i-PATHWAY: Development and validation of a prediction model for childhood obesity in an Australian prospective birth cohort

Oliver J. Canfell*, Robyn Littlewood, Olivia R.L. Wright, Jacqueline L. Walker

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

8 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)1250-1258
Number of pages9
JournalJournal of Paediatrics and Child Health
Issue number8
Publication statusPublished - Aug 2021


  • child
  • obesity
  • preventive medicine
  • Raine study
  • risk


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