Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
Digital Health Cooperative Research Centre, Australian Government, Sydney, New South Wales, Australia.
J Paediatr Child Health. 2021 Aug;57(8):1250-1258. doi: 10.1111/jpc.15436. Epub 2021 Mar 13.
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.
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.
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.
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.
利用澳大利亚前瞻性出生队列，开发并验证一种模型（i-PATHWAY），用于预测儿童期（8-9 岁）超重/肥胖，预测指标为婴儿期（12 个月）数据。
遵循透明报告多变量预测模型个体预后或诊断（TRIPOD）清单。参与者为 1947 名儿童（8-9 岁），来自 Raine 研究 Gen2-澳大利亚前瞻性出生队列，在随访时具有完整的人体测量数据。主要结局为儿童超重或肥胖（8-9 岁），定义为年龄和性别特异性切点。使用 2000 个独特的向后逐步逻辑回归模型进行多重插补以处理缺失数据。使用预测性能通过校准、区分和决策阈值分析进行评估。通过 1000 次重复的自举法对内嵌 i-PATHWAY 进行验证，以调整乐观程度并提高可靠性。开发了一个临床模型以支持与实践相关。
在 8-9 岁时，18.9%（n=367）的儿童超重或肥胖。i-PATHWAY 的预测因素包括：体重变化（0-1 岁）；母亲怀孕前的 BMI；父亲的 BMI；母亲怀孕期间吸烟；早产；婴儿睡眠模式；和性别。验证后，预测准确性可接受：校准斜率=0.956（0.952-0.960），截距=-0.052（-0.063，-0.048），曲线下面积=0.737（0.736-0.738），最佳灵敏度=0.703（0.568-0.790），最佳特异性=0.646（0.571-0.986）。临床模型保留了可接受的预测准确性，而无需父亲的 BMI。
i-PATHWAY 是一种简单、有效且具有临床相关性的儿童超重/肥胖预测模型。进一步验证后，该模型可影响国家和州的超重/肥胖早期筛查政策。
