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Open Access Highly Accessed Research article

Alternative regression models to assess increase in childhood BMI

Andreas Beyerlein1*, Ludwig Fahrmeir2, Ulrich Mansmann23 and André M Toschke14

Author Affiliations

1 Ludwig-Maximilians University of Munich, Division of Pediatric Epidemiology, Institute of Social Pediatrics and Adolescent Medicine, Munich, Germany

2 Ludwig-Maximilians University of Munich, Department of Statistics, Munich, Germany

3 Ludwig-Maximilians University of Munich, Department of Medical Informatics, Biometry and Epidemiology (IBE), Munich, Germany

4 King's College London, Division of Health and Social Care Research, Department of Public Health Sciences, London, UK

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BMC Medical Research Methodology 2008, 8:59  doi:10.1186/1471-2288-8-59

Published: 8 September 2008

Abstract

Background

Body mass index (BMI) data usually have skewed distributions, for which common statistical modeling approaches such as simple linear or logistic regression have limitations.

Methods

Different regression approaches to predict childhood BMI by goodness-of-fit measures and means of interpretation were compared including generalized linear models (GLMs), quantile regression and Generalized Additive Models for Location, Scale and Shape (GAMLSS). We analyzed data of 4967 children participating in the school entry health examination in Bavaria, Germany, from 2001 to 2002. TV watching, meal frequency, breastfeeding, smoking in pregnancy, maternal obesity, parental social class and weight gain in the first 2 years of life were considered as risk factors for obesity.

Results

GAMLSS showed a much better fit regarding the estimation of risk factors effects on transformed and untransformed BMI data than common GLMs with respect to the generalized Akaike information criterion. In comparison with GAMLSS, quantile regression allowed for additional interpretation of prespecified distribution quantiles, such as quantiles referring to overweight or obesity. The variables TV watching, maternal BMI and weight gain in the first 2 years were directly, and meal frequency was inversely significantly associated with body composition in any model type examined. In contrast, smoking in pregnancy was not directly, and breastfeeding and parental social class were not inversely significantly associated with body composition in GLM models, but in GAMLSS and partly in quantile regression models. Risk factor specific BMI percentile curves could be estimated from GAMLSS and quantile regression models.

Conclusion

GAMLSS and quantile regression seem to be more appropriate than common GLMs for risk factor modeling of BMI data.