Potential Selection Effects when Estimating Associations Between the Infancy Peak or Adiposity Rebound and Later Body Mass Index in Children

Claudia Börnhorst, Alfonso Siani, Michalis Tornaritis, Dénes Molnar, Lauren Lissner, Susann Regber, Lucia Reisch, Alexander Decker, Luis A. Moreno, Wolfgang Ahrens, Iris Pigeot

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    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 BMI at IP and AR and later weight status.
    Subjects and methods: In 4 744 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/I.Family cohort study, fractional polynomial multi-level 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 to 6 (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. 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 age 1 and age 5 might be more appropriate to use as predictors for later weight status instead.
    Original languageEnglish
    JournalInternational Journal of Obesity
    Issue number4
    Pages (from-to)518–526
    Number of pages9
    Publication statusPublished - Apr 2017

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