Neck Circumference as a Predictor of Malnutrition among School Age Children in Bharatpur, Nepal: A Community Based Study

Background Malnutrition, including both undernutrition and obesity, remains a major public health concern among children in developing countries such as Nepal. Conventional anthropometric measures like BMI require standardized equipment and trained personnel, limiting their feasibility in large-scale screenings. Neck circumference (NC) has emerged as a simple and practical alternative for identifying adiposity in children. This study aimed to examine the association between NC and established anthropometric indicators and to determine optimal NC cutoff values for identifying overweight among school-aged children. Methods A community-based descriptive cross-sectional study was conducted from July to October 2025 among 300 apparently healthy children aged 6–11 years in Ward No. 16, Bharatpur Metropolitan City, Nepal. Sociodemographic data were collected using structured interviews. Anthropometric measurements including height, weight, NC, waist circumference (WC), and hip circumference (HC) were obtained using standardized procedures. BMI-for-age classifications were based on WHO AnthroPlus growth references. Pearson correlation, chi-square tests, and receiver operating characteristic (ROC) curve analyses were performed using SPSS version 16. Statistical significance was set at p < 0.05. Results Among the 300 children, 48.3% had normal BMI-for-age, 41.3% were underweight, and 10.3% were overweight. NC showed significant associations with BMI-for-age, height-for-age, and weight-for-age (p < 0.001), but not with waist–hip ratio (p = 0.26). Pearson correlation analysis demonstrated strong positive correlations between NC and weight (r = 0.792), waist circumference (r = 0.797), BMI (r = 0.723), hip circumference (r = 0.734), and height (r = 0.639) (p < 0.001 for all). ROC curve analysis indicated excellent diagnostic accuracy of NC for identifying overweight. The optimal cutoff values were 27.75 cm for boys (AUC = 0.884; sensitivity = 88.9%; specificity = 66.2%) and 26.75 cm for girls (AUC = 0.904; sensitivity = 100%; specificity = 69.4%). The overall cutoff value was 27.25 cm (AUC = 0.883; sensitivity = 80.6%; specificity = 74.3%). Conclusions Neck circumference is significantly correlated with established anthropometric indicators and demonstrates high diagnostic accuracy for identifying overweight and obesity among school-aged children. NC measurement is a simple, reliable, and cost-effective screening tool that may be particularly useful in school-based and resource-limited settings.