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Potential selection effects when estimating associations between the infancy peak or adiposity rebound and later body mass index in children

International Journal of Obesity volume 41, pages 518–526 (2017)Cite this article

Subjects

Abstract

Introduction:

This study aims to evaluate a potential selection effect caused by exclusion of children with non-identifiable infancy peak (IP) and adiposity rebound (AR) when estimating associations between age and body mass index (BMI) at IP and AR and later weight status.

Subjects and methods:

In 4744 children with at least 4 repeated measurements of height and weight in the age interval from 0 to 8 years (37 998 measurements) participating in the IDEFICS (Identification and Prevention of Dietary- and Lifestyle-Induced Health Effects in Children and Infants)/I.Family cohort study, fractional polynomial multilevel models were used to derive individual BMI trajectories. Based on these trajectories, age and BMI at IP and AR, BMI values and growth velocities at selected ages as well as the area under the BMI curve were estimated. The BMI growth measures were standardized and related to later BMI z-scores (mean age at outcome assessment: 9.2 years).

Results:

Age and BMI at IP and AR were not identifiable in 5.4% and 7.8% of the children, respectively. These groups of children showed a significantly higher BMI growth during infancy and childhood. In the remaining sample, BMI at IP correlated almost perfectly (r⩾0.99) with BMI at ages 0.5, 1 and 1.5 years, whereas BMI at AR correlated perfectly with BMI at ages 4–6 years (r⩾0.98). In the total study group, BMI values in infancy and childhood were positively associated with later BMI z-scores where associations increased with age. Associations between BMI velocities and later BMI z-scores were largest at ages 5 and 6 years. Results differed for children with non-identifiable IP and AR, demonstrating a selection effect.

Conclusions:

IP and AR may not be estimable in children with higher-than-average BMI growth. Excluding these children from analyses may result in a selection bias that distorts effect estimates. BMI values at ages 1 and 5 years might be more appropriate to use as predictors for later weight status instead.

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Acknowledgements

This work was carried out as part of the IDEFICS study (http://www.idefics.eu) and the I.Family Study (http://www.ifamilystudy.eu/). We thank the financial support of the European Community within the Sixth RTD Framework Programme Contract No. 016181 (FOOD) for the IDEFICS study and within the Seventh RTD Framework Programme Contract No. 266044 for the I. Family study.

Author contributions

Each author has seen and approved the contents of the submitted manuscript. All authors contributed to conception and design, acquisition of data, analysis or interpretation of data. Final approval of the version published was given by all the authors. All the authors revised the article critically for important intellectual content.

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Authors and Affiliations

  1. Biometry and Data Management, Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany

    C Börnhorst, W Ahrens & I Pigeot

  2. Unit of Epidemiology and Population Genetics, Institute of Food Sciences, National Research Council, Avellino, Italy

    A Siani

  3. Research and Education Institute of Child Health, Strovolos, Cyprus

    M Tornaritis

  4. Department of Pediatrics, University of Pécs, Pécs, Hungary

    D Molnár

  5. Section for Epidemiology and Social Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    L Lissner

  6. School of Health and Welfare, Halmstad University, Halmstad, Sweden

    S Regber

  7. Department of Intercultural Communication and Management, Copenhagen Business School, Frederiksberg, Denmark

    L Reisch

  8. Department of Public Health, Ghent University, Ghent, Belgium

    A De Decker

  9. GENUD (Growth, Exercise, Nutrition and Development) Research Group, Faculty of Health Sciences, Universidad de Zaragoza, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria Aragón (IIS Aragón), Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Zaragoza, Spain

    L A Moreno

  10. Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany

    W Ahrens & I Pigeot

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on behalf of the IDEFICS and I Family consortia

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Correspondence to C Börnhorst.

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Börnhorst, C., Siani, A., Tornaritis, M. et al. Potential selection effects when estimating associations between the infancy peak or adiposity rebound and later body mass index in children. Int J Obes 41, 518–526 (2017). https://doi.org/10.1038/ijo.2016.218

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