TY - JOUR
T1 - Not so implausible
T2 - impact of longitudinal assessment of implausible anthropometric measures on obesity prevalence and weight change in children and adolescents
AU - Boone-Heinonen, Janne
AU - Tillotson, Carrie J.
AU - O'Malley, Jean P.
AU - Marino, Miguel
AU - Andrea, Sarah B.
AU - Brickman, Andrew
AU - DeVoe, Jennifer
AU - Puro, Jon
N1 - Funding Information:
This publication was funded through a Patient-Centered Outcomes Research Institute Award (1306-04716; DeVoe and Puro) for the National Patient-Centered Clinical Research Network, known as PCORnet. The statements presented in this publication are solely the responsibility of the author(s) and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors or Methodology Committee or other participants in PCORnet. ADVANCE data are accessible to outside investigators through approval by the ADVANCE Research Leadership Committee and, subsequently, research collaboration and agreement with ADVANCE investigators. The project described was also supported by the National Institute of Digestive Disorders and Nutrition K01-DK102857 (J.B.H.).
Funding Information:
This publication was funded through a Patient-Centered Outcomes Research Institute Award ( 1306-04716 ; DeVoe and Puro) for the National Patient-Centered Clinical Research Network , known as PCORnet. The statements presented in this publication are solely the responsibility of the author(s) and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors or Methodology Committee or other participants in PCORnet. ADVANCE data are accessible to outside investigators through approval by the ADVANCE Research Leadership Committee and, subsequently, research collaboration and agreement with ADVANCE investigators. The project described was also supported by the National Institute of Digestive Disorders and Nutrition K01-DK102857 (J.B.H.).
Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2019/3
Y1 - 2019/3
N2 - Purpose: Implausible anthropometric measures are typically identified using population outlier definitions, conflating implausible and extreme measures. We determined the impact of a longitudinal outlier approach on prevalence of body mass index (BMI) categories and mean change in anthropometric measures in pediatric electronic health record data. Methods: We examined 996,131 observations from 147,375 children (10–18 years) in the ADVANCE Clinical Data Research Network, a national network of community health centers. Sex-stratified, mixed effects, linear spline regression modeled weight, height, and BMI as a function of age. Longitudinal outliers were defined as observations with studentized residual greater than |6|; population outliers were defined by Centers for Disease Control-defined z-score thresholds. Results: At least 99.7% of anthropometric measures were not extreme by longitudinal or population definitions (agreement ≥ 0.995). BMI category prevalence after excluding longitudinal or population outliers differed by less than 0.1%. Among children greater than 85th percentile at baseline, annual mean changes in anthropometric measures were larger in data that excluded longitudinal (girls: 1.24 inches, 12.39 pounds, 1.53 kg/m 2 ; boys: 2.34, 14.08, 1.07) versus population outliers (girls: 0.61 inches, 8.22 pounds, 0.75 kg/m 2 ; boys: 1.53, 11.61, 0.48). Conclusions: Longitudinal outlier methods may reduce underestimation of anthropometric change in children with elevated baseline values.
AB - Purpose: Implausible anthropometric measures are typically identified using population outlier definitions, conflating implausible and extreme measures. We determined the impact of a longitudinal outlier approach on prevalence of body mass index (BMI) categories and mean change in anthropometric measures in pediatric electronic health record data. Methods: We examined 996,131 observations from 147,375 children (10–18 years) in the ADVANCE Clinical Data Research Network, a national network of community health centers. Sex-stratified, mixed effects, linear spline regression modeled weight, height, and BMI as a function of age. Longitudinal outliers were defined as observations with studentized residual greater than |6|; population outliers were defined by Centers for Disease Control-defined z-score thresholds. Results: At least 99.7% of anthropometric measures were not extreme by longitudinal or population definitions (agreement ≥ 0.995). BMI category prevalence after excluding longitudinal or population outliers differed by less than 0.1%. Among children greater than 85th percentile at baseline, annual mean changes in anthropometric measures were larger in data that excluded longitudinal (girls: 1.24 inches, 12.39 pounds, 1.53 kg/m 2 ; boys: 2.34, 14.08, 1.07) versus population outliers (girls: 0.61 inches, 8.22 pounds, 0.75 kg/m 2 ; boys: 1.53, 11.61, 0.48). Conclusions: Longitudinal outlier methods may reduce underestimation of anthropometric change in children with elevated baseline values.
KW - Anthropometry
KW - Biologically implausible values
KW - Body mass index
KW - Longitudinal
KW - Obesity
KW - Outliers
KW - Youth
UR - http://www.scopus.com/inward/record.url?scp=85061822376&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85061822376&partnerID=8YFLogxK
U2 - 10.1016/j.annepidem.2019.01.006
DO - 10.1016/j.annepidem.2019.01.006
M3 - Article
C2 - 30799202
AN - SCOPUS:85061822376
SN - 1047-2797
VL - 31
SP - 69-74.e5
JO - Annals of Epidemiology
JF - Annals of Epidemiology
ER -