwell M, Hsieh SD. Six reasons why the waist-to-height ratio is a rapid and effective global indicator for health risks of obesity and how its use could simplify the international public health message on obesity. Int J Food Sci Nutr 2005;56:303-7.  Back to cited text no. 15
16.Molarius A, Seidell JC, Sans S, Tuomilehto J, Kuulasmaa K. Waist and hip circumferences and waist-hip ratio in 19 populations of WHO MONIKA Project. Int J Obes Relat Metab Disord 1999;23:116-25.  Back to cited text no. 16
17.Wang TD, Goto S, Bhatt DL, Steg PG, Chan JC, Richard AJ, et al. REACH Registry Investigators: Ethnic differences in the relationships of anthropometric measures to metabolic risk factors in Asian patients at risk of atherothrombosis: Results from the REduction of Atherothrombosis for Continued Health (REACH) Registry. Metabolism 2010;59:400-8.  Back to cited text no. 17
18.Taylor RW, Jones IE, Williams SM, Goulding A. Evaluation of waist circumference, waist-to-hip ratio and the Conicity index as screening tools for high trunk fat mass, as measured by dual energy X-Ray absorptiometry, in children aged 3-19 years. Am J Clin Nutr 2000;72:490-5.  Back to cited text no. 18
19.Ben-Noun L, Sohar E, Loar A. Neck circumference as a simple screening measure for identifying overweight and obese patients. Obes Res 2001;9:470-7.  Back to cited text no. 19
20.Ben-Noun LL, Laor A. Relationship between changes in neck circumference and changes in blood pressure. Am J Hypertens 2004;17:409-14.  Back to cited text no. 20
21.Chakraborty R, Bose K. Central adiposity, body mass index and percent body fat among bengalee hindu male slum dwellers of dum dum, West Bengal, India. Open Obes J 2009;1:32-7.  Back to cited text no. 21
22.Sanya AO, Ogwumike OO, Ige AP, Ayanniyi OA. Relationship of waist-hip ratio and body mass index to blood pressure of individuals in Ibadan North Local Government. AJPARS 2009;1:7-11.  Back to cited text no. 22
23.Brenner DR, Tepylo K, Eny KM, Cahill LE, El-Sohemy A. Comparison of body mass index and waist circumference as predictors of cardiometabolic health in a population of young Canadian adults. Diabetol Metab Syndr 2010;2:28.  Back to cited text no. 23
24.Mazicioglu MM, Kurtoglu S, Ozturk A, Hatipoglu N, Cicek B, Ustunbas HB. Percentiles and mean values for neck circumference in Turkish children aged 6-18 years. Acta Paediatr 2010;99:1847-53.  Back to cited text no. 24
25.Liu Y, Tong G, Tong W, Lu L, Qin X. Can body mass index, waist circumference, waist-hip ratio and waist-height ratio predict the presence of multiple metabolic risk factors in Chinese subjects? BMC Public Health 2011;11:35.  Back to cited text no. 25
26.Gill T, Chittlebourough C, Taylor A, Ruffin R, Wilson D, Phillips P. Body mass index, waist hip ratio and waist circumference: Which measure to classify obesity? Soz Preventivmed 2003;48:191-200.  Back to cited text no. 26
27.Neovious M, Linne Y, Rossner S. BMI, waist circumference and waist-hip ratio as diagnostic tests for fatness in adolescents. Int J Obes (Lond) 2005;29:163-9.  Back to cited text no. 27
28.Bose K. Which measure of abdominal adiposity best relates with body mass index among older Bengalee Hindus of Kolkata, India? A comparison of three measures. Int J Anthropol 2006;21:247-52.  Back to cited text no. 28


  [Figure 1]

  [Table 1], [Table 2]

This article has been cited by
1 Hip circumference correlates negatively with insulin resistance in type 2 diabetic patients
NafisaYusuf Wali,MukhtarIsyaku Gwarzo,SalisuAhmed Ibrahim
Sahel Medical Journal. 2020; 23(1): 12
[Pubmed] | [DOI]
2 Positive association of neck circumference and cardio-metabolic risk factors in Ekiti, Nigeria
Taiwo Raimi,Ayokunle Dada,Abimbola Solanke
Journal of Surgery and Medicine. 2018;
[Pubmed] | [DOI]
3 Neck circumference as a screening measure of overweight/obesity among Indian adults
Nitish Mondal,Jaydip Sen,Kaushik Bose,Ruplin Timungpi,Moniram Kathar,Sarlongki Hanse
Anthropological Review. 2016; 79(3)
[Pubmed] | [DOI]


Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  In this article
Subjects and Methods
Article Figures
Article Tables

 Article Access Statistics
    PDF Downloaded547    
    Comments [Add]    
    Cited by others 3    

Recommend this journal