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



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).


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 (r0.99) with BMI at ages 0.5, 1 and 1.5 years, whereas BMI at AR correlated perfectly with BMI at ages 4–6 years (r0.98). 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.


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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This work was carried out as part of the IDEFICS study ( and the I.Family Study ( 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.

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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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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).

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