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June 26, 2026BMC PediatricsOpen Access

Nonlinear association between body mass index and physical fitness in primary school children: a single-school cross-sectional study using generalized additive models

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Authors

JZJunhui ZhuMZMingling ZhaoMZMeiling Zheng

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Overview

Single-school analysis reveals a nonlinear link between BMI and fitness measures, suggesting the need for multischool investigations.

Key Points

  • This study aims to explore the non-linear relationship between body mass index (BMI) and physical fitness in primary school children.
  • Analyzed records from 1,572 students (Grades 1-6) at a single school in Sichuan, China.
  • Used quadratic regression and generalized additive models to assess the association of BMI with four fitness indicators.
  • Applied cluster-robust standard errors to adjust for class-level clustering.
  • Confirmed a statistically significant nonlinear association of BMI with the 50-m sprint (EDF = 4.4, P < 0.001) and 1-min rope skipping (EDF = 5.1, P < 0.001).
  • Identified an optimal predicted performance for the 50-m sprint at about 16.2 kg/m²; composite index lacked a stable optimum across BMI.
  • Exploratory subgroup analyses showed persistent nonlinearity in girls and certain grades, but not in boys.

Cite This Study

Zhu et al. (2026) studied this question.

synapsesocial.com/papers/6a3e16cd030ad1a9b30907adhttps://doi.org/10.1186/s12887-026-07226-2
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