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Updated: Feb 4, 2026

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Published on: June 21, 2018
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A Multistate Model for Analyzing Transitions Between Body Mass Index Categories During Childhood: The Generation XXI
American Journal of Epidemiology
|October 13, 2018
Summary
Childhood overweight and obesity are rising public health concerns. A Markov model analysis of 4,887 children aged 4-10 years found that normal-weight children are more likely to gain weight, while sex and maternal education influence progressive transitions.
Area of Science:
- Pediatrics
- Public Health
- Biostatistics
Background:
- Childhood overweight and obesity prevalence has increased significantly in developed nations.
- These conditions pose immediate and long-term health risks, escalating public health concerns.
- Understanding BMI category transitions is crucial for early intervention strategies.
Purpose of the Study:
- To analyze body mass index (BMI) category transition rates in children aged 4-10 years.
- To investigate the influence of explanatory variables on these BMI transitions.
- To identify factors associated with progressive weight gain in childhood.
Main Methods:
- Utilized a 4-state Markov model based on BMI z-score categories: underweight, normal weight, overweight, and obese.
- Analyzed data from 4,887 children in the Generation XXI Birth Cohort Study (Portugal, 2005-2017).
- Evaluated anthropometric data at ages 4, 7, and 10 years, with follow-up in at least one wave.
Main Results:
- Normal-weight children showed a higher probability of transitioning to higher BMI categories compared to lower ones.
- Overweight children exhibited similar transition rates to adjacent BMI categories (normal or obese).
- Statistically significant associations were found between progressive transitions and child's sex and maternal education level.
Conclusions:
- Childhood BMI trajectories indicate a tendency for normal-weight children to progress towards higher weight categories.
- Maternal education and child's sex are significant predictors of weight gain progression.
- These findings highlight the need for targeted public health interventions focusing on early childhood weight management.
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