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i‐PATHWAY : Development and validation of a prediction model for childhood obesity in an Australian prospective birth cohort
Author(s) -
Canfell Oliver J,
Littlewood Robyn,
Wright Olivia R L,
Walker Jacqueline L
Publication year - 2021
Publication title -
journal of paediatrics and child health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.631
H-Index - 76
eISSN - 1440-1754
pISSN - 1034-4810
DOI - 10.1111/jpc.15436
Subject(s) - medicine , prospective cohort study , overweight , body mass index , logistic regression , cohort , pediatrics , anthropometry , childhood obesity , clinical prediction rule , cohort study , obesity , demography , sociology
Aim To develop and validate a model (i‐PATHWAY) to predict childhood (age 8–9 years) overweight/obesity from infancy (age 12 months) using an Australian prospective birth cohort. Methods The Transparent Reporting of a multivariable Prediction model for individual Prognosis or Diagnosis (TRIPOD) checklist was followed. Participants were n = 1947 children (aged 8–9 years) from the Raine Study Gen2 – an Australian prospective birth cohort – who had complete anthropometric measurement data available at follow up. The primary outcome was childhood overweight or obesity (age 8–9 years), defined by age‐ and gender‐specific cut‐offs. Multiple imputation was performed to handle missing data. Predictors were selected using 2000 unique backward stepwise logistic regression models. Predictive performance was assessed via: calibration, discrimination and decision‐threshold analysis. Internal validation of i‐PATHWAY was conducted using bootstrapping (1000 repetitions) to adjust for optimism and improve reliability. A clinical model was developed to support relevance to practice. Results At age 8–9 years, 18.9% ( n = 367) of children were classified with overweight or obesity. i‐PATHWAY predictors included: weight change (0–1 year); maternal pre‐pregnancy body mass index (BMI); paternal BMI; maternal smoking during pregnancy; premature birth; infant sleep patterns; and sex. After validation, predictive accuracy was acceptable: calibration slope = 0.956 (0.952–0.960), intercept = −0.052 (−0.063, −0.048), area under the curve = 0.737 (0.736–0.738), optimised sensitivity = 0.703(0.568–0.790), optimised specificity = 0.646 (0.571–0.986). The clinical model retained acceptable predictive accuracy without paternal BMI. Conclusions i‐PATHWAY is a simple, valid and clinically relevant prediction model for childhood overweight/obesity. After further validation, this model can influence state and national health policy for overweight/obesity screening in the early years.