Abstract
BACKGROUND: With the increasing prevalence of abdominal obesity among children and adolescents, identifying easily measurable, safe, efficient, low-cost, and highly effective indicators is crucial in public health management. While neck-to-height ratio (NHtR) is a better indicator of upper body fat than neck circumference (NC), current research on this indicator mainly assesses its role in obesity and related metabolic diseases among adults. Therefore, this study aimed to investigate the clinical significance of the (NHtR) in screening for abdominal obesity among children and adolescents. METHODS: The cross-sectional study enrolled 3,728 children and adolescents aged 7-17 years. Participants were categorized into three groups: abdominal obesity, pre-abdominal obesity, and normal. Continuous variables (NC, NHtR, WC, WHtR) were compared using analysis of variance or the Kruskal-Wallis H test. Partial correlation analysis was conducted between NHtR and WC/WHtR.ROC curve analysis assessed NHtR's accuracy in screening abdominal obesity. A subset of 970 participants underwent model validation using both internal (7:3 split) and external datasets, evaluated by receiver operating characteristic (ROC), area under the curve (AUC), and calibration curves. RESULTS: The prevalence of abdominal obesity was 22.91% among participants. Significant statistical differences were observed in NC and NHtR among the three groups. After controlling for age, partial correlation analysis revealed positive correlations between NHtR and both WC and WHtR in boys and girls. Receiver operating characteristic curve analysis revealed that the area under the curve for NHtR, in assisting with the screening of abdominal obesity, was 0.810. The optimal cutoff values of NHtR were 0.21 and 0.20 for boys and girls, respectively, with age-specific values ranging from 0.20 to 0.22. Furthermore, the NHtR model demonstrated strong predictive ability for abdominal obesity, with excellent goodness of fit. CONCLUSIONS: This study highlights NHtR as an effective indicator for screening abdominal obesity in children and adolescents, supporting early detection and intervention strategies to improve public health outcomes related to abdominal obesity.